Burn Injury and Treatment Quiz

Burn Overview

• More than 60% of burn injuries are admitted to specialized burn centers.
• A significant portion of morbidity and mortality associated with burn injuries is due to associated injuries, such as inhalation injury.
• More than 90% of burns are preventable through education and legislative efforts.

Burn Etiology

• Not all burns are caused by fire.
• Tissue damage can result from exposure to chemicals, hot liquids, tar, electricity, lightning, or frostbite.

Thermal Burns

• Represent the majority of burns.
• Can result from flame, flash, steam, or scalding liquids.

Scald Burns

• Scalds from hot liquids are the most common cause of all burns.
• Exposure to 60°C water for 3 seconds can cause deep partial-thickness or full-thickness burns.
• 69°C water causes the same burn in only 1 second (e.g., fresh brewed coffee is about 82°C).
• Common causes include tap water, soups, sauces, cooking oil and grease.
• Adults older than 60 disproportionately are affected by hot liquids.

Flame Burns

• The number of house fires has decreased due to the increased use of smoke detectors.
• Common causes include careless smoking, motor vehicle crashes, and clothing ignited from stoves or heaters.

Electrical Burns

• Electricity passing through the body transforms to heat proportionally to amperage and resistance.
• Initial injury is on entry and exit points (extensive internal damage).
• Nerves, blood vessels, and muscle are more susceptible to damage than bone or fat.
• The smaller the body part affected, the more intense the heat and less it is dissipated.
• Extensive damage may occur in fingers, hands, forearms, toes, feet, and lower legs.
• Papillary muscle damage can cause sudden valve incompetence and cardiac failure.

Chemical Burns

• Chemicals cause protein denaturing and cell dryness.
• Chemical concentration and exposure duration determine the extent of the burn.
• Alkali products cause more tissue damage than acids.
• Removing wet chemicals quickly via thorough flushing is key.
• Dry chemicals need to be brushed off before flushing.
• Chemical burns can be deceiving as to their depth, appearances similar to superficial discoloration until sloughing days later.
• All chemical burns should be considered deep partial-thickness or full-thickness until proven otherwise.

Frostbite

• Occurs when tissues freeze from exposure to freezing or below-freezing temperatures.
• Body's response to cold is vasoconstriction to reduce heat exchange.
• Unprotected extremities expose intracellular and extracellular fluids to freezing, forming crystals, and causing tissue damage.
• Rapid rewarming using warm water, avoiding excessive heat (like steam), and immobilization with a padded splint is critical.

Burn Assessment

• Burn depth and extent are assessed to determine severity.
• Final determination may not be made for several days.

Burn Depth

• Burns are described as partial-thickness (2nd degree) or full-thickness (3rd degree).
• More accurate depth determination is possible within 48 to 72 hours.

Burn Extent

• Extent assessment is performed using formulas such as the rule of nines.
• Age correction (1% subtracted from head for each year up to 10 years, and 0.5% added to each lower extremity).
• The size of the patient's palm is used to represent 1%.
• In electrical injuries, describing the injury anatomically is more critical than calculating percentage of BSA burned.

Burn Severity

• Based on burn extent, depth, patient age, presence of concomitant injuries, smoke inhalation, and preexisting conditions.
• Categorization into minor, moderate, and major burns.
• Criteria for transfer to a burn center, based on these factors.

Inhalation Injury

• Burn injury in patients with pre-existing medical conditions can complicate management, prolong recovery, or cause fatality.
• Any patient with burn injury and concomitant trauma should be initially treated by a trauma center, with transfer to a burn center when stable.

Pulmonary Response to Smoke Inhalation

• Inhalation injury or smoke inhalation is a syndrome comprising distinct problems: carbon monoxide intoxication, upper airway obstruction, and chemical injury to the lower airways and lung parenchyma.
• Majority of deaths are due to smoke inhalation rather than the burn itself.
• Exposure to carbon monoxide has a high affinity to hemoglobin compared to oxygen, causing muscle weakness.
• Symptoms are marked by pink-to-cherry-red skin, tachypnea, tachycardia, headache, dizziness, and nausea.
• Arterial blood gas samples measure the carboxyhemoglobin level.
• Levels below 15% are usually asymptomatic, 15% to 40% cause headache and confusion, and above 40% leads to coma.
• Pulse oximeters do not differentiate between oxygenated hemoglobin and carboxyhemoglobin. therefore, patients suspected of carbon monoxide poisoning should be placed on 100% oxygen.

Management

• High index of suspicion for smoke inhalation is critical in burn patients.
• Administrating high-flow oxygen.
• Patients with COPD should receive immediate intubation to avoid progressive carbon dioxide retention.
• The half-life of carboxyhemoglobin is reduced to 75 to 80 minutes with 100% oxygen.
• Hyperbaric oxygen can reduce the half-life to approximately 20 minutes, potentially speeding up recovery.
• Use of hyperbaric oxygen is controversial.
• Circumferential full-thickness chest burns require escharotomies.

Wound Care

• Wound care must be delayed until the patient stabilizes to avoid potential complications from swelling affecting circulation to the affected area.
• Ruptured blisters should be cleaned but intact blisters are left undisturbed.
• Topical antibacterial agents (e.g., silvadene or bacitracin) are used.
• Chemical burns require immediate irrigation with tap water or normal saline for extended periods.
• Electrical burns with massive muscle injury beneath normal skin require gentle cleaning.

Spinal Trauma

• The majority of spinal cord injuries occur in males under 38.
• Motor vehicle collisions (MVCs) are the leading cause of spinal injuries in adults.

Spinal Anatomy and Physiology

• Cervical vertebrae are commonly injured.
• Cervical spine has 7 vertebrae .Thoracic spine has 12 vertebrae. Lumbar spine has 7 vertebrae.
• The spine is comprised of sacrum and coccyx.
• Spinal cord, intervertebral disks, and vertebral bodies are part of the spinal structures.

Patient Assessment

• Identify and secure all patients with multi-system injuries or significant mechanism of injury.
• Protect all patients with suspected spinal injury.
• Methods of protecting spines include:
  • manual immobilization with the hands
  • and with a cervical collar
  • Lateral head support with head blocks or rolled sheets
  • Whole spine immobilization with straps across chest, abdomen, and knees
  • Identify risk factors for injuries:
    • Falls from greater than 3 feet
    • Vehicle collisions at high speed
    • Involved in a rollover or ejections
    • Vehicle damage or intrusion into the passenger compartment
    • Any falls or collisions that produced severe force to the body
    • Patient age
    • Any associated injuries (e.g., injuries to the head or face)

Mechanism of Injury

• Defined as the process to study the transfer of energy from the environment to the individual.
• Essential for:
  • Anticipate injuries
  • Provide diagnosis
  • Provide treatment
  • Preventing future complications

Mechanism of Injury: Key Concepts

• Acceleration: Increase in velocity or speed of a moving object.
• Deceleration: Decrease in velocity or speed of a moving object.
• Cavitation: temporary cavity creation as tissues stretch and compress.
• Force: The physical factor that changes a body's motion, whether at rest or already in motion.
• Inertial resistance: The body's tendency to resist any change in motion.

Mechanism of Injury Classification

• Blunt injury: A sudden, forceful impact from a non-sharpened object.
• Penetrating injury: An injury from a sharper object penetrating the body.

Thoracic Trauma

• Mortality rates for thoracic trauma are second only to brain and spinal cord injuries.
• Focused Assessment Sonography for Trauma (FAST) is important.

Rib Fractures

• Common in ribs 4-10.
• Fractures that separate the sternum from costal cartilage are not evident on a radiograph.

Flail Chest

• Defined as fractures in two or more adjacent ribs in two or more places or bilateral detachment of the sternum from costal cartilage.
• Unstable segment of chest wall moves in opposition to normal movement of the chest wall.
• Loss of coordinated movement of the chest wall results in hypoventilation, atelectasis, and eventually hypoxia.

Sternal Fracture

• Occurs with tremendous force to the chest.
• Common site includes the junction of the manubrium and body of the sternum.
• Potential for underlying cardiac and pulmonary injuries, including contusions, blunt cardiac injury, and pericardial tamponade.

Laryngeal Injury

• Fracture of the larynx is a rare, life-threatening injury.
• Symptoms include hoarseness, stridor, hematoma, ecchymosis, laryngeal tenderness, subcutaneous emphysema, crepitus, or loss of anatomic landmarks
• Intubation can worsen the existing injury, so tracheostomy may be necessary.

Pneumothorax

• Accumulation of air in the pleural space, leading to lung collapse.
• Common causes are lung lacerations and rib fractures.
• Symptoms include chest pain, shortness of breath (SOB), decreased/absent breath sounds, tachycardia, and tachypnea.

Open Pneumothorax

• Opening in the chest that exceeds two-thirds the diameter of the trachea.
• Loss of negative intrathoracic pressure.
• Treat by applying a sterile, nonporous, three-sided occlusive dressing over the injury; a chest tube may be required for re-expansion of the lung.
• If injury is caused by penetrating trauma with an impaled object, the object should be stabilized and not removed in the ED

Tension Pneumothorax

• Life-threatening condition resulting from air accumulation in the pleural space; the accumulation forces the thoracic contents to the opposite side.
• Immediate needle decompression of affected side is critical.

Hemothorax

• Free blood in the pleural space.
• Usually caused by injury to the intercostal arteries, resulting in bleeding into the pleural space
• Immediate chest tube insertion is required. If blood loss via chest tube is 1000 ml or more, surgical intervention may be required.

Pulmonary Contusion

• 75% of blunt chest trauma cases have underlying pulmonary contusion with about 40% mortality rate.
• Injury to lung parenchyma (widespread bleeding and ruptures into pulmonary tissue, alveoli, and small airways leading to collapse and loss of ventilation, pulmonary shunting, and hypoxemia).

Diaphragmatic Injury

• Lateral impact from an MVC is three times more likely than another type of impact to cause rupture.
• Most ruptures occur on the left side secondary to the liver's protection of the right side.
• Chest radiograph and CT scan of chest may demonstrate an elevated diaphragm, loss, of the diaphragmatic shadow, irregularities in the diaphragm, or a gastric tube extending into the chest cavity.

Blunt Cardiac Injury

• Formerly known as "cardiac concussion" or "cardiac contusion".
• Injury is differentiated by echocardiogram.
• Common symptoms are nonspecific and range from asymptomatic to cardiogenic shock.
• Dysrhythmias associated with this injury can range from sinus tachycardia to atrial fibrillation/flutter and ventricular tachycardia/fibrillation.

Penetrating Cardiac Injuries

• Most victims arrive in the ED in cardiac arrest or significant hypotension due to cardiac tamponade or hemorrhage.
• The right ventricle is most frequently injured due to its anterior position.
• Penetrating injuries are associated with high mortality (83%).

Cardiac Tamponade

• Rapid accumulation of blood in the pericardial sac decreases ventricular filling.
• Symptoms (Beck's triad) include hypotension, muffled heart tones, and distended neck veins.
• Pericardiocentesis may be lifesaving in acute cases.

Aortic Disruption

• Majority of victims die at the scene.
• Common injury sites are the area just distal to the left subclavian artery and just adjacent to the ligamentum arteriosum.
• The innominate artery, aortic arch, and aortic valve are often affected.

Esophageal Injury

• Injury to the esophagus is rare and often fatal.
• Common cause is instrumentation during invasive procedures such as endoscopy or intubation (causing mediastinitis from contamination by saliva and gastric contents).
• Surgical repair is often required.

Head Trauma

• Traumatic brain injury (TBI) is a leading cause of death and permanent disability.
• A small percentage of severe TBI patients will have a cervical spine fracture as well.

Head Trauma Sites and Causes

• Common trauma sites consist of the scalp, skull, and brain.
• Common causes include firearm-related injuries, motor vehicle accidents, falls, assaults, sports-related injuries, and recreational accidents.

Head Trauma: Specific Injury Classifications

• Categorization by severity into mild, moderate, and severe injuries.
• Categorization by mechanism of injury, to include blunt and penetrating types, and focal and diffuse injuries.
• Describes symptoms for each type of injury

Intracranial Pressure(ICP)

• ICP results from the combined pressure of brain, cerebrospinal fluid, and blood in the skull.
• Normal ICP is less than 10 mmHg. Elevated ICP can reduce blood flow to brain tissue, causing damage or death.

Cerebral Perfusion Pressure (CPP)

• The pressure difference between arterial and venous blood entering and exiting the brain.
• Normal CPP is 50-150 mmHg; low CPP indicates a poor prognosis.

Patient Management Overview

• Treatment depends on specific injury type, patient status, and presenting symptoms.
• Management to include but not limited to:
  • Early intubation and targeted ventilation for patients with severe brain trauma (<GCS 8),
  • Adequate blood pressure
  • Maintaining a controlled environment for the treatment of any impaled object injuries.
  • Administering hypotonic or hyperosmolar therapy as needed.

Test your knowledge on burn injuries, their characteristics, and appropriate treatments. This quiz covers various types of burns including electrical, chemical, and frostbite-related injuries, along with immediate care protocols. Perfect for students in healthcare or emergency response courses.