Burns and Their Impact on Skin

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Questions and Answers

Which factor is NOT associated with an increase in metabolic rate following a severe burn?

Large wound size

Increased ambient temperature (correct)

Young patient age

Inflammation and infection

What happens to liver glycogen stores when corticosteroids and glucagon levels increase?

Glycogen stores increase

Glycogen stores decrease (correct)

Glycogen stores become resistant to hormones

Glycogen stores remain unchanged

During the hypermetabolic period after a burn, which physiological change occurs?

Decreased inflammatory response

Increased gluconeogenesis (correct)

Increased protein anabolism

Decreased oxygen consumption

What is the primary method of nutrient delivery to patients after severe burns when paralytic ileus occurs?

Total parenteral nutrition Signup and view all the answers

For which type of burn is the rule of nines NOT applicable, according to the classification provided?

Localized third-degree burns Signup and view all the answers

What is the primary physiological effect of burns on the respiratory system?

Decreased oxygen transport to tissues due to carboxyhemoglobin production Signup and view all the answers

Which classification of burns is characterized by the presence of blisters and extreme pain?

Second degree superficial burns Signup and view all the answers

During the ebb period after a burn, how is oxygen transport to tissues affected?

It decreases due to reduced oxygen delivery to tissues Signup and view all the answers

What primary complication arises from edema due to burns?

Local ischemia as a result of vasodilation Signup and view all the answers

Which demographic groups are at highest risk for suffering from burns?

Infants and elderly individuals Signup and view all the answers

What characterizes the metabolic response during the hypermetabolic period after a burn?

Increased energy expenditure and catecholamine release Signup and view all the answers

What type of burn is primarily caused by exposure to a hot substance or flame?

Thermal burns Signup and view all the answers

What is the typical healing time for second degree deep burns?

More than 3 weeks Signup and view all the answers

Which of the following is a consequence of chest wall burns?

Formation of contractures Signup and view all the answers

What is the immediate treatment for severe electrical burns?

Provide 0.5-1 ml/kg of urine with 0.9% NaCl if urine color is normal Signup and view all the answers

Which type of burn results from exposure to caustic chemicals?

Chemical burns Signup and view all the answers

Which of the following scenarios indicates that a patient will require more fluid during burn treatment?

High voltage electrical burns Signup and view all the answers

What finding is most suggestive of inhalation burns based on clinical criteria?

Tar colored sputum Signup and view all the answers

Which statement regarding treatment of inhalation burns is true?

Elevating the head by 30° can facilitate venous return Signup and view all the answers

Which condition would NOT typically lead to higher fluid requirements in burn patients?

Patients with renal failure Signup and view all the answers

What is the primary concern for patients with a blood COHb level greater than 40%?

They are at high risk for mortality Signup and view all the answers

In cases of ARDS resulting from inhalation burns, when does late bronchopneumonia typically occur?

5-7 days post-injury Signup and view all the answers

What complication is most commonly associated with burns?

Curling ulcer Signup and view all the answers

Which condition would require hospitalization according to the American Burn Association criteria?

A 4-year-old with 12% 2nd degree burns Signup and view all the answers

What is the recommended duration for washing alkali chemical burns?

60 minutes Signup and view all the answers

Which of the following treatment considerations is unnecessary?

Prophylactic antibiotic use Signup and view all the answers

What is the primary method of pain relief recommended for burn patients?

Meperidine Signup and view all the answers

Why should a patient with chemical burns be completely undressed?

To ensure thorough washing and prevent re-exposure Signup and view all the answers

Which of the following is NOT a symptom indicating the need for monitoring urine output?

Infection signs Signup and view all the answers

What position should a patient be placed in to reduce edema during treatment?

30-degree sitting position Signup and view all the answers

Which type of burn requires escharotomy?

Burns involving the thorax Signup and view all the answers

What is the primary reason for limiting the use of central venous catheters (CVC)?

They have a high risk of hypercoagulation and thromboembolism Signup and view all the answers

How often should catheters in peripheral veins be replaced?

Every 3-4 days Signup and view all the answers

What happens to the risk of infection and sepsis due to not changing a CVC after the 4th day?

Increases by 1% for each day after the 4th day Signup and view all the answers

In the first 24 hours of fluid resuscitation for burns, how is the fluid administered?

Half in the first 8 hours and half in the next 16 hours Signup and view all the answers

What kind of fluid is ideal for fluid resuscitation in burn patients?

Isotonic and glucose-free solutions Signup and view all the answers

How is fluid lost through evaporation calculated after the first 48 hours?

25 x % burn x 2 x body surface area Signup and view all the answers

What is the maximum amount of fluid for adults with burns exceeding 50% according to the Modified Baxter formula?

0.5 ml/kg/% burn Signup and view all the answers

What should urine output not fall below in children during fluid resuscitation?

1 ml/kg/hour Signup and view all the answers

Study Notes

Burn Definition

Occurs when tissues encounter more energy than they can absorb
Causes:
- Hot substances
- Caustic chemicals
- Electrical current
- Radiation

Skin Impacts

Fluid and electrolyte loss through the skin due to evaporation
Prevents bacterial invasion due to the skin's protective barrier

Burn Risk Groups

Under 15 years old, especially those under 4 years old
Physically disabled children
Elderly individuals
Active working age group (18-45 years old), especially those in open work areas

Factors Influencing Burn Severity

Age
Burn type
Burn width
Burn depth
Anatomical location of the burn
Presence of comorbid conditions (pre-existing health issues)

Burn Types

Thermal burns (heat)
Inhalation burns (breathing in smoke, fumes)
Electrical burns
Chemical burns

Wound Classification by Degree

First degree: Light red, dry, painful, recovers in 3-10 days
Second degree superficial: Red with blisters, extremely painful, recovers in 7-21 days
Second degree deep: Dark red, blister with little exudate, painful, recovery in 3 weeks
Third degree: White/grey/black, dry, painless, requires debridement and grafting

Physiopathology of Burns

Edema:
- Initial vasoconstriction followed by vasodilation
- Leakage of fluid and protein from microcirculation into interstitial space
Respiratory system:
- Histamine, serotonin, and thromboxane A2 cause bronchoconstriction
- Chest wall burns can result in contractures
- Decreased oxygen pressure in the air due to burning can cause hypoxia
- Carbon monoxide (CO) poisoning disrupts oxygen transport, leading to decreased ATP production
Metabolism:
- Ebb period:
  - Decreased oxygen transport and metabolism
  - Increased catecholamines, leading to vasoconstriction and hyperglycemia
  - Increased anaerobic metabolism, leading to elevated lactate levels
- Hypermetabolic period:
  - Increased protein catabolism
  - Increased oxygen consumption
  - Increased body temperature due to inflammation and endotoxins
  - Insulin resistance
  - Increased gluconeogenesis and hyperglycemia
Erythrocyte loss:
- Caused by hemolysis, thrombosis, cell destruction, and fluid loss
- Initial increase in hematocrit followed by decrease with fluid replacement
Paralytic ileus:
- Gastric dilatation, vomiting, and aspiration
- Nasogastric decompression is applied, and oral food is withheld for 2 days

Burn Severity Assessment

Rule of nines:
- A method to estimate the total body surface area affected by burn
Minor burns:
- Less than 15% first and second degree burns in adults
- Less than 10% first and second degree burns in children
- Less than 2% third degree burns, excluding eyes, ears, face, and genitals
Moderate burns:
- 15-25% second degree burns in adults
- 10-20% second degree burns in children
- 2-10% third degree burns, excluding eyes, ears, face, and genitals
Major burns:
- Greater than 25% second degree burns in adults
- Greater than 20% second degree burns in children
- Greater than 10% third degree burns
- Burns involving eyes, ears, face, hands, feet, genitals, or major joints
- Inhalation burns
- Electrical burns
- Burns associated with major trauma or pre-existing conditions

American Burn Association (ABA) Hospitalization Criteria

Burns in children under 10 years old or adults over 50 years old covering more than 10% with second and third degree burns
More than 15% second degree burns or 5% third degree burns in any age group
Burns involving face, hands, feet, genitals, perineum, or major joints
Infected burns
Inhalation burns
Chemical burns
Burns on individuals with diabetes, cardiopulmonary disease, cancer, or cerebrovascular disease
Burns associated with major trauma
Suspected child neglect or abuse

Considerations in Burn Treatment

Undress the patient; don't remove any clothing if chemical burns are present
Cover the patient with clean, warm, dry clothing to prevent hypothermia
Wash wounds with sterile water or tap water for 60 minutes if alkali burns, or 30 minutes if acid burns
Position the patient in a 30-degree sitting position to reduce edema
Provide humidified oxygen to clear respiratory secretions
Give metaproterenol by inhalation to prevent bronchospasm
Apply nasogastric decompression in burns exceeding 15% in children and 20% in adults
Monitor urine output with a Foley catheter
Prophylactic antibiotics and steroids are not typically used
Tetanus prophylaxis is given based on previous vaccination history
Escharotomy may be performed in burns involving the thorax
Use morphine or meperidine for pain relief

Fluid Resuscitation

Administer fluid therapy through peripheral veins, avoiding central venous catheters due to complications
Replace peripheral venous catheters every 3-4 days and central venous catheters on the 4th and 8th days
Use isotonic, glucose-free fluids (Lactated Ringer's solution)
Fluid replacement is given intravenously in 20% of adult burns and 15% of pediatric burns
New York Hospital method:
- First 24 hours: LR 4mL/kg/%burn in adults
- Children under 30 kg: LR 4mL/kg/%burn + 100mL/kg for the first 10 kg, 50mL/kg for the second 10 kg, and 20mL/kg for the third 10 kg
- Second 24 hours: 5% Dextrose H2O + colloid 0.5mL/kg/%burn
First 48 hours:
- Ringer's lactate 4mL/kg/%burn in the first 24 hours, half in the first 8 hours and half in the next 16 hours
- Urine output: 0.5mL/kg/hour in adults, 1mL/kg/hour in children
- Second 24 hours: 5% Dextrose H2O or Ringer's lactate (for children under 30kg electrolyte solutions like 5% Dextrose 0.5% NaCl) 1.5mL/kg/%burn
- Colloid (5% albumin) can be given in extensive second and third degree burns, 0.3mL/kg/%burn for 30-50% burns and 0.5mL/kg/%burn for burns over 50%
Modified Baxter formula:
- Fluid loss through evaporation, nasogastric loss, and urine output are considered to calculate daily recirculation
Special cases:
- High voltage electrical burns: Require more fluid
- Patients under 2 years old, patients over 50 years old, patients with cardiopulmonary disease, and patients with renal failure: Require less fluid
- Patients with delayed resuscitation, severe intoxication at the time of burn: Require increased fluid

Inhalation Burns

Clinical types:
- Acute asphyxia: Usually fatal
- Upper respiratory tract damage: Progressive airway edema causing obstruction
- ARDS (Acute Respiratory Distress Syndrome): Occurs in the early period, followed by late bronchopneumonia
Carbon monoxide poisoning:
- Levels of 15-20% cause headaches, confusion, and mild dyspnea
- Levels of 20-40% lead to disorientation, fatigue, nausea, visual disturbances, agitation, and ataxia
- Levels of 40-60% cause collapse and coma
- Levels over 60% have a 50% mortality rate

Intubation Criteria for Inhalation Burns

Burn in a closed area
Unconsciousness
Severe burns in the perioral region, neck, and oropharynx
Tar-colored sputum
Burns on nose hair
Hoarseness
Bronchoscopic and laryngoscopic confirmation of mucosal damage
Blood COHb greater than 40%

Treatment of Inhalation Burns

Intensive care is required
Postural drainage and bronchospasm treatment
Head elevation to 30 degrees
High PEEP (Positive End-Expiratory Pressure)
Maintain oxygen saturation greater than 90%
Steroids are not effective

Treatment of Electrical Burns

Monitor urine color
If urine is red (myoglobinuria), provide osmotic diuresis with 20% Mannitol and 44 mEq NaHCO3
Monitor for ventricular fibrillation with ECG

Burn Complications

Burn wound infections
Suppurative thrombophlebitis
Curling ulcer
Contractures (late complication)

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Description

This quiz covers the definitions, causes, and risk factors associated with burns. It also examines the different types of burns and their severity classifications based on various influences. Test your knowledge on how burns affect the skin and the demographic groups that are most at risk.