Burns Management and Epidemiology

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Questions and Answers

What is the primary advantage of using an autograft for skin replacement?

It is more cost-effective than other grafts.

It does not require a donor site.

It is the patient's own skin and will not be rejected. (correct)

It can be obtained from any person.

Why are the thighs often used as donor sites for split-thickness skin grafts?

They are the least painful area to harvest skin from.

They have the thinnest skin, making it easier to graft.

They heal the fastest and can be reharvested soonest.

They allow for a continuous donor sheet of skin. (correct)

When is burn excision typically considered for a patient?

When the patient starts showing signs of infection.

As soon as the patient is hemodynamically stable. (correct)

Once initial healing of the burned area begins.

After two weeks of hospital admission regardless of the patient's condition.

What is the purpose of meshing a skin graft?

To allow for maximal wound coverage when skin is limited. (C) Signup and view all the answers

What advantage do sheet grafts have over meshed grafts in exposed areas?

They offer a better cosmetic appearance. (C) Signup and view all the answers

In which scenario might a small full-thickness skin graft be preferred?

To ensure the best function in specific anatomical locations. (B) Signup and view all the answers

What is the typical range for a mesh expansion ratio used in meshed grafts?

1:2 to 1:4 (A) Signup and view all the answers

For which body areas are sheet grafts typically utilized, and why?

Face and hands, for better cosmetic results. (B) Signup and view all the answers

What characterizes superficial burns?

Mild erythema and hypersensitivity, resolving in 24 to 72 hours (B) Signup and view all the answers

Which burn type is most commonly associated with sunburn?

Superficial burn (C) Signup and view all the answers

What is the typical healing time for superficial partial-thickness burns?

1-2 weeks (A) Signup and view all the answers

Which burn type involves both the epidermis and the superficial layers of the dermis?

Superficial partial-thickness burn (C) Signup and view all the answers

What is a characteristic feature of superficial partial-thickness burns?

Wet, weeping blisters (D) Signup and view all the answers

How is capillary refill time affected in superficial partial-thickness burns with open blisters?

Normal (A) Signup and view all the answers

What is one of the primary goals at the end of the emergent phase for a burn patient?

Absence of respiratory distress (D) Signup and view all the answers

Why is it important for the family of a burn patient to understand the procedures?

To alleviate fear and anxiety in the patient (C) Signup and view all the answers

A burn characterized by closed or open blisters with a waxy appearance, cherry red color, and sluggish or no blanching is likely:

Deep partial-thickness burn (D) Signup and view all the answers

What differentiates superficial partial-thickness from deep partial-thickness burns based on pain assessment?

Superficial partial-thickness burns are hypersensitive overall, while deep partial-thickness burns have hypersensitivity primarily at the edges. (B) Signup and view all the answers

Which of the following is a priority during the intermediate phase of burn management?

Wound healing and closure (B) Signup and view all the answers

How should a burn patient's family help reduce the risk of infection?

By wearing gloves, gowns, and practicing hand washing (C) Signup and view all the answers

What is an expected indicator of effective fluid resuscitation in a burn patient?

Adequate urine output of 0.5 mL/kg/hr (B) Signup and view all the answers

Why is maintaining a warm environment important for burn patients?

To decrease the risk of hypothermia (D) Signup and view all the answers

What should be immediately reported if observed in a patient with burns?

Decreased urine output (B) Signup and view all the answers

What is a sign that helps recognize an inhalation injury in a burn patient?

Coughing or hoarseness (B) Signup and view all the answers

What is the top priority in assessing a patient with electrical burns?

Assessing the patient's airway (D) Signup and view all the answers

What type of oxygen delivery is recommended for all patients with burn injuries?

Non-rebreather mask with 100% oxygen (A) Signup and view all the answers

Which finding indicates a high risk for intubation in a burn patient?

Carbon noted in the sputum and hoarseness (C) Signup and view all the answers

What method is recommended for securing an endotracheal tube in a patient with facial burns?

Umbilical twill or commercial endotracheal tube holders (A) Signup and view all the answers

What is the appropriate initial fluid resuscitation for burn patients?

Lactated Ringer's solution (B) Signup and view all the answers

In addition to airway assessment, what is another immediate priority in the primary survey of a burn patient?

C-spine stabilization (A) Signup and view all the answers

What information needs to be collected during the secondary survey regarding the circumstances of the burn injury?

Whether an accelerant was used (C) Signup and view all the answers

Which laboratory tests are important to obtain for patients with electrical burns?

ECG, troponin, and creatine kinase-MB (CK-MB) (C) Signup and view all the answers

Why is maintaining a high ambient temperature crucial for burn patients, especially when wounds are exposed?

To prevent hypothermia due to the loss of skin's thermoregulatory function. (D) Signup and view all the answers

Which of the following are specialized heating equipment commonly used in burn centers?

Heat shields above the bed and space heaters (D) Signup and view all the answers

What is the primary reason burn patients are at high risk for infection and sepsis?

Loss of the skin's protective barrier and altered immunological defenses. (D) Signup and view all the answers

What is Systemic Inflammatory Response Syndrome (SIRS) in the context of burn injuries?

An exaggerated inflammatory response that occurs throughout the body after a burn injury (B) Signup and view all the answers

Besides the loss of skin integrity, what other factors contribute to the heightened risk of sepsis in burn patients?

Release of abnormal inflammatory factors and altered metabolic profile (D) Signup and view all the answers

What is the leading cause of death in burn patients who survive the first 24 hours after the initial injury?

Sepsis (D) Signup and view all the answers

Why are standard medical definitions of sepsis not always applicable to burn patients?

Burn patients often exhibit sepsis criteria without actual infection (A) Signup and view all the answers

When did a panel of burn care experts convene to develop a consensus definition for infection and sepsis in burn patients?

2007 (B) Signup and view all the answers

A patient presents with facial burns, hoarseness, and carbonaceous sputum. Which nursing diagnosis is the most immediate priority?

Ineffective airway clearance (D) Signup and view all the answers

Which medication is NOT typically used for pain management in burn patients?

Haloperidol (A) Signup and view all the answers

What is the primary purpose of administering medications like famotidine or pantoprazole to a burn patient?

To decrease stomach acid and risk of ulceration (A) Signup and view all the answers

Which assessment finding is NOT indicative of a potential inhalation injury?

Hypotension (A) Signup and view all the answers

Why is enoxaparin administered to burn patients?

To promote venous return and decrease risk for thromboembolism (C) Signup and view all the answers

Which nursing intervention is crucial during the emergent phase of burn management?

Airway management (C) Signup and view all the answers

What is the purpose of administering medications like lorazepam or midazolam to burn patients?

Induce sedation and decrease anxiety (D) Signup and view all the answers

A burn patient exhibits rhonchi, stridor, and hoarseness. What is the likely cause?

Edema and irritation of the airway (C) Signup and view all the answers

What is the purpose of administering oxandrolone to a burn patient?

Preservation of lean body mass and promotion of weight gain (B) Signup and view all the answers

Which medication is used to prevent the overgrowth of yeast in the oral mucosa of burn patients?

Nystatin (D) Signup and view all the answers

Study Notes

Burns Introduction

Patients with burns are best managed in a burn center, due to the specialized care provided by interprofessional teams skilled in burn injury treatment.
Currently, there are 82 burn centers verified by the American Burn Association in the US (https://ameriburn.org/resources/find-a-burn-center/).
Patients often receive initial care in local hospitals before transfer to a burn center.

Burns Incidence and Epidemiology

In 2021, 1.35 million fires were reported in the US, resulting in 3,800 civilian deaths and 14,700 civilian injuries.
Property damage from these fires was estimated at $15.9 billion.
Fire death rates vary significantly by state, with higher rates typically found in states with higher rates of poverty, disabilities, smoking, and with a high percentage of Native American, Alaskan Native, African American, or Black populations.

Burn Center Referral Criteria

Burn centers can treat adults and children.
Partial-thickness burns equal to or greater than 10% of total body surface area.
Burns involving the face, hands, feet, genitalia, perineum, or major joints.
Full-thickness burns in any age group.
Electrical injuries, including lightning injury.
Chemical injuries.
Inhalation injuries.
Patients with pre-existing medical conditions that may complicate management, prolong recovery, or affect mortality.
Patients with burns and concomitant trauma (e.g., fractures).
Burned children in hospitals without qualified personnel or equipment for the care of children.
Patients needing special social, emotional, or rehabilitative intervention.

Additional Burn Etiologies

Outdoor fires are the leading cause of property fires (49%).
Residential and non-residential structure fires comprise another 36% of fires, though they cause the most deaths and injuries (79% and 86%, respectively).
Vehicle fires account for 15% of all fires.
The two most commonly reported causes of burn injuries are fire/flame, and scald injuries.
Cooking is the leading cause of both residential and nonresidential structure fires.

Burn Depth

Burns are classified as superficial, superficial partial-thickness, deep partial-thickness, and full-thickness.
Depth and severity are best assessed frequently over the first 24 to 72 hours due to burn injuries evolving.

Superficial burns

Affect only the epidermis.
Result in mild erythema (redness), hypersensitivity.
Typically heal in 24-72 hours without scarring.

Superficial Partial-Thickness Burns

Affect the epidermis and minimal dermis.
Often accompanied by wet, painful blisters.
Typically heal in 1-2 weeks with little to no scarring.

Deep Partial-Thickness Burns

Affect the epidermis and deeper layers of dermis.
Usually appear waxy and may not have weeping blisters.
Often take 3-6 weeks to heal and some scarring may be present.

Full-Thickness Burns

Destroy the epidermis, dermis, and subcutaneous tissue.
Appear dry and leathery with no blisters.
Requires skin grafts for healing.

Other Important Considerations

Age and past medical history play a significant role in determining burn related mortality and morbidity.
Patients with limited physical/mental abilities are at increased risk.
Children ages 4 and under were once at high risk, but this risk has decreased.
Older adults (65+) have a higher risk of death (2.5 times) in a fire, that increases to 3 times for those over 85 years old.
Men are disproportionately affected by burn injuries or deaths.
Fire/flame and scald injuries are the leading causes of burn injuries.
In the US, the leading cause of work-related deaths (other than vehicle crashes) is electrical injury (4th leading cause of all workplace tragedies).
Electrical burns can cause extensive damage to organs.
Electrical injuries can cause damage ranging from mild to lethal.
Electrical injuries can cause severe complications like cardiac and neurological problems, even when there doesn't appear to be significant skin damage.
Chemical burns account for about 3% of burn center admissions.
Radiation burns are rare, usually caused by industrial exposure or nuclear accidents
Burns can be caused by sources like flash, scald, contact with hot objects or flames.
Burn injury encompasses a wide spectrum of damage.
Burns require interprofessional treatment and collaboration.

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Description

This quiz covers essential aspects of burn management, including the importance of burn centers and the epidemiology of burn incidents. It highlights statistics on burn injuries, referrals, and demographic factors affecting burn rates. Test your knowledge on these crucial topics related to burn care and prevention.