Burns Quiz: Classifications and Effects

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Questions and Answers

Which of the following types of burns is the least common?

Electrical

Chemical

Thermal

Radiation (correct)

What percentage of Total Body Surface Area (TBSA) burned do adults start with?

25%

20% (correct)

15%

10%

In the Parkland formula, what is the preferred crystalloid for fluid resuscitation?

LR (correct)

Normal Saline

Plasmalyte

D5W

Which burn zone represents the area with the most severe damage?

Zone of Coagulation Signup and view all the answers

How long is the first half of the calculated fluid infused in the Parkland formula?

8 hours Signup and view all the answers

What depth of burn involves damage to the epidermis and minimal layers of dermis?

Superficial partial-thickness Signup and view all the answers

What is the TBSA percentage for the perineum in the Rule of Nines?

1% Signup and view all the answers

Which factor is NOT considered when determining burn severity?

Type of social support Signup and view all the answers

Which of the following complications can arise from untreated ulcerative colitis?

Toxic megacolon Signup and view all the answers

What is a common manifestation of hepatitis?

Severe itching Signup and view all the answers

Which route is NOT commonly associated with the transmission of hepatitis?

Direct skin contact Signup and view all the answers

What is the primary treatment option for acute hepatitis?

Antivirals Signup and view all the answers

Which type of hepatitis virus requires the presence of another virus for infection?

HepD Signup and view all the answers

Which condition is a leading cause of cirrhosis of the liver?

Chronic hepatitis C Signup and view all the answers

What can be an outcome of effective management failed acute hepatitis?

Cirrhosis Signup and view all the answers

Which of the following describes a common risk factor for developing hepatitis?

Excessive alcohol consumption Signup and view all the answers

What is a primary symptom of metabolic acidosis due to ketone production?

Fruity smelling breath Signup and view all the answers

Which diagnostic criteria indicates the presence of hyperosmolar hyperglycemic syndrome?

Serum osmolality >320 Signup and view all the answers

What is the most common treatment for hyperosmolar hyperglycemic syndrome?

Fluid replacement Signup and view all the answers

Which type of thyroid cancer is most common in females?

Papillary Signup and view all the answers

In which part of the gastrointestinal tract does Crohn's disease primarily manifest?

From mouth to anus Signup and view all the answers

What is a common complication of Ulcerative Colitis?

Diarrhea with blood, mucus, or pus Signup and view all the answers

Which of the following symptoms is NOT typically associated with metabolic acidosis due to ketones?

Profound dehydration Signup and view all the answers

What is a common feature in the diagnosis of Inflammatory Bowel Disease?

Use of ultrasound and biopsy for confirmation Signup and view all the answers

What are the common manifestations of liver cancer?

Weight loss and jaundice Signup and view all the answers

Which of the following is a complication of pancreatitis?

Pancreatic pseudocysts Signup and view all the answers

What is a significant risk factor for developing liver cancer?

Chronic Hepatitis B or C Signup and view all the answers

Which sign is indicative of retroperitoneal hemorrhage in acute pancreatitis?

Grey Turner's sign Signup and view all the answers

What often causes the autodigestion seen in acute pancreatitis?

Alcohol and gallstones Signup and view all the answers

What is the prognosis typically associated with late-stage liver cancer?

Poor prognosis with death typically within 6-12 months Signup and view all the answers

Which of the following management techniques is NOT typically associated with liver issues?

Bone marrow biopsy Signup and view all the answers

What is indicated by ascites in liver conditions?

Accumulation of protein-rich fluid in the abdominal cavity Signup and view all the answers

What is a common symptom associated with pancreatic disease?

Pale or clay colored stool Signup and view all the answers

Which of the following risks is associated with pancreatic cancer?

Age over 60 Signup and view all the answers

What is a characteristic feature of rheumatoid arthritis?

Morning stiffness lasting more than 1 hour Signup and view all the answers

What defines the etiology of Diffuse Connective Tissue Diseases?

Chronic inflammation and degeneration with an immunologic basis Signup and view all the answers

Which management option is least likely to be used for chronic pancreatitis?

Antiviral medications Signup and view all the answers

What is a notable demographic characteristic of Systemic Lupus Erythematosus (SLE)?

More prevalent in females, especially during childbearing age Signup and view all the answers

Which manifestation is commonly seen in pancreatic cancer?

Dull pain in the epigastric area and back Signup and view all the answers

During which age range is rheumatoid arthritis most likely to develop?

20 to 40 years Signup and view all the answers

What is the primary metabolic change observed in burn patients following a burn injury?

Hypermetabolic state leading to increased caloric needs Signup and view all the answers

Which of the following accurately describes the zone of stasis in burn injuries?

It surrounds the zone of coagulation and consists of damaged cells with impaired circulation. Signup and view all the answers

What is a common renal complication seen in burn patients, particularly those with electrical injuries?

Decreased renal perfusion Signup and view all the answers

What is a key priority in the management of burn patients during the emergent phase?

Airway management and fluid resuscitation Signup and view all the answers

What is the leading cause of death in burn patients after the first 24 hours post-injury?

Sepsis Signup and view all the answers

Which type of burn injury requires urgent flushing with water if chemicals are involved?

Chemical burns Signup and view all the answers

What surgical procedure is primarily performed to relieve pressure in burn patients experiencing compartment syndrome?

Fasciotomy Signup and view all the answers

Which element should be monitored closely in burn patients due to the risk of hyperkalemia?

Potassium Signup and view all the answers

What is a long-term psychological consideration that must be addressed in burn recovery?

Avoidance of contractures Signup and view all the answers

Which of the following is NOT a systemic effect of burns?

Stable metabolic rate Signup and view all the answers

Study Notes

Burns

Classified by etiology (thermal, electrical, chemical, radiation)
Thermal burns: flash, scald, house fires, cooking accidents
Electrical burns: arc between two objects
Chemical burns: 3% of all burn admissions
Radiation burns: least common, severity depends on exposure location, depth, and duration.
Depth of tissue damage: superficial, superficial partial-thickness, deep partial-thickness, full-thickness
Superficial: epidermal damage, erythema, resolves in 24-72 hours
Superficial partial-thickness: involves epidermis and minimal dermis
Deep partial-thickness: involves epidermis and deeper layers of dermis
Full-thickness: destroys epidermis, dermis, and portions of subcutaneous tissue
Total Body Surface Area (TBSA): crucial for fluid resuscitation and treatment calculation.
Adults: TBSA starts at 20%
Elderly and Pediatrics: TBSA starts at 10%
Severity: factors include the extent of the burn, age of the patient, medical history, and location of the burn.
Burn Zones include Coagulation, Stasis and Hyperemia zones.

Rule of Nines

Commonly used method for estimating TBSA burned.
Diagram showing body segments and their percentage of TBSA.
Anterior view and posterior view body diagrams showing percentage per body part.

Fluid Resuscitation Using Parkland Formula

4 ml LR x weight in kg x %TBSA
LR (Lactated Ringers) is the crystalloid of choice
One half of calculated fluid infused in 8 hours
The other half infused over 16 hours.

Anatomical Changes

Zone of Coagulation: most severe damage from heat source, extensive protein coagulation. Eschar (dead tissue) frequently present.
Zone of Stasis: surrounds Coag, with damaged cells and impaired circulation.
Zone of Hyperemia: outermost layer. Blood flow increases to deliver nutrients for tissue recovery. Location over joints or other sensitive areas requires heightened care.

Systemic Effects of Burns

Significant consequences on multiple organ systems due to cytokine and mediator release
Impact on respiratory, cardiovascular, renal, and gastrointestinal systems
Metabolic changes including increased caloric needs and impaired wound healing.
Immunological responses with high risk for infection
Systemic inflammatory response syndrome (SIRS)

Sepsis

Leading cause of death in burn patients after first 24 hours.
Infection control is paramount
Approximately 28-65% of burn patients die due to sepsis.

Special Considerations for Special Burns (Inhalation, Electrical, Chemical)

Inhalation: often involves carbon monoxide and CO2 poisoning, requiring immediate high oxygen therapy.
Electrical: extent of injury isn't always apparent, necessitating attention to spinal cord injuries and compartment syndrome.
Chemical: immediate flushing with water and further specialist assessment and intervention is critical.

Burn Phases

Emergent Phase: airway management, fluid resuscitation, addressing life-threatening injuries, stabilization, and early intervention
Intermediate Phase: wound care, infection control, and managing secondary complications
Rehabilitative Phase: preventing contractures, managing lingering physical and psychological effects.

Endocrine System

Complications of Diabetes Mellitus (DM): inadequate insulin impacting normal cellular metabolic processes
Diabetic Ketoacidosis (DKA): rapid breakdown of fat, producing ketones, triggering lower pH, and metabolic acidosis.
Hyperosmolar Hyperglycemic Syndrome (HHS): high glucose, dehydration, but not high ketones, commonly resulting from infection.
Diagnoses for DKA or HHS: serum glucose >250mg and/or ketones in the urine, pH <7.3, bicarbonate <18mEq/L, possible altered level of consciousness (LOC) or coma.

Diabetic Ketoacidosis (DKA)

High blood sugar, dehydration, without ketones, result of infection
Pathophysiology: less insulin. Fat is broken down for energy; ketones result in lower pH
Manifestations: high blood sugar, dehydration
Diagnostics: glucose > 250, serum ketones and pH <7.3, HCO3 levels <18.
Treatment: fluid and electrolyte replacement, insulin.
Potential consequences include hypotension, tachycardia, kussmal respirations.

Hyperosmolar Hyperglycemic Syndrome (HHS)

High blood glucose, severe dehydration
Pathophysiology: Enough insulin to prevent ketones, but not enough to regulate blood sugar and cause dehydration
Manifestations: profound dehydration, altered level of consciousness possible
Diagnostics: glucose > 600, serum osmolality > 320
Treatment: fluid replacement, insulin.

Thyroid Cancer

Classification: papillary, follicular, medullary, anaplastic
Manifestations: nodule
Diagnosis: ultrasound, biopsy
Treatment: radiation, surgery, lifelong hormone replacement. Common in females

Gastrointestinal System: Inflammatory Bowel Disorders

Types: Crohn's disease and Ulcerative colitis
Incidence higher in US, Canada, UK, Sweden and Norway, with Canada's incidence being the highest globally.
Management: controlling symptoms (diarrhea, abdominal pain, cramping), addressing fluid/electrolyte imbalance and stool blood, potentially requiring colectomy in severe cases.
Complications: increased risk of small bowel or colon cancer.

Esophageal, Stomach, Colorectal Cancer

Different types of GI cancers requiring specific knowledge of anatomy, physiology, diagnostics, treatment, and patient education.

Hepatic and Pancreatic System

Hepatitis (viral and non-viral): Types HepA thru HepG, with different routes of contagion and treatment options. Hepatitis is caused by several viruses and is transmitted through fecal-oral, blood, or bodily fluids. Chronic cases can potentially lead to liver cancer.
Cirrhosis: HepC leading cause, followed by chronic excessive alcohol consumption. Pathophysiology involves altered blood flow within liver. Potentially leading to scarring and liver failure.

Liver Cancer

Risk factors include age > 65, male, history of chronic hepatitis B/C and heavy/prolonged alcohol abuse.
Usually fatal within 6-12 months
Manifestations: often asymptomatic until advanced, including pain, weight loss, anorexia, weakness, fatigue, jaundice, and ascites
Management: early diagnosis is difficult, treatments are varied and range in effectiveness. Often only effective treatment involves surgery (if appropriate), and/or transplantation.

Pancreatitis

Acute: reversible inflammation, risk factors include ETOH, gallstones, or trauma.
Chronic: irreversible. Risk factor: prolonged alcohol use, causes digestive enzymes to autodigest surrounding tissues and pancreas.
Manifestations: severe epigastric pain radiating to back, intensity peaks minutes after eating or drinking, tender abdomen,guarding, rebound tenderness, and Cullen's sign, Grey Turner's sign.
Management: pain relief, fluid/electrolyte management, supportive care, nutritional support, and surgical interventions (if needed).

Pancreatic Cancer

Quick to spread and high mortality rate
Risk factors: age/gender, history of chronic pancreatitis, high fat diets, smoking, and/or diabetes.
Often asymptomatic until advanced, presenting with dull pain in epigastric/back areas, weight loss, jaundice, and possible vague symptoms similar to other GI disorders.
Treatment: ERCP (endoscopic retrograde cholangiopancreatography), combined radiation and chemotherapy. Sometimes a Whipple procedure.

Autoimmune Disorders

Includes arthritis and rheumatic diseases
Arthritis: primary affects joints, also muscles, bone, ligaments, and cartilage
Classification: monoarticular or polyarticular. Inflammatory or noninflammatory
Marked by inflammation, autoimmunity, and degeneration

Diffuse Connective Tissue Diseases

Group of chronic disorders causing inflammation and degeneration in connective tissues
Unknown cause, likely immunologic
Characterized by periods of exacerbation and remission
Includes conditions like rheumatoid arthritis and systemic lupus
Specific symptoms and diagnoses will vary for each condition.

Rheumatoid Arthritis

Development: ages 20-40, more common in females
Pathophysiology: synovial tissue moves into the joint leading to inflammation
Symptoms: morning stiffness longer than an hour, pain, warmth, swelling of the joints.
Management: ROM exercises, protection of bony prominences, immunosuppressants or anti-inflammatory medications

Systemic Lupus Erythematous (SLE)

Combo of genetic, immunologic, and environmental factors involved.
Manifestations: fever, malaise, weight loss, commonly affects muscles, renal systems, nervous system, cardiovascular system, and respiratory system. Butterfly rash.
Diagnostics: no specific unique test. Table 20.9 (pg. 398 - 399) useful for differential diagnosis.
Management: anti-inflammatory medications, corticosteroids, cytotoxic agents for controlling inflammation and immune response.

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Description

Test your knowledge on the various classifications of burns, including thermal, electrical, chemical, and radiation burns. Explore the depth of tissue damage and Total Body Surface Area (TBSA) assessments crucial for treatment. This quiz will challenge your understanding of burn severity and treatment considerations.