ATLS Module 9 - Thermal Injuries
American burn affiliation analysis necessities for inhalation harm - ANS-exposure to flamable
agent and symptoms of publicity to smoke in decrease airway, beneath vocal cords, seen on
bronchoscopy
are burns considered easy? - ANS-clean burns are easy areas that must be blanketed from
contaminations
*if it burns the pores and skin, it burns the micro organism
red text
are prophylactic antibiotics necessary in early postburn period? - ANS-not until required for
different accidents
*reserve use of antibiotics for tx of contamination
direct thermal injury to decrease airway is uncommon... When does is largely arise? -
ANS-most effective after publicity to superheated steam or ignition of inhaled flammable
gases
red text
electric burns frequently are more critical than they seem on the body floor... How do the
currents travel? - ANS-modern-day travels inside blood vessels and nerves and might cause
nearby thrombosis and nerve damage
*excessive injuries typically reason extremity contracture
*extremities, especially digits, are mainly at hazard
hot tar or asphalt burns are possible in commercial settings... Tar adheres to pores and skin
and infiltrates apparel, ensuing in persevered transfer of heat... How is that this handled? -
ANS-speedy cooling of tar and care to keep away from further trauma whilst removing it
*mineral oil is used to dissolve tar
how can burn injuries effect the airway? - ANS-airway can come to be obstructed from direct
damage (inhalation harm) and the massive edema as a consequence of burn injury
crimson textual content
how can you lower the pain of wounds? - ANS-cowl wounds
how are you going to lessen neck and chest wall edema following inhalation harm? -
ANS-after spinal damage has been excluded... Elevate head and chest to 30 ranges
how do you modify the amount of fluids given to the sufferers? - ANS-modify primarily based
on urine output
*target of 0.5mL/kg/hr in adults; 1 mL/kg/hr in kids
*if preliminary resuscitation rate fails to produce target urine output, increase fluid charge till
urine output is met
how do you manage resuscitation of fluids in pediatric burn sufferers? - ANS-pediatric pts
with 2nd or 3rd diploma burns
3mL ringers x weight (kg) x % TBSA
, <30kg - add maintenance fluids of 5% dextrose in water
how do you prevent patients developing deep-tissue injury from constricting burn eschar? -
ANS-recognize that burned skin is not elastic
*circumferential burns may require escharotomies
how do you prevent severe pain with dressing change? - ANS--provide adequate analgesia
before manipulating burns
-use non-adherent dressings or burn sheets to protect burn from contamination before
transfer
how do you stop the burn if contaminated with chemicals? - ANS-be careful when removing
any clothing contaminated by chemicals... Brush any dry chemical powders from the
wounds... Then irrigate the burn areas with copious amounts of warm saline irrigation or
rinsing in warm shower
how do you stop the burning process? - ANS-completely remove the clothing... But don't
peel off adherent clothing
*but prevent overexposure and hypothermia
*recognize that "stop drop & roll" is appropriate but can lead to contamination of burn with
debris/contaminated water
how does frost bite create damage? - ANS-due to freezing of tissue, ice crystal formation
causing cell membrane injury, microvascular occlusion, subsequent tissue anoxia
*some damage can occur from reperfusion injury from rewarming
how does the resuscitation of burn patients differ from other types of trauma in which fluid
deficit is typically due to hemorrhage? - ANS-burn resuscitation is required to replace
ONGOING losses from capillary leak due to inflammation
red text
How is burn resuscitation affected when the patient also has an injury causing hemorrhage?
- ANS-control bleeding and resuscitate per standard ATLS protocol for hemorrhagic shock
before starting burn resuscitation
how much does the palmar surface (including fingers) of a patient's hand represent in
comparison to body surface? - ANS-1%
red
how should frozen toes be thawed? - ANS-use moist rewarming
*recognize this can be very painful & lead to systemic effects, such as a drop in core temp
as the frozen limb becomes perfused
*remember, pt can develop reperfusion syndrome
in what situation is it not advisable to immediately wash off chemicals with irrigation? -
ANS-irrigation to chemicals in a pt with chemical burn injury should not occur until airway
has been assessed and secured
pt with inhalation injuries should be transferred to burn centers. What do you do if transport
time is prolonged? - ANS-intubate before transport
what are 2 interventions for treating rhabdomyolysis, including their rationale? -
ANS-increase fluids to a target urine output of 100cc/hr, which theoretically washes out the
myoglobin before it can settle in.
Administer mannitol, which acts as a free radical scavenger, and an osmotic diuretic,
theoretically increasing the urine output and wash out of the myoglobin
what are the 3 causes that breathing concerns arise from? - ANS-hypoxia, carbon monoxide
poisoning, smoke inhalation injury
American burn affiliation analysis necessities for inhalation harm - ANS-exposure to flamable
agent and symptoms of publicity to smoke in decrease airway, beneath vocal cords, seen on
bronchoscopy
are burns considered easy? - ANS-clean burns are easy areas that must be blanketed from
contaminations
*if it burns the pores and skin, it burns the micro organism
red text
are prophylactic antibiotics necessary in early postburn period? - ANS-not until required for
different accidents
*reserve use of antibiotics for tx of contamination
direct thermal injury to decrease airway is uncommon... When does is largely arise? -
ANS-most effective after publicity to superheated steam or ignition of inhaled flammable
gases
red text
electric burns frequently are more critical than they seem on the body floor... How do the
currents travel? - ANS-modern-day travels inside blood vessels and nerves and might cause
nearby thrombosis and nerve damage
*excessive injuries typically reason extremity contracture
*extremities, especially digits, are mainly at hazard
hot tar or asphalt burns are possible in commercial settings... Tar adheres to pores and skin
and infiltrates apparel, ensuing in persevered transfer of heat... How is that this handled? -
ANS-speedy cooling of tar and care to keep away from further trauma whilst removing it
*mineral oil is used to dissolve tar
how can burn injuries effect the airway? - ANS-airway can come to be obstructed from direct
damage (inhalation harm) and the massive edema as a consequence of burn injury
crimson textual content
how can you lower the pain of wounds? - ANS-cowl wounds
how are you going to lessen neck and chest wall edema following inhalation harm? -
ANS-after spinal damage has been excluded... Elevate head and chest to 30 ranges
how do you modify the amount of fluids given to the sufferers? - ANS-modify primarily based
on urine output
*target of 0.5mL/kg/hr in adults; 1 mL/kg/hr in kids
*if preliminary resuscitation rate fails to produce target urine output, increase fluid charge till
urine output is met
how do you manage resuscitation of fluids in pediatric burn sufferers? - ANS-pediatric pts
with 2nd or 3rd diploma burns
3mL ringers x weight (kg) x % TBSA
, <30kg - add maintenance fluids of 5% dextrose in water
how do you prevent patients developing deep-tissue injury from constricting burn eschar? -
ANS-recognize that burned skin is not elastic
*circumferential burns may require escharotomies
how do you prevent severe pain with dressing change? - ANS--provide adequate analgesia
before manipulating burns
-use non-adherent dressings or burn sheets to protect burn from contamination before
transfer
how do you stop the burn if contaminated with chemicals? - ANS-be careful when removing
any clothing contaminated by chemicals... Brush any dry chemical powders from the
wounds... Then irrigate the burn areas with copious amounts of warm saline irrigation or
rinsing in warm shower
how do you stop the burning process? - ANS-completely remove the clothing... But don't
peel off adherent clothing
*but prevent overexposure and hypothermia
*recognize that "stop drop & roll" is appropriate but can lead to contamination of burn with
debris/contaminated water
how does frost bite create damage? - ANS-due to freezing of tissue, ice crystal formation
causing cell membrane injury, microvascular occlusion, subsequent tissue anoxia
*some damage can occur from reperfusion injury from rewarming
how does the resuscitation of burn patients differ from other types of trauma in which fluid
deficit is typically due to hemorrhage? - ANS-burn resuscitation is required to replace
ONGOING losses from capillary leak due to inflammation
red text
How is burn resuscitation affected when the patient also has an injury causing hemorrhage?
- ANS-control bleeding and resuscitate per standard ATLS protocol for hemorrhagic shock
before starting burn resuscitation
how much does the palmar surface (including fingers) of a patient's hand represent in
comparison to body surface? - ANS-1%
red
how should frozen toes be thawed? - ANS-use moist rewarming
*recognize this can be very painful & lead to systemic effects, such as a drop in core temp
as the frozen limb becomes perfused
*remember, pt can develop reperfusion syndrome
in what situation is it not advisable to immediately wash off chemicals with irrigation? -
ANS-irrigation to chemicals in a pt with chemical burn injury should not occur until airway
has been assessed and secured
pt with inhalation injuries should be transferred to burn centers. What do you do if transport
time is prolonged? - ANS-intubate before transport
what are 2 interventions for treating rhabdomyolysis, including their rationale? -
ANS-increase fluids to a target urine output of 100cc/hr, which theoretically washes out the
myoglobin before it can settle in.
Administer mannitol, which acts as a free radical scavenger, and an osmotic diuretic,
theoretically increasing the urine output and wash out of the myoglobin
what are the 3 causes that breathing concerns arise from? - ANS-hypoxia, carbon monoxide
poisoning, smoke inhalation injury
