Small Ani. Med- ECC- burn and electrocution

drraythe's version from 2016-04-29 15:42

TBSA= total body surface area. SBI= severe burn injury

Question Answer
3 major and severe derangements of systems caused by burns that were concerned about?(1) metabolic (2) cardiovascular (3) pulmonary
what are the 2 ways to classify burns?(1) burn depth (how to tx pt an manage wounds based off this) (2) total body surface area affected
what should you know about the 1*, 2* 3* burn classification system?NOT USED ANYMORE. (dont reflect depth)
4 classifications of a burn based on depth?(1) superficial (2) superficial partial thickness (3) deep partial thickness (4) full thickness
depth classification: Superficial: Dermal layers involved****? wound characteristics? healing? (focus on layers involved)LAYERS: epidermis only. characteristics: erythematous, desquamation, dry and flakey. Heal: 3-5d via re-epithelization, minimal scar
depth classification: Superficial partial thickness: Dermal layers involved****? wound characteristics? healing? (focus on layers involved)epidermis + upper 1/3dermis. Character: Erythmatous, moist, painful blisters. Heal: 1-2wk, minimal scar
depth classification: deep partial thickness: Dermal layers involved****? wound characteristics? healing? (focus on layers involved)epidermis+ all of dermis. Character: red waxy white, reduced pain, reduced pain sensation. Heal: 2-3wk, sx intervention recc to prevent scar.
depth classification: full thickness: Dermal layers involved****? wound characteristics? healing? (focus on layers involved)epidermis + dermis + SQ tissue. Character: eschar formatin, bloodless white eschar. hair easily plucked. Heal: requires sx for healing.
based on % total body surface area...what is considered a local burn? versus a severe burn injury?<20% of total body surface area is a local burn. A Severe burn injury is >20-30% of TBSA, and you will see systemic derangements, and will require intensive management
rough estimate of how much total body surface area is affected by a burn is determined of these charts. Extrapolated from ppl so not super accurate.
trunk is how much of TBSA?about 18%.
head is how much of TBSA?about 9%
1 arm is about how much of TBSA?9%
pelvis/genitals is about how much of TBSA?1%
1 leg is about how much of TBSA?18%
what is the "rule of nines"?How to classify TBSA of a burn-- all percents are 9 or 18 (except genitals/pelvis is one)
what are the 3 zones of a burn wound, starting from middle going out? how are they characterized?(1) zone of coagulation: center, initial area of injury. coagulative necrosis here. (2) zone of stasis: zone surrounding the center, there is capillary constriction here with ischemia, and viable and non-viable cells. (potentially rescuable here) (3) zone of hyperemia: viable cells, local inflammation.
what is a local burn injury again?<20-30% TBSA
What should you not use to heat pt?dont use heating pads- if you do, have sthing to separate between the pt and the pad
is there metabolic derangements with a local burn?no (Aggressive systemic tx typically not required)
how long before a local burn might become evident?24-48hrs (area may be painful)
how do you tx local burn?tx topically , dressings, +/- debridement (can be surgically, wet to dry bandages (mechanical), chemical debridement, maggots/leeches (brings blood to area etc bc local anticoag and prevent thrombosis and ischemic necrosis) )
clinical appearance of superficial burn?May not show up at all, might just be hypersensitive.
clinical appearance of partial and full thickness burns?Readily apparent after injury, Thick leathery surface of dead tissue=eschar.
why do we dislike eschars?Promotes bacterial growth (can be abscess under there), makes classification of depth difficult (cant see under it- can form with partial or full thicnkess, might not know classification till you remove it)
A severe burn injury results in...SYSTEMIC DERANGEMENTS!! results in burn shock (poor pulses, tachycardia, pale mm)
what are the two distinct phases of burn shock, and what problems characterize it?PHASES: (1) Hypodynamic or resuscitation phase (2) Hyperdynamic hypermetabolic phase. In burn shock you will see: Intravascular volume depletion, Reduced cardiac output, Increased systemic vascular resistance, Reduced peripheral blood flow
which phase of burn shock happens immediately following severe burn injury/The hypodynamic/resuscitation phase
when does the hypodynamic/resuscitation phase start in relation to a severe burn injury, how long does it last? how would you describe this? what is your 1* goal of this phase?starts IMMEDIATELY following SBI and lasts 24-72 hrs (1-3d). You see INC VASCULAR PERMEABILITY (so if you try to bolus it can just leak into interstitial/3r space), the fluid shift--->HYPOVOLEMIA + EDEMA in tissues. You will also see ******REDUCED CARDIAC OUTPUT (poorly responsive to therapy). So, your 1* goal for this phase is to restore and preserve tissue perfusion
when does the hyperdynamic/hypermetabolic phase start in relation to a severe burn injury, how long does it last? how would you describe it?see 3-5d after a SBI, and you can see the associated increased metabolic rate for up to 24 MONTHS after the injury. the hypermetabolic phase is characterized by protein catabolism, gluconeogenesis, glycogenolysis, lipolysis (think hormones like glucagon and HSL). There is also REDUCED vascular permeability, inc HR, dec vascular resistance, and inc CO.
when eval pt, what should you be looking for/concerned about in terms of the resp system?Concomitant smoke inhalation, Airway obstruction, Hypoventilation, ARDS (acute respiratory distress syndrome) (severe inflammation to lower resp system-->edema), Facial burns, singed nasal passages, Edema, bronchospasm
when eval pt, what should you be looking for/concerned about in terms of the cardio system?Hypotension, Arrhythmias, Inflammatory mediators & myocardial depression (direct damage or hypoxemia)
when eval pt, what should you be looking for/concerned about in terms of the neuro system?Assess for trauma, complete neuro exam, look for Change in mentation or seizures (Concern for CO and cyanide toxicity)
what neuro toxes are you worried about with burns?CO and cyanide
when eval pt, what should you be looking for/concerned about in terms of the ocular system?Immediate and subsequent swelling may prohibit ocular exam. Look out for exposure keratopathy, Corneal ulceration, RARELY corneal burns-- IRRIGATE EYES LIBERALLY.
what should you do with paw pad burns?Daily debridement, topical ab’s, bandaging
how can cooling be helpful as burn tx? how do you do cooling?RAPID cooling beneficial, can reduce depth of burn injury, and if within 30min of injury, can prevent ongoing damage/prevents necrosis (eschar formation) (of zone of coag and stasis). Do COLD tap water (59*F) for 20 min
MOST IMPORTANT TX FOR SBI? why?FLUIDS!!! helps maintain perfusion and avoid ischemia
what kinda fluids do you wanna use to tx sbi? how much?CRYSTALLOIDS! 4-6ml/kg per %TBSA in 1st 24hrs ( Half of this amount administered in 1st 8 hours)
titrate your fluid therapy to maintain...urine output, perfusion parameters, and MAP
how often do you need to manage SBI wounds? what solution do you use in the first 1-2 days? what do you do in general? what are other important things you MUST do?need DAILY wound management, with decontamination, debridement, and dressing (wet-to-dry) as well as daily hydrotherapy. FOR THE FIRST 1-2 DAYS, use a 1:40 dilute chlorhex or a 1:9 povodone iodine solution. WE ONLY DO THIS FIRST DAY OR TWO BECAUSE THESE SOLUTIONS ARE CYTOTOXIC TO THE GRANULATION TISSUE WE WANT TO FORM. so after first 1-2 days just hydrotherapy with water.Also, ANALGESIA is INCREDIBLY important
WOUND CARE: for.... (1) superficial? (2) superficial partial thickness? (3) Deep partial thickness+full thickness?(1) superficial: keep moist and clean, will heal in a week. (2) clean and debride, heal 1-2 wk. (3) eschar removal, topical agents, +/- sx excision/graft
2 topical therapies you can use for your deep partial thickness to full thickness burns?silver sulfadiazine, honey
Topical tx: Silver sulfadiazine: spectrum? pros? Cons?Spectrum: broad spectrum: G+, G-, MRSA, yeast, mold. pro: Painless, soothing, Penetrates eschar, Few side effects, Sustained release products available. Cons: delayed wound healing, delays eschar separation, hypersensitivity rxn
Topical tx: Honey: Spectrum? pros? cons?Spectrum: broad, G+, G-, MRSA (silver sulfadiazine also does yeast and mold tho). Pro: improved healing rate, less wound contracture, dec excessive granulation. CONS: tissue dehydration (if use too much can dehydrate) local hypersensitivity reaction
burn pts at high risk for what kinda infections?pneumonia, Sepsis 2’ to loss of skin barrier, necrosis
why are abx not prophylactically prescribed in burn pts when there is high risk for infxn? If there IS a systemic infection, what do you do? Risk of resistant infections, Topicals typically suffice. If there IS a systemic infection, administer systemic ab’s x 1 week. Repeat culture.
electrical current does what, and leads to what problems?disrupts electrophysiological activity, leading to: Muscle spasms, Cardiac arrhythmias, Loss of consciousness, resp arrest. ALSO, cellular fluids become heated (so see burns too)--> Coagulation of tissue proteins, Thrombosis of vessels, Necrosis of tissues, Ischemic injury
what with electricity will cause more damage?higher voltage= more damage.
common signalment of elec. injury?Young dogs and cats (bc stupid)-->Chew electrical cords. Average age= 3.5 months. 2-12 months most common
what/where will you commonly see with electrical cord burns?Mucus membranes, tongue, lips, palate, dental fractures, Fistulas (can present with foul smelling mouth)
which cardio probs are common with electrical injury?****Arrhythmias (ESP VENTRICULAR ARRHYTHMIAS), Vfib (common cause of sudden death), v-tach, sinus tach.
when do you use a defibrillator?only D-fib for V-fib.
if there is V-tach, how treat?LIDOCAINE!!
resp system probs you can see with electrical injury?Respiratory distress, Tachypnea, Cyanosis, Orthopnea, Coughing, apnea, neurogenic (non-cardiogenic) pulmonary edema
explain neurogenic (non-cardiogenic) pulmonary edema and its relation to electrical injuryHappens bc elec can cause MASSIVE sympathetic outflow--> vasoconstriction--> hypertension--> vessels leak and burst.
tx for elec injury?SUPPORT!! O2, tx arrhythmias, bronchodilators, diuretics (DONT CAUSE HYPOVOLEMIA THO) GI support, nutrition, Burn wound management, PAIN MANAGEMENT