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Burns, Chapter 23
Mosby's Paramedic Textbook 3ED-R
105
Health Care
Undergraduate 1
03/31/2012

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Term
what are the different types of energy that can cause a burn
Definition
thermal, chemical, electrical, radiation
Term
This type of burn is caused by a substance that may or may not be accompanied by heat
Definition
chemical
Term
How does a chemical burn damage the skin
Definition
It changes the chemistry of the skin
Term
What is the most dangerous chemical burn regarding morbidity
Definition
Eye burn
Term
How does electrical burn injure your skin
Definition
Electricity produces heat that burn you. This comes from the resistance of the tissues and the movement of energy
Term
What are the two type of radiation that can produce a burn
Definition
ionizing and nonionizing
Term
What is Jacksons thermal wound theory
Definition
3 distinct zones of injury
Term
zone of coagulation
Definition
the central area of the burn wound which has sustained the most intense contact with the burn source
Term
This area of skin is nonviable and is necrotic
Definition
zone of coagulation
Term
zone of stasis
Definition
surrounds the critically injured area, consists of potentially viable tissue, cells die within 24-48 hours if now supportive measures are taken
Term
zone of hyperemia
Definition
increased blood flow from the inflammatory response
Term
Another term for burn shock
Definition
hypovolemic shock
Term
this type of burn is painful, red , and dry and blanch with pressure
Definition
superficial burn
Term
These degree of burns can heal without surgery
Definition
superficial and partial thickness
Term
what is a common characteristic of 2 degree burns
Definition
blisters
Term
how long does it take for 2 degree burns to heal
Definition
14 days
Term
this degree of burn involves the basal layer of the dermis
Definition
deep partial thickness burn
Term
this degree of burn only involves the skin layers up to the basal layer
Definition
2nd degree partial thickness
Term
why do they try to prevent scar formation with burn patients
Definition
because scaring prevents movement of limbs and joints
Term
this burn may be red and wet or white and dry
Definition
2nd degree full thickness
Term
Def Eschar
Definition
Dead tissue that falls off
Term
This type of burn has a loss of sensation and capillary refill
Definition
3rd degree
Term
This is a full thickness burn that penetrates the sub q, muscle, fascia, or bone
Definition
4th degree
Term
Children over what age is the rule of 9's most accurate for
Definition
10
Term
The rule of palms
Definition
the patients palm is equal to 1% of the body surface area
Term
What is the most accurate method for estimating burns
Definition
lund and browder chart
Term
This burn chart is used to measure burns in infants and young children
Definition
lund browder chart
Term
when does the greastest loss of intravascular fluid occur
Definition
the first 8-12 hours
Term
Def hemolyze
Definition
it is when red blood cells burst
Term
What is the consensus formula
Definition
the first 24 hours- 4mL/kg lactated ringer solution or NS multiplied by percent of TBSA-- 50% administered in the first 8 hours, 25% in the second 8 and 25% in the third 8 hours
Term
How do you stop the burning process with a superficial burn
Definition
by cooling the local area with cold water
DONT USE ICE COLD WATER, ICE OR SNOW
Term
What is the first step in managing the burn
Definition
stop the burning process
Term
How long should you cool a superficial burn
Definition
15-30 minutes
Term
If the paramedic is forced to start an IV in a burned arm, how should he or she secure the iv
Definition
with the use of a bandage, not tape
Term
If the patient has a burned face, how do you prevent swelling of the face
Definition
elevate the head of the cot to 30 degrees
Term
when should you remove burn pt jewelry?
Definition
As soon as possible because of the swelling might cause vascular compromise
Term
What is the problem with circumferential burns
Definition
it makes the skin tight and produces a tourniquet like effect that can compromise circulation
Term
what is the treatment for circumferential burns
Definition
escharotomy- incisions in the burn to releave pressure
Term
what are the characteristics of carbon monoxide and where does it come from
Definition
it is colorless, odorless, tasteless gas produced by incomplete burning of carbon based fuels
Term
Is carbon monoxide directly toxic to tissue
Definition
no, it harms the body by displacing oxygen
Term
When carbon monoxide binds with hemoglobin it forms this
Definition
carboxyhemoglobin
Term
Carbon monoxide has about _______ times the attraction to hemoglobin then o2 does
Definition
250
Term
how does a 20% atmosphere of carbonmonoxide affect the pt
Definition
pt can complain of headache, nausea, vomiting and loss of manual dexterity
Term
Levels of carbon monoxide above what percentage is lethal
Definition
60%
Term
Why is tachpenea and cyanosis not seen in carbon monoxide patients
Definition
because arterial oxygen tension is normal
Term
what is the most commonly seen s&S of carbon monoxide
Definition
pale skin with lip coloration
Term
In room air how long will carbon monoxide stay in your blood (half life)
Definition
4 hours
Term
Where does cyanide come from
Definition
buring of materials that are rubber and plastic in nature
Term
True or false- lower airway burns are common
Definition
false- the upper airway absorbs the heat and the lower airway rarely gets burnt
Term
What are two ways the lower airway gets burned
Definition
inhalation of superheated gasses and inhalation of toxic materials
Term
What is the most common lower airway injury
Definition
inhalation of toxic chemicals
Term
What are the three caustic agents that are associated with burns
Definition
alkalis, acids, and organic compounds
Term
what chemicals are forms of alkalis
Definition
hydroxides, carbonates of sodium, potassium, ammonium, lithium, barium, and calcium
Term
What common organic compounds are dangerous to humans
Definition
pheonols, creosote and petroleum products such as gasoline
Term
This takes priority over transport when taking care of a chemical burn patient
Definition
irrigation
Term
another term for tearing
Definition
lacrimation
Term
how do you irrigate an affected eye
Definition
irrigate from the medial to the lateral aspect
Term
If the patient has a chemical burn to the eyes should the patient remove the contact lenses?
Definition
yes
Term
what is a morgan lens
Definition
its a device used to irrigate the eye
Term
what is the best agent for treating most chemical burns
Definition
water
Term
Why are neutralizing agents for chemical burns generally not used
Definition
because they produce heat and could burn the patient
Term
What is one of the most corrosive materials known- it used to clean fabrics and metals
Definition
Hydrofluoric acid
Term
How do you neutralize hydrofluoric acid
Definition
with calcium or magnesium
Term
What is the biggest problem with a hydrofluoric acid burn
Definition
it continues to burn even after being neutralized
Term
this is an aromatic hydrocarbon
Definition
phenol
Term
Why are phenol burns not always felt
Definition
because the chemical has anesthetic properties
Term
This alkali is noxious, irritating gas that is water soluble
Definition
ammonia
Term
The respiratory injury from ammonia vapors depends on two things, what are they?
Definition
concentration and ruation of exposure
Term
What are forms of alkali metals
Definition
sodium and potassium
Term
How do you treat a patient with alkali metal embedded in the skin
Definition
Do not rinse with water because the water could react with the metal causing large amounts of heat. Cover the wound with oil and a bandage
Term
What are the three types of electrical burns
Definition
direct contact, arc injuries and flash burns
Term
This electrical burn happens when electric current directly penetrates the resistance of the skin and underlying tissues
Definition
direct contact burn
Term
Where does the greatest tissue damage occur with an electrical injury
Definition
directly under and adjacent to the contact point.
Term
What part of the electrical injury poses the greatest threat to the patient life
Definition
the injury between the wounds (organs)
Term
This electrical injury occurs when a person is close enough to a high voltage source that has current between to contact points near the skin overcomes the resistance in the air
Definition
arc injuries
Term
What is the common injury site for an flash burn
Definition
face or eyes
Term
does electrical current pass through the body in a flash burn
Definition
no
Term
This electrical injury happens when the heat of the electrical current ignites a nearby combustible source
Definition
flash burn
Term
What does direct contact and current passing through the body cause
Definition
wide areas of coagulation necrosis
Term
oral burns are common with these type of patients
Definition
children under 2
Term
What generic vital signs are commonly found with electrical injury patients
Definition
hypertension and tachycardia, possible heart dysrthymias and seizures
Term
Why do electrical injury patients sometimes have seizures
Definition
because nerve tissue is a good conductor of electricity which may result in seizures
Term
why do electrical burn patients sometimes develop acute renal failure
Definition
damage to vessels leads to muscle necrosis which then releases myoglobin clogging up the kidneys
Term
How can AC current cause a patient to have respiratory arrest and death
Definition
AC current can cause tetany fo the muscles of respiration
Term
What is the most common source of radiation exposure
Definition
industrial radiography and non-destructive testing
Term
What are forms of ionizing radiation
Definition
alpha, beta, and gamma
Term
These radiation particles get stopped by paper clothing and skin
Definition
alpha
Term
This is the most dangerous form of internal radiation exposure
Definition
alpha particles
Term
How can responders protect themselves from alpha and beta particles
Definition
by wearing fully encapsulating suit PPE with SCBA
Term
This is the most dangerous form of penetrating radiation
Definition
Gamma rays
Term
What are characteristics of Beta particles
Definition
they can penetrate subcutaneous tissue and normally enter the body through damaged skin, ingestion or inhalation
Term
What are forms of nonionizing radiation
Definition
radio waves and microwaves
Term
What is the term for the amount of emitted radiation
Definition
roentgens
Term
What is a rad
Definition
it is the absorbed dose
Term
How many rems would it take to kill 50% of the exposed population
Definition
450
Term
This occurs when radioactive materials in the form of gases liquids or solids are released into the environment
Definition
contamination
Term
this term refers to the uptake of radioactive materials by body cells, tissues, and target organs such as bone liver, thyroid or kidney
Definition
incorporation
Term
This term is used to describe when all or part of the body is exposed to penetrating radiation fron an external source
Definition
external irradiation
Term
What diseases are likely to develop after sever radiation poisoning
Definition
anemia and forms of cancer
Term
Where should command set up when dealing with a possible radiation leak
Definition
200-300 feet upwind of the site
Term
To protect yourself from radiation, what are the for factors you need to know
Definition
time, distance, shielding and quantity
Term
Is a person who has been exposed to radiation radioactive
Definition
no, only the residue poses a threat to rescuers
Term
What does it mean for a patient to considered clean
Definition
that the patient was exposed but not contaminated
Term
what does it mean for a patient to be dirty
Definition
it means that the patient was contaminated
Term
Why does a patient go into shock after a thermal injury
Definition
it results from edema and accumulation of vascular fluid
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