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Chapter 32
Trauma: Burns
102
Medical
Not Applicable
09/13/2016
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Term
What is the continuous shedding of the dead cells on the surface of the skin?
 Definition
Desquamation
Term
What is a complex material composed chiefly of collagen fibers, elastin fibers, and a mucopolysaccharide gel?
 Definition
Dermis
Term
What is a fibrous protein with a very high tensile strength, so it gives the skin high resistance to breakage under mechanical stress?
 Definition
Collagen
Term
What imparts elasticity to the skin, allowing it to spring back to its usual contours?
 Definition
Elastin
Term
What gives the skin resistance to compression?
 Definition
Mucopolysaccharide Gel
Term
What is a noninflammatory acne lesion?
 Definition
Comedo
Term
Children younger then 5 Y/O and elderly people are at high risk of
 Definition
dying in fires
Term
What has vastly improved burn care?
 Definition
Better understanding of burn shock, advances in the use of fluid therapy and antibiotics, improved ability to excise dead tissue, and the use of biologic dressings to aid early wound closure.
Term
The skin is
 Definition
durable, flexible, and able to repair itself
Term
the skin has 4 functions
 Definition
Protects underlying tissues, aids in thermoregulation, helps maintain the chemical stability of the internal environment, and serves as a sense organ
Term
Nerve endings in the skin mediate
 Definition
the senses of touch, temperature, pressure and pain.
Term
Cutaneous blood vessels regulate
 Definition
body temperature by regulating the volume of blood that flows from the body's warm core to its cooler surface.
Term
Sensations such as cold and fright stimulate the
 Definition
autonomic nervous system, which brings out the contraction of those muscles and results in gooseflesh.
Term
damage to nasal hair, eyebrows, and eyelashes in burn patients indicates
 Definition
airway injury
Term
Deeper skin structures have been damaged when
 Definition
Hair on the arms and legs falls out or can be removed without pain.
Term
Muscles have thick, fibrous capsules that are prone to
 Definition
hypoxia and anaerobic metabolism in a burn state.
Term
Eyes are sensitive to burn injuries from
 Definition
a flame, super heated gases, light source, or chemicals.
Term
Ocular damage is a common result of
 Definition
Alkali base injury.
* the higher the pH of the substance, the more severe the damage to the eye.
Term
Burns are diffuse soft tissue injuries created by
 Definition
destructive energy transfer via radiation, thermal, or electrical energy
Term
When the skin is burned, the patient is at a high risk for
 Definition
Infection, hypothermia, hypovolemia, and shock.
Term
Burns are not
 Definition
isolated soft tissue injuries.
Term
Burn shock occurs because of two types of injury
 Definition
Fluid loss across damaged skin and a serious of volume shifts within the rest of the body.
Term
Adequate fluid resuscitation is essential
 Definition
to avoid devastating consequences of burn shock.
Term
The progression of a chemical burn is MOSTLY dependent on:
 Definition
the length of time the corrosive chemical remains on the skin.
Term
The degree of absorption of a corrosive chemical determines
 Definition
whether toxicity is local or systemic
Term
Chemicals such as Lewisite and phosgene oxime:
 Definition
are vesicant agents that produce cutaneous blisters rapidly.
Term
Which of the following chemicals causes a painless burn and can result in significant damage before it is identified?
 Definition
Phenol
Term
The appropriate treatment for MOST chemical burns is:
 Definition
flushing with copious amounts of water.
Term
A person who is exposed to cement:
 Definition
may not notice a skin burn for hours because cement penetrates through clothing and reacts with sweat
Term
The outer zone of an entrance or exit wound caused by a contact electrical burn is:
 Definition
the red zone of coagulation necrosis.
Term
Victims standing near an object that is struck by lightning:
 Definition
often have burns characterized by a feathering pattern.
Term
Cardiac arrest following an electrical shock:
 Definition
may occur secondarily from hypoxia or as a direct result of the shock.
Term
The two MOST common causes of death from an electrical injury are:
 Definition
asphyxia and cardiopulmonary arrest.
Term
The skin sheds excess heat from the body through:
 Definition
the evaporation of sweat.
Term
Which of the following locations would provide the BEST protection from a lightning strike?
 Definition
A car with the windows rolled up
Term
The majority of victims struck by lightning:
 Definition
experience confusion and some degree of amnesia.
Term
Compared to beta radiation particles, alpha radiation particles
 Definition
have minimal penetrating energy.
Term
________ radiation is very penetrating and easily passes through the body and solid materials.
 Definition
Gamma
Term
When assessing a burn patient, it is MOST important to:
 Definition
be alert for occult trauma that could affect patient outcome.
Term
While standing by at the scene of a structural fire, it is MOST important to remember that:
 Definition
toxic gases are often present, even after the fire is out.
Term
Upon initial contact with a severely burned patient, you must:
 Definition
ensure that the patient is not still burning.
Term
If a burn patient presents with a hoarse voice and states, "I'm cold," your MOST immediate concern should be:
 Definition
inhalation injury.
Term
Patients suspected of having burns to the upper airway will benefit MOST from:
 Definition
cool, humidified oxygen
Term
With regard to a thermal burn injury, the zone of coagulation
 Definition
is the central part of the burn and suffers the most damage.
Term
The severity of a thermal burn correlates directly with:
 Definition
the temperature of the heat source, the amount of heat energy possessed by the object or substance, and the duration of exposure.
Term
Unlike partial-thickness burns, full-thickness burns:
 Definition
destroy the base membrane of the dermis that produces new skin cells.
Term
According to the rule of nines, an adult man with partial- and full-thickness burns to his head, face, and anterior chest has burns to ____% of his total body surface area.
 Definition
18
Term
Which of the following statements regarding the rule of palms is correct?
 Definition
The patient's palm, excluding the fingers, represents 1% of his or her total body surface area
Term
The purpose of estimating a patient's total body surface area burns in the prehospital setting is to:
 Definition
help the paramedic determine the most appropriate destination hospital.
Term
The secondary assessment of a severely burned patient is intended to:
 Definition
identify other injuries that may have a higher priority for treatment.
Term
A burn patient with a history of chronic obstructive pulmonary disease:
 Definition
may be triaged as a critically burned patient, even if the burn injury is small.
Term
Assessment of a patient who may have been exposed to radiation begins by:
 Definition
determining if the scene is safe to enter.
Term
The MOST acute complication associated with large body surface area burns is:
 Definition
hypothermia
Term
Nasotracheal intubation of a patient with upper airway burns:
 Definition
is a complicated procedure and should be avoided.
Term
If intubation of a burn patient becomes necessary, you should avoid cutting the ET tube down to make it shorter because:
 Definition
facial edema may cause tube dislodgement 2 to 3 days after the burn.
Term
Which of the following burn injuries or patterns should make you the MOST suspicious for abuse?
 Definition
Burns with formed shapes
Term
The application of ice to partial-thickness burns:
 Definition
can exacerbate tissue injury and should be avoided.
Term
A patient with full-thickness burns surrounded by areas of superficial and partial-thickness burns should be treated with all of the following, EXCEPT:
 Definition
moist dressings.
Term
A partial-thickness burn is considered to be critical if it:
 Definition
involves more than 30% of the body surface area.
Term
A full-thickness burn is considered to be critical if it:
 Definition
occurs in a patient with a significant medical illness.
Term
You are caring for a 41-year-old man who was trapped in his burning house before being rescued by fire fighters. He has full-thickness burns to his head and anterior trunk, and mixed partial- and full-thickness burns to both anterior upper extremities. What percentage of his total body surface area has been burned?
 Definition
36
Term
During your primary assessment of a 21-year-old man with a suspected inhalation injury, you note that he is combative and his respirations are profoundly labored and stridorous. The closest appropriate medical facility is approximately 25 miles by ground, and the local air transport service is unavailable. You should:
 Definition
assist ventilations with a bag-mask device, start an IV, administer a sedative and a neuromuscular blocker, and intubate his trachea.
Term
You and your partner are transferring a severely burned patient from a community hospital to a burn specialty center. The patient, a 110-pound woman, has partial- and full-thickness burns that cover approximately 55% of her body. She has two large-bore IV lines in place, is intubated, and is on a cardiac monitor. According to the Parkland formula, how much normal saline should she receive in 30 minutes?
 Definition
340mL
Term
A 52-year-old man sustained superficial and partial-thickness burns to his left arm approximately 15 minutes ago when he opened the radiator cap on his car. He is conscious, alert, and in severe pain. His BP is 138/76 mm Hg, pulse is 110 beats/min and strong, respirations are 22 breaths/min and regular, and oxygen saturation is 99% on room air. He denies any other injuries. Initial management for this patient involves:
 Definition
applying cool, wet dressings to the burn and elevating his arm.
Term
A 33-year-old man was burned when the hot water heater he was working on exploded. The patient has superficial and partial-thickness burns to his face, neck, and arms. Your primary assessment reveals that he is restless and tachypneic. His BP is 80/54 mm Hg and his heart rate is 120 beats/min and weak. You should:
 Definition
administer high-flow oxygen, keep him warm, start at least one large-bore IV of normal saline, and administer fluid boluses to maintain adequate perfusion
Term
A 4-year-old boy pulled a pot of boiling water off of the stove and experienced partial-thickness splash burns to his neck, anterior trunk, and both anterior arms. During your assessment, you note that the child is conscious but is not crying. He is tachypneic and tachycardic, and his skin is cool and moist. Other than the burns, there are no other gross injuries. Which of the following statements regarding this scenario is correct?
 Definition
The child may be hypoglycemic and requires assessment of his blood glucose level.
Term
Flash burns:
 Definition
are usually relatively minor compared with the potential for trauma from whatever caused the flash.
Term
A 74-year-old man experienced partial- and full-thickness burns to his arms and chest resulting from a fire that started after he fell asleep while smoking his cigar. The patient's son, who arrived at the scene shortly after you, states that his father has congestive heart failure, rheumatoid arthritis, and atrial fibrillation. In addition to administering supplemental oxygen, it is MOST important for you to:
 Definition
auscultate his breath sounds before administering IV fluids.
Term
You respond to an industrial plant for a 42-year-old man with a chemical burn. Upon arrival at the scene, you find the patient to be ambulatory. He tells you that he was moving some bags of dry lime when one of the bags broke and spilled lime all over him. After donning the appropriate personal protective equipment, you should:
 Definition
remove his clothing, brush as much of the lime off of him as possible, and flush the affected areas with copious amounts of water.
Term
Burn shock is caused by:
 Definition
fluid loss across damaged skin and volume shifts within the rest of the body.
Term
If an acutely burned patient is in shock in the prehospital setting:
 Definition
you should look for another injury as the source of shock.
Term
Supraglottic damage following a burn is MOST often caused by:
 Definition
the inhalation of superheated gases.
Term
Which of the following statements regarding carbon monoxide (CO) poisoning is correct?
 Definition
Never rule out CO poisoning because of the absence of cherry red skin.
Term
The LEAST significant complication associated with damage to the skin following a burn injury is:
 Definition
decreased melanin granules.
Term
Thermal burns are MOST commonly caused by exposure to:
 Definition
an open flame
Term
Which of the following statements regarding scald burns is correct?
 Definition
Scald burns often cover large surface areas because liquids spread quickly.
Term
What type of thermal burn is MOST commonly associated with inhalation injury?
 Definition
steam burns
Term
Which of the following is the LEAST common cause of death from fires?
 Definition
Integument burns
Term
Dry powder chemicals:
 Definition
should be brushed off the skin before irrigation with water.
Term
Phosphorus is found in _____________ and burns when exposed to _____________.
 Definition
fireworks, air
Term
A burn caused by a sodium metal should be treated by:
 Definition
covering the burn wound with oil.
Term
Relative to the entrance wound caused by an electrical burn, the exit wound:
 Definition
can be quite extensive and deep.
Term
Damage to the kidneys following an electrical injury:
 Definition
occurs when damaged muscle produces myoglobin.
Term
Most lightning-related injuries occur when the victim:
 Definition
receives a "splash" effect after lightning strikes a nearby object
Term
After an adult victim is struck by lightning and experiences cardiac arrest:
 Definition
his or her heart may resume beating spontaneously.
Term
Many of the physiologic changes caused by acute radiation syndrome:
 Definition
occur over time and will not be apparent in the prehospital setting
Term
The onset of ___________ soon after exposure to radiation is a predictor of poor outcomes.
 Definition
vomiting
Term
Unlike chemical burns, radiation burns:
 Definition
may appear hours or days after exposure.
Term
With regard to a thermal burn injury, the zone of coagulation:
 Definition
is the central part of the burn and suffers the most damage.
Term
A superficial burn is:
 Definition
characterized by reddened skin with varying degrees of pain
Term
Which of the following statements regarding partial-thickness burns is correct?
 Definition
Partial-thickness burns are usually extremely painful for the patient.
Term
Full-thickness circumferential burns to the chest:
 Definition
may cause significant restriction of respiratory excursion.
Term
Immediate care for a burn patient involves:
 Definition
stopping the burning process.
Term
Which of the following statements regarding prehospital vascular access and fluid therapy in the severely burned patient is correct?
 Definition
At least one large-bore IV should be started while en route to the hospital
Term
When considering analgesia for a burn patient who is in severe pain, you must remember that
 Definition
burns increase the metabolic rate, which may necessitate higher than normal doses of analgesics.
Term
The application of ice to partial-thickness burns:
 Definition
can exacerbate tissue injury and should be avoided.
Term
A patient with full-thickness burns surrounded by areas of superficial and partial-thickness burns should be treated with all of the following,
 Definition
EXCEPT moist dressings
Term
Which of the following statements regarding sodium metal chemical burns is correct?
 Definition
Do not flush with water as doing so may produce heat and cause an explosion.
Term
Specific treatment for a hydrofluoric acid burn is:
 Definition
calcium chloride.
Term
Which of the following burn injuries would MOST likely require transport to a burn specialty center?
 Definition
Burns that involve the hands, feet, or genitalia
Term
A 24-year-old woman was struck by lightning. Bystanders moved the patient to an area of safety but did not provide any other care before your arrival. Your primary assessment reveals that the patient is pulseless and apneic. You begin CPR and apply the cardiac monitor, which reveals asystole. After requesting a backup paramedic unit, the MOST appropriate treatment for this patient involves:
 Definition
continuing CPR, protecting her spine while ventilating, reassessing her cardiac rhythm after 2 minutes of CPR, and defibrillating if necessary.
Term
You are transporting a conscious but confused 29-year-old man after he was electrocuted. The patient is on high-flow oxygen, has an IV line of normal saline in place, is on a cardiac monitor, and has his spine fully immobilized. During transport, it is especially important for you to:
 Definition
remain alert for lethal cardiac dysrhythmias and be prepared to defibrillate.
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