(1) Approach to Burns Flashcards
types of burn
thermal
chemical
electrical
radiation
cold injury
types of thermal injury
- scald - hot liquids and steam
- flame- direct exposure to fire
- flash- exposure to flame
- contact- exposure to a very hot stimulus for a very short amount of time e.g. industrial accident or expsoure to host surface for abnormally long amount of time e.g. uconscious patient and radiator
chemical burns can be
- acid
- alkali (worse- result in deeper and mroe severe burns due to protein denaturation and fat saponification)
electrical burn
usually hand and feet - can look like minor burns but cause a significant injury
Types
- Direct contact
- Electrical arc
electrical: direct contact
current from an electrical source passes directly through the body (Can cause extensive internal damage)
- Burn conducts through organs
- Rhabdomyolysis
- Cardiac arrhythmias
electrical arc
flash thermal burn occurs due to an electrical arc coming briefly into contact with skin
- An arc is an electrical breakdown of a gas that produces a prolonged electrical discharge.
radiation burn example
- UV e.g. sunburn
- X-ray e.g. radiotherapy
Approach to Burns in A & E
A- E
A
Airway
Look for: Nasal soot, singeing, stridor, hoarseness of voice
Management
- Pre-emptive intubation may be considered
- Protect cervical spine until clinically cleared
burn and airway
if a person has been in a fire they may have an inhalation injury
inhalatin injury
- Damage to airway secondary to inhalation of hot air
- Increases mortality by 20%
- Causes erythema or oedema
- Features
o Stridor
o Hoar voice
o Soot
o Singed nasal hairs
o Respiratory compromise - Management: earlt involvement of anaesthetics to secure definitive airway e.g. intubation
B
Breathing
Look for: Circumferential burns, inhalation burns
Management
- 100% oxygen via on-rebreathe mask
- In more extensive burns, evaluate the need for escharotomy (emergency procedure which involves incising through areas of burnt skin to release the eschar and constrictive effects -> allows distal circulation and a equate ventilation
- Obtain ABG and check carboxyhaemoglobin levels (CO poisoning)
- CXR
C
Circulation
Look for: fluid depletion signs (pulse, cold peripheries etc, slow CRT)
Manaegemnt
- 2 wide bore cannulas (avoid inserting through burns)
- Take routine bloods, G&S, clotting, CK
- Aggressive IV fluid therapy
- Insert Urinary catheter (fluid balance monitoring)
- ECG
D
Disability
Look for: associated trauma (bone etc), GCS, BM, temp
Management
- prevent hypothermia (warm room)
E
Exposure and environment
- Fully expose patient to get accurate estimation of % total body surface area (TBSA) burned and check for concomitant injury
- Give tetanus booster