Burns Flashcards
Skin function
Barrier
Thermoregulation
Vitamin D synthesis
Sensory
Layers of skin
Epidermis
Dermis
Subcutaneous fat
Muscles, tendons, bones
Epidermis key factors
Reproduces all the time leads to shedding skin
First line of defence
Contains melanin
Dermis key factors
High elastic layer contains collagen, elastin, muco polysaccharides
Nerve endings
Blood vessels
Sweat glands
Hair follicles
Subcutaneous key factors
Adipose tissue
Insulator for hot and cold
Energy reserves for body
Cushion
Muscles/tendons/ bones key factors
Prone to hypoxia and anaerobic metabolism in burnt state
Bones still living tissue and can be damaged by burns
Eye burns
Irrigate with lots of water
Very susceptibile
Types of burns
THERMAL
Flame, scald, contact, steam, flash
CHEMICAL
Acid/ alkali
ELECTRICAL
Flash burns entry and exit wounds
Classifications of burns
Superficial
Superficial partial
Deep partial
Full thickness
Superficial burns
Eperdermis involvement only
Blister after 24 hours
Heal 3-5 days
Pain relief and water
Superficial burns
Partial dermis involvement
Blisters develop in minutes
Nerve endings exposed
3 to 4 weeks healing
Deep partial
Reaches subcutaneous
Appears white and waxy
Likely to scar
Hair grows back 7-10 days
Full thickness
Dry and leathery
Loses elasticity
Circulation compromise, nerve endings destroyed
Rule of 9s -
Head front - 4.5 back - 4.5
Arm front -4.5 back -4.5
Torso - 18
Back -18
Leg front -4.5 back -4.5
Genitalia - 1
Burns shock
Hypovolaemia - massive loss of fluid
Cardiac contractility reduced due to multiple organ dysfunction - CO reduced
Cellular affects metabolism and immune system
2 major factors influencing body’s response to shock
Surface are affected
Depth of burn on
Cardiovascular response to burn
Increased capillary permeability
Evaporate fluid
Vasodilation
Massive oedema associated with burns
Hyper metabolism
Increased glycogenolysis
Provides energy for repair but affects metabolism
Patient may become tachycardic, tachypnoic, hyper pyrexic and hyperglycaemic
Immune response to burns
Severely immunosupressed
Bacteria in gut can entree blood stream and lead to sepsis
How to do cricoidthyroidotomy
45 degree towards feet attach tubing 1 second on 4 seconds off use biggest cannula and do not allow kink
Use to allow time or if no other choice
Complications of cricoidthyroidotomy
Penetration of adjacent structures subcutaneous emphysema Swelling Severe bleeding Damage to larynx Injury to thyroid or parathyroid gland
CO poisoning
Gas not visible
When incomplete combustion
Give oxygen on 100% as it binds to the haemoglobin
Will have nausea, headache
Hydrogen cyanide poisoning
Not visible, almond smell
Plastic burning
Mild - nausea, dizziness, drowsiness, hyperventilation and anxiety
Moderate - reduced conscious level, vomiting, convulsions, hypotension
Severe - coma, fixed dilated pupils, cvs collapse, deep failure, cyanosis
Give 100% O2 regardless of sats
Smoke inhalation
May have airway burns
Treat with salbutamol
