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Critical Care > Burns > Flashcards

Burns Flashcards

1
Q

What is burns?

A

Coagulative necrosis of skin epithelium

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2
Q

What are types of burns?

A
  • Thermal
  • Electrical
  • Chemical
  • Radiation
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3
Q

Local effects of burn

A
  • Tissue damage/ disctruction
  • Fluid loss due to increase vessel permeability
  • Infection
  • Red cell destruction
  • Venous thrombosis
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4
Q

Regional effects of burns

A
  • Compartment syndrome
  • Contracture/ hypertrophic scar
  • Circulation compromise
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5
Q

Systemic effect of burns

A
  • Fluid and electrolyte imbalance
  • Protein loss/ Catabolism /Hypermetabolism
  • Impaired humeral and cellular immune response → sepsis/ SIRS/ multi-organ failure
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6
Q

SUPERFICIAL (1st) BURNS

What is the depth?

What are the features?

How long does it take to heal?

A

Depth: Epidermis only

Features: erythema, no blister

Healing duration: few days, no scarring

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7
Q

PARTIAL BURNS (SUPERFICIAL + DEEP)

A

Depth: superficial (epidermis + upper layer of dermis), deep (extends to deeper layer of dermis)

Features: erythema, blanch on pressure, blister, painful with intact pinprick sensation, deep: (no blanching on pressure, reduced pain sensation)

Duration:

superficial: 2-3 weeks, no scar, hyperpigmentation
deep: longer than 3 weeks, hypertrophic scar

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8
Q

FULL THICKNESS (3rd degree) BURNS

A

Depth: full thickness

Features: no pain, non-blanchable, deadly white

Healing: fibrosis, contracture

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9
Q

What is classified as a major burn?

A

Adult 15-20% TBSA

Children 10% TBSA

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10
Q

Describe the rule of 9

A
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11
Q

Modified Brooke formula

A

2ml/kg x % TBSA = amount of lactated Ringer solution over first 24 hours, with 50% over first 8 hours

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12
Q

Parkland formula

A

4ml/kg x weight x % TBSA = total fluids in 24 hours with half in first 8 hours

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13
Q

What is standard ATLS guidelines for fluid management in burns

A

2ml lactated Ringer’s x BW x % TBSA, half in first 8 hours, half in remainin in subsequent 16 hours

Subsequent fluids adjusted to target urine output 0.5ml/kg/hr (30-50ml/hr) for adults and 1ml/kg/hr for children

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14
Q

Management framework for burns

A
  • Immediate:
    • Arrest burning process
    • ATLS protocol
  • Early
    • Resuscitation
      • Fluid mx
    • Pain control
    • Sepsis control
    • Sedation
    • PPI prophlyaxis
    • Nutrition
    • Tetanus
  • Local wound management
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15
Q

Signs for inhalation injury

A
  • Singed nostril/facial hair
  • Soot on face
  • Facial neck burns
  • Erythema/swelling within mouth
  • Carbon deposites in oropharynx
  • Stridor, hoarsness of voice, CO>10%
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16
Q

What are the pathophysiological zones of injury in burns?

A
  • Zone of coagulation: coagulative necrosis with permanent cell death
  • Zone of stasis: tissue not permanently damaged but may progress if poorly managed
  • Zone of hyperaemia: inflammation, no permanent tissue damage
17
Q

At what temperature does permanent cell death occur?

A

45C

18
Q

At what temperature does protein denaturation occur?

A

42C

19
Q

What are potential systemic effects of burns?

A
  • Cardiovasular:
    • hypovolemic shock due to fluid shift
    • Peripheral/splanchnic vasoconstriction
    • Decrease cardiac output (decrdase myocardial contractility
  • Respiratory
    • Bronchoconstriction -inflammatory mediators
    • ARDS: due to direct lung injury or inflammatory mediators
  • Metabolic: increase BMR, catabolism
  • Immune: downregulation
20
Q

Criteria for complex burn injuries that may require transfer to burn unit?

A
  • Burn factors
    • Location/size: large
    • Site: face/ hands/feet/genitalia/circumferential
    • Causative agent: chemical, electrical
  • Patient factors: extreme age, vulnerable
  • Concerning features: unwell, child, NAI, non-healing burns for 2 weeks
21
Q

What is initial management for circumferential burns?

A
  • Remove any jewelry/watches from patient’s extremities
  • Assessment of neurovascular status to
  • Relieve any circulatory compromise by escharotomy
22
Q

How to perform escharotomy on the upper limb?

A

Two parallel incision on the radial and ulnar borders of forearm and arm through burnt skin until subcutaneous tissue.

Care near elbow and wrist not to injure neurovasculature.

23
Q

Signs and symptoms of compartment syndrome

A
  • Pain out of proportion to stimulus or injury
  • Pain on passive stretching of affected muscle
  • Tense swelling
  • Paresthesia or altered sensation in distal to affected compartment
24
Q

How do you perform escharotomy for circumferential chest/abdominal burns?

A

Longitudinal incisions along anterior axillary lines with cross-incision at clavicular line and junction of thorax/ abdomen

25
Q

Specific management for chemical burns

A
  • Rapid removal of chemical with large amounts of warm water for 20-30 minutes
26
Q

Are alkali or acidic burns worse? Why?

A

Alkali burns as they penetrate more deeply by liquefaction necrosis of tissue

27
Q

Specific concerns for electrical burns

A
  • forced contraction of muscles
    • muscle: rhabdomyolysis
    • bone: spinal fracture
    • heart: arrhythmia, cardiac arrest

Critical Care (12 decks)

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