Burns Flashcards
Functions of the skin
- Protects the body from pathogens
- (langerhans cells - tissue based macrophages)*
- Prevent water loss
- Sensation
- Temperature regulation
- Vit D synthesis
- Excretion of urea, ammonia, uric acid
Identify the different type of burns
- *Thermal/Temperature**
- From flame, scold, cold/frostbite
- *Chemical**
- Acidic, alkaline, hydroflouric acid, concrete
- *Electrical**
- Inc lightening
- *Radiation
- **sunburn, radiotherapy
- *Flash**
- Exposure to bright UV light causing inflammation of the cornea
- Eg. welding torch*
Discuss the assessment of burns
Depth
Epidermal:
Only outer layer, red, blanching, dry, not included in TBSA
eg. sunburn
Superficial dermal partial thickness:
Blisters from oedema, vasculature intact, moist, cap refil present
Mild dermal partial thickness:
Damaged but viable tissue as base of dermis. Red, delayed cap refil
Deep dermal partial thickness burn
Early development of extensive blisters, rupture to expose deep damaged dermis. Skin red/pale. No/v sluggish blanching. Reduced sensation
Full thickness
Destroyed epidermis and dermis. White/waxy/charred/leathery. Dry (BV destroyed). Sensory nerves destroyed - no pain. No blanching.
Circumfrential burns
Surrounds the circumference of a limb/torso.
Deep, dermal/full thickness burn looses the ability to expand with oedema progression. May interfere with circulation, may need escharotomy to reduce risk of compartment syndrome.
Extent
Major burn: >10% TBSA in paediatric, >20% TBSA in adults
Severity
Burns requiring t/f to burns unit:
Chemical burns, inhalation bunhs, electrical burns,
Full thickness burn, burn > 10% TBSA
paediatric, elderly, pregnancy, circumfrential burn
What is the main aim of burms management
To increase perfusion to the stasis zone of the burn
- Adequate burn first aid
- Prevention of hypothermia
- Good fluid resus
- Elevation of affected limb
- Prevention of infection
- Cover burn wound
- Analgesia
Describe the pathophysiology of fluid shift in burns
- *Zone of coagulation** - rapid cell death with irreversable tissue necrosis
- *Zone of stasis** - surrounds ZOC, reduced dermal circulation but potentially viable
- Z*one of hyperaemia - limited cell damage, widespread vasodilation/increased blood flow for ZOS
Pro-inflammatory cytokines cause vasodilation and increased vascular permeability → albumin and fluid shift from intravascular to interstitial space → interstitial oedema and hypotension
Sodium shifts into cells in exchange for potassium due to change in cell permeability → depletion of IV sodium → rapid development if oedema
Emergency management of inhalation burn
Look for:
- perioral facial burns
- hoarsness/change of voice
- increased WOB
- carbonaceous sputum
- ALC
Above larynx
- watch for oedema and obstruction
- dexamethazone
- adrenaline nebs
Below larynx
- watch for bronchoconstriction and parenchymal injury
(impaired gas exchange)
- CXR, bronchoscopy diagnosis
- Bronchodilators
- Heparin
- Acetylcysteine
Fluid replacement in burns
Crystalloid (eg Hartmann’s)
Parkland formula
3-4ml/kg/%burn/24h
Half over 8 hours, the rest over 24 hours.
Titrate to urine output (0.5-1ml/kg/hr)
Managenemt of circumferential burn
Escharotomy
Temperature control in burns
Cool wound for 20 mins
- Warm IV fluids
- Bair hugger
- Space blanket
- Cover head
Pain magnagement with burns
- Narcotics
- Ketamine
- Neuropathic
Infection management in burns
- Clean with NaCl, chlorhex if contaminated
- Cover with cling film and burn aid
-
Clinical manifestations and ED management of carbon monoxide poisoning
- affinity to heamaglobin 200 times that of o2. Binds to form carboxyhaemoglobin, unable to bind o2, causes tissue hypoxia.
Halflife of 4/24.
Clinical manifestations
- Nausea
- Breathlessness
- Collapse
- Dizziness
- Headache
- Renal impairment
Management
A:? inhalation injury
B: Half life can be changed to 40 minutes with 100% o2 concentration. SpO2 sensor not reliable - assess RR, WOB, skin colour.
C: CCM - potential arrhythmia.
D: GCS probs decreased
E: Look for other injuries - burns, traumatic injuries
Management of superficial, partial thickness, full thickness burns
Superficial
- Burns heal spontaneously by epithelialisation within 2 weeks
Partial thickness / full thickness
- Silver / antibacterial dressing
- ?surgical management
