Burns Flashcards
Name 6 cardiovascular complications of burns
- Increased capillary permeability (fluids-protein loses)
- vasoconstriction
- decreased myocardial contractility - TNFA
- systemic hypotension, organ hypoperfusion
- organ damage
- sepsis- leading to multiple organ failure
Name 4 respiratory complications of burns
. Bronchoconstriction (histamine) . Ards • effects of inhalation injury . Co toxicity Pneumonitis
Name 3 metabolic complications of burns
• Increased metabolic rate, 3-4x normal • catabolism (sepsis, non healing) • disruption gut integrity (sepsis) Renal failure Curling ulcers
Name 2 immunologic complications of burns
• Down regulation of both humoral and cell mediated responses → immunosupression
• inflammation
Infection
State depth, sensation, heal time, and appearance of superficial thickness burns
- Epidermis only
- pink/red, dry, small blisters , non-blanching
- Heal in 5-10 days without scar. Can give moisturizer
- very painful
State depth, sensation, heal time, and appearance of superficial partial thickness burns
- Superficial dermis
- Red, blistering, wet,
- extremely painful
- heal in 3 weeks without need skin graft
Most serious complication acid Burns?
Coagulative necrosis
Most serious complication alkaline burns?
Liquefactive necrosis
State depth, sensation, heal time, and appearance of deep partial thickness burns
• Deep dermis
. Minimally painful
. Yellow, white, dry leathery, blanching (ischaemia) and Petechiae appearance
•Heal in 3-8 weeks with scarring. Always need skin graft
Name 3 occult complications of electrical injuries
- Acute renal failure
- cardiac arrhythmia
- compartment syndrome
Classify the burn in picture 30
Superficial burn
Classify the burn in picture 31
Superficial partial thickness burn
Classify the burn in picture 32
See picture 33
Classify the burn in picture 34
Deep partial thickness burn
Classify the burn in picture 35
Full thickness
What is considered a minor burn in adults and children in terms of TBSA?
Adults <15%
Children <10%
What is considered a moderate burn in adults and children in terms of TBSA?
Adults 15-25%
Children 10-15%
What is considered a severe burn in adults and children in terms of TBSA?
Adults > 25%
Children > 15%
Describe the rule of nines for burns
See picture 36
Name 7 criteria for admission for burns
- Severe and moderate burns
- facial
- hands
- genitals
- electrical
- chemical
- inhalation
- extremes of age
- Full thickness
- circumferential burns
Which surgical procedure should be done after burns to enable chest expansion?
Escarotomy
Definitive management of burns (2)
- Sloughectomy and temporary wound coverage
* skin graft once wound granulated
Name the 3 local effects of burns
• Coagulation - worsen hyperaemia (inflamm)
• stasis -worsen both
. Hyperaemia - worsen coag
Treatment Co toxicity?
High concentration oxygen
Appropriate way to position shoulder joint following burn injury?
Abduction
Appropriate way to position mp joint following burn injury?
Flexion
Appropriate way to position neck joint following burn injury?
Extension
Appropriate way to position wrist joint following burn injury?
Extension
Appropriate way to position thumb joint following burn injury?
Abduction
Which 2 signs are most indicative of inhalation burns?
Stridor and sternal retraction during ventilation
Which type electrical burns have best prognoses?
Flash burns
Treatment electrical burns?
- Initial debridement
- decompression fasciotomy
- aggressive planned debridement and early skin coverage
Name 3 late complications electrical injuries
- Delayed cardiac arrhythmia - uncommon
- complex regional pain syndrome
- cataracts
Management burns? (3)
• atls
- airway; if inhalation burn suspected, intubate. Progressive swelling may occur and make intubation difficult.
- breathing: escharotomy to enable chest expansion
-Circulation: parkland formula
. Definitive = sloughectomy and temporary wound coverage.
• skin graft once wound granulated
Describe the parkland formula for burns.
•4ml x % TBSA according to rule of nines x body mass
• 50% in first 8 hours from time of burn. So if present late, give all fluid
• 50% in last 16 hours
Isotonic ringers lactate = fluid of choice. (do blood gas to confirm no hyperkaelemia - in that case saline)
Physiology and complications of burns? (5)
• Direct coagulation of microvasculature with extension of injury
• large area skin exposed with secondary infection and activation vasoactive substance → systemic inflammatory response.
• this causes capillary permeability with leakage fluids and interstitial oedema.
• cardiac output reduced and low metabolic rate.
. After full resuscitation, hyper metabolism and increased cardiac output. Here nutritional support should be considered (initially diabetic diet, then high protein. Nb vitamin c)
Name 5 signs inhalation burns
- Singing nasal hair and eyebrows
- carbonaceous sputum
- closed environment
- burns to face
- voice change- hoarse
