Burns Flashcards
Factors which influence the severity of a burn
• Cause of burn
• Duration of exposure
• Anatomical site
• Size of involved area
• Use of early first aid cooling
Types of burn
Thermal
Chemical
Electrical
Friction
Radiation
High voltage electrical shock can lead to:
- Extensive deep tissue damage
- Compartment syndrome
- Myonecrosis
- Rhabdomyolosis
- Renal failure
High voltage vs low voltage
Low = <1000volts (usually domestic)
High = >1000volts (usually industrial)
Lightning = up to 300 million volts
Which electrical current is more likely to cause cardiac arrhythmias, Alternating or direct?
Alternating
Do acids or alkalines cause deep tissue burns?
Alkalines
In relation to electrical burns and electric shock, what is arcing?
Arcing occurs when electrical current jumps between two objects without a direct connection. This can result in a flash injury without electrical current passing through the individual.
What are the classifications of burn depth?
1) Superficial
2) Partial thickness/Dermal - Partial dermal
- Deep dermal
3) Full thickness
Characteristics of a superficial burn
Erythema/Redness
Painful
Characteristics of a superficial dermal burn
Blisters
Painful
Pink
Blanching
Characteristics of a deep dermal burn
Blisters
Sensation reduced
Prolonged CRT
Blotchy pink/red
Characteristics of a full thickness burn
Charred black or leathery white
‘Woody’ feel
Insensitive to light touch
Non-blanching
Water temperature for cooling a burn
Ideally between 8 - 15 degrees Celsius.
(Cool to dissipate the heat but not ice cold which could vasoconstriction and deepen the burn)
Signs of inhalation burn injury
- Burns to face/neck
- Swelling to mouth/oropharynx
- Soot in nose or mouth
- Singed nasal hair
- Cough with black sputum
- Hoarse voice or stridor
- Wheeze on auscultation
- Dyspnoea and hypoxia
Parkland formula
3ml x Patient weight (kg) x TBSA (%)
- This gives the total amount to be given in a 24 hour period
- First half of this to be given in the first 8 hours
- Second half to be given in the following 16 hours.
Carbon Monoxide (CO) has an affinity how many times more than oxygen to haemoglobin
240 times
Antidote for Cyanide poisoning
Hydroxycobalamin (Cyanokit)
Dicobalt editate
Half-life of CO
Breathing Air - 320 minutes
This can be reduced to 80 minutes breathing 100% oxygen
Escharotomy
- For Circumferential full thickness burns where there is restricted ventilation or vascular compromise.
Burns referrals - Burns unit criteria for Adults
≥10%<40%
or
≥10%<25% with inhalation injury
Burns referrals - Burns unit criteria for paediatrics
≥5% <30%
≥5% <15% if under 1 year old
Burns referrals - Burns centre criteria for adults
> 40% TBSA
or
25% TBSA with inhalation injury
Burns referrals - Burns centre criteria for paediatrics
> 30%TBSA
15% TBSA in under 1
20% TBSA if full thickness
Burns centre vs Burns unit
Burn Centres – This level of in-patient burn care is for the highest level of injury complexity and offers a separately staffed, geographically discrete ward. The service is skilled to the highest level of critical care and has immediate operating theatre access.
Burn Units – This level of in-patient care is for the moderate level of injury complexity and offers a separately staffed, discrete ward.
Where would an adult with 35% TBSA burns go?
Burns Unit
Burns unit criteria for adults:
≥10%<40%
or
≥10%<25% with inhalation injury
Where would an adult with 30% TBSA burns and inhalation injury go?
Burns Centre
Burns Centre criteria for adults:
>40% TBSA
or
>25% TBSA with inhalation injury
Where would a 2 year old with 10% TBSA burns go?
Burns unit
(Burns unit criteria for peads:
≥5% <30%
≥5% <15% if under 1 year old)
Where would a 4 year old with 18% TBSA burns go?
Burns unit
(Burns unit criteria for peads:
≥5% <30%
≥5% <15% if under 1 year old)
Where would a 5 year old with 25% full thickness TBSA burns go?
Burns Centre
Burns centre criteria for paeds:
> 30%TBSA
> 15% TBSA in under 1
> 20% TBSA if full thickness
Treatment of chemical burn
Irrigate copiously
amphoteric irrigating agent if possible such as Diphoterine
Do not wrap in cling film
Definition of major burns in Adults
> 20% TBSA
Clinical features correlating with the need for early intubation in burns
Full thickness facial burns
Stridor
Respiratory distress
Swelling on laryngoscopy
Smoke inhalation
Singed nasal hairs
Carbon monoxide severe poisoning
> 30%
Optimal duration of burn cooling
20 mins
Optimal water temp for burn cooling
12oC
Optimal Flow rate of water for burn cooling
1-1.5 l/min
Burn cooling effective up to _____ hours after injury
3
Which burn type should we not apply cling film?
Chemical
Which type of burns should irrigation be continued for as long as practicably possible?
Chemical
In burns greater than ___% fluid resuscitation should be started pre-hospitally for both adults and children
20%
Which drugs should not be administered for analgesia in burns patients requiring fluid administration?
NSAIDS
Indications for hydroxycobalamin
Smoke inhalation with altered mental status or cardiovascular instability
Intubation of a burns patient
Uncut tube
Largest tube possible
Avoid tie around the neck/face
Normal CO levels in non-smokers, smokers and heavy smokers
Non-smokers = <3%
Smokers = <5%
Heavy smokers = <9%
