Burns Flashcards
types of burns
thermal
contact
chemical
electrical
what is inhalation injury
Damage to airways: stridor, hoarse voice, respiratory compromise
Secondary to inhalation of hot air
Intubation needed
Other features: singed nasal fairs, facial burns, soot deposits around nose
Nasoendoscopy: erythema or oedema of airway on direct visualisation
definition of major burn
A major burn is any burn with >20% TBSA (>10% in children) of partial or full-thickness burns (i.e. not including superficial burns).
Major burns can result in profound inflammatory responses and large fluid shifts occurring, and aggressive fluid resuscitation is often required to mitigate burn shock.
initial burns assessment
Assessment in warmed room
Giving warmed fluids
Reducing wound exposure time
Secondary survey
airway burns
Inhalation injury: burn above vocal cords
Pre-emptive intubation may be required if suspected or high-risk
Protect c spine
signs of inhalation injury
History of flame burns or burns in an enclosed space
Full thickness burns
Singed nasal hair
Carbonaceous sputum
Change in voice, with hoarseness or harsh cough
Stridor, tachypnoea, or dyspnoea
Erythema or swelling of oropharynx on direct visualisation
breathing in burns
100% oxygen via non-rebreather mask
Evaluate need for escharotomy
Obtain ACG and check carboxyhaemoglobin levels
circulation in burns
Two wide bore iv cannulas
IV fluid therapy
Insertion of urinary catheter
disability in burns
Evaluate neurological status
GCS
Temperature check, increased risk of hypothermia
exposure in burns
Body surface area percentage
Ensure patient is given tetanus booster
history of burns
mechanism
timings
injury
injury history of burns
Liquid
Solute in liquid
Voltage
Flash or arcing
Contact time
Chemical
Non accidental?
mechanism history of burns
Type of burn agent: scald, flame, electrical, chemical
How did it come into contact with patient
What first aid was performed
What treatment has been started
Risk of concomitant injuries
Risk of inhalation injuries
timings history of burns
When did the injury occur
How long was patient exposed to energy source
How long was cooling applied
When was fluid resuscitation started
assessing burn severity
Severity of burn: percentage total body surface area burned and burn depth
Initial fluid volume requirements
Wallace’s Rule of Nines: head + neck = 9%, each arm = 9%, each anterior part of leg = 9%, each posterior part of leg = 9%, anterior chest = 9%, posterior chest = 9%, anterior abdomen = 9%, posterior abdomen = 9%
Lund and Browder chart: the most accurate method
the palmar surface is roughly equivalent to 1% of total body surface area (TBSA). Not accurate for burns > 15% TBSA
superficial (first degree burn)
epidermis
dry, blanching, erythema
painful
heals without scarring, 5-10 days
superficial partial thickness (second degree)
upper dermis
blisters, wet, blanching, erythema
painful
heals without scarring, <3 weeks
deep partial thickness (second degree)
lower dermis
yellow or white, dry, non-blanching
decreased sensation
heals in 3-8 weeks, likely to scar if healing >3 weeks
full thickness (third degree)
subcutaneous tissue
leathery or waxy white, non-blanching, dry
painless
heals by contraction, >8 weeks, will scar
management of minor burns
First aid
Remove non-adherent clothing
Put wound under running water
initial management of burns
initial first aid as above
review referral criteria to ensure can be managed in primary care
superficial epidermal: symptomatic relief - analgesia, emollients etc
superficial dermal: cleanse wound, leave blister intact, non-adherent dressing, avoid topical creams, review in 24 hours
Early intubation
fluid resuscitation in burns
Limit hypovolaemia
Minimise tissue ischaemia in the immediate post-burn periods
Fluids are calculated from time of burn
Modified parkland formua: volume of crystalloid fluid (Hartmans)
50% of callculated volume given within first 8 hours post-burn, and the remaining 50% is given in the remaining 16 hours
escharotomies management in burns
Indicated in circumferential full thickness burns to the torso or limbs.
Careful division of the encasing band of burn tissue will potentially improve ventilation (if the burn involves the torso), or relieve compartment syndrome and oedema (where a limb is involved)
goal-directed therapy in burns management
The goal of fluid resuscitation is achieving adequate end-organ perfusion.
Due to the systemic inflammation seen in burns patients, conventional markers of fluid balance are not always feasible.
Urine output can be monitored closely as the main marker of fluid balance status, which should be maintained (in adults) at >0.5mL/kg/hr.
Other measures include use of mean arterial pressures (MAPs) and blood gas measurements.
referral to secondary care in burns
all deep dermal and full-thickness burns.
superficial dermal burns of more than 3% TBSA in adults, or more than 2% TBSA in children
superficial dermal burns involving the face, hands, feet, perineum, genitalia, or any flexure, or circumferential burns of the limbs, torso, or neck
any inhalation injury
any electrical or chemical burn injury
suspicion of non-accidental injury
ongoing care management of burns
Depending on the injuries involved, patients with burns may require transfer to either a burns unit or a burns centre (see Appendix):
Burn Units are facilities that have a specialised burns ward staffed by skilled burns professionals, capable of caring for moderate level of injury complexity.
Burn Centres represent the highest level of inpatient burn care, with immediate operating theatre access and highly-skilled critical care staff, for the management of highly complex burn injuries.
complications of burns
Airway compromise
Airway oedema from smoke inhalation
Respiratory failure
Fluid loss and electrolyte imbalance
Hypothermia
Compartment syndrome
complications of penetrating injuries burns
tension pneumothoraces
lung contusions
alveolar trauma
ARDS
complications of smoke inhalation in burns
Bronchospasm, inflammation and bronchorrhea
Ateletcasis or pneumonia
Non-invasive management: nebulisers and positive pressure ventilation
complications of carboxyhaemoglobin in burns
Carbon monoxide
Hyperbaric therapy
