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Trauma Course > Burns > Flashcards

Burns Flashcards

1
Q

What is a frequent method of assault in adults and is a method of child abuse?

A

Burning

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2
Q

Approximately how many burns are there each year, what percentage will require hospitalisation and what percentage of that will be life-threatening?

A

250,000 per year, 10% hospitalised, 10% life threatening

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3
Q

When assessing the patient with severe burns what should be followed and why may specific consideration have to be taken?

A

<C>ABCDE, considerations have to be made due to the mechanisms of injuries commonly associated with severe burns
</C>

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4
Q

What are the 3 zones that are used to describe the local response to burns?

A
  • zone of necrosis/zone of coagulation
  • zone of stasis
  • zone of hyperaemia/inflammation
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5
Q

What is the model used to describe the 3 zones of a burn?

A

Jackson’s Burn Wound Model

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6
Q

What is the zone of necrosis/zone of coagulation?

A

The area which is closest to the heat source

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7
Q

What happens at the zone of stasis?

A

Next to the necrotic/coagulation zone
Damage is less severe but circulation is compromised
If left untreated it will go necrotic in 3-5 days

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8
Q

What happens in the zone of hyperaemia/inflammations?

A

Inflammatory mediators are produced which causes dilation of the blood vessels

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9
Q

What happens at a cellular level when a patients gets burnt?

A

Changes in capillary exchange caused by inflammatory mediators released by damaged endothelial cells, platelets and leucocytes

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10
Q

Why does a burns patients get oedema?

A

Vasodilation causes stretching of the capillary wall, increasing capillary membrane surface area and opening spaces between endothelial cells as well as pooling of blood in the small veins. There is an increase in permeability of the capillary membrane, allowing mass movement of albumin out of the circulation and into the interstitial space

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11
Q

What does a 20% or over TBSA burn cause?

A

Release of the inflammatory mediators and neural stimulations

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12
Q

Why does a burns patient get hypovolaemia?

A

Due to protein and fluid loss into the interstitial space

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13
Q

What does the release of the stress hormones cortisol, catecholamines and glucagon cause in a burns patient?

A

A hyper metabolic state which causes muscle protein breakdown and the patient will become tachycardia and hyperthermic

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14
Q

What is the leading cause of death in burns patients?

A

Infection - their immune system is suppressed

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15
Q

Why is it important that burns patients should be started on entrap nutrition early?

A

To prevent bacterial translocations because the gut is impaired due to reaction of the injury and shock

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16
Q

Even if a burns patients has not had an inhalation injury, because of the inflammatory response what might occur?

A

ARDS

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17
Q

What are some of the long term changes that can occur as a result of a burn?

A

Decreased muscle growth
Decreased bone mineralisation
Increased central deposition of fat

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18
Q

Why do inhalation injuries increase mortality in all burns patients?

A

Due to burns to the respiratory tract and the potential toxic systemic effects of smoke

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19
Q

What % of patients with burns to the face have an inhalation injury?

A

45%

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20
Q

What are inhalation injuries organised into?

A
  • airway injury above the larynx
  • airway injury below the larynx
  • systemic intoxication injuries
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21
Q

What type of patients can have an element of all 3 inhalation injuries?

A

Severe inhalation injury patients

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22
Q

What are airway injuries above the larynx caused by?

A

Thermal burns caused by the inhalation of hot gases - the same mechanism of injury occurs as thermal injury to the skin

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23
Q

What can lead to airway obstruction for burns patients?

A

Oedema

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24
Q

Why is a burn to the skin of the neck more likely in children to aggravate airway obstruction by producing neck oedema?

A

They have narrow airways and short necks which can easily be distorted with oedema

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25
Q

What are airway injuries below the larynx caused by?

A

The inhalation of products of combustion

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26
Q

What do fires cause?

A

Oxidation and reduction of a multitude of compounds which produces noxious substances such as carbon monoxide, cyanide and complex organic compounds

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27
Q

What do acids and alkalise produced when compounds from products of combustion combine with respiratory mucous and tissue fluids?

A

A chemical burn

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28
Q

What can cause lower airways to become plugged with debris, causing distal airway obstruction?

A

Particles of soot that are aerosolised which damage the alveoli and cause the production of inflammatory mediators which results in oedema and possible shedding of tracheobronchial mucosa

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29
Q

What is most commonly caused by carbon monoxide and cyanide?

A

Systemic intoxication injury

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30
Q

What happens when carbon monoxide combines with haemaglobin?

A

It reduced the oxygen carrying capacity causing tissue hypoxia

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31
Q

Why should all patients with suspected carbon monoxide poisoning be treated with high flow oxygen?

A

It reduces the half life of carboxyhaemoglobin to 40 mins

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32
Q

How do patients with CO poisoning present?

A

Confused, with similar symptoms to those with head trauma, hypoxia and alcohol intoxication

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33
Q

How does cyanide poisoning occur?

A

Burning plastics, it is rapidly absorbed by the lungs and binds with the cytochrome system

34
Q

What are symptoms of cyanide poisoning?

A

Loss of consciousness
Neurotoxicity
Convulsions

35
Q

What is the antidote for cyanides poisoning?

A

Cyanokit or hydroxocobalamin

36
Q

For all burns, what should you aim to exclude?

A

An inhalation injury

37
Q

What should you have all inhalation injuries?

A

Low threshold for intubation and a minimum of high flow oxygen

38
Q

What do you use calculate the total body surface area of an adult patients?

A

The rule of 9s

39
Q

What do you use to calculate the total body surface area of paediatric burns patients?

A

Lund & Browder method

40
Q

What % TBSA is classed as a large burn?

A

20% and over

41
Q

What % is a large burn for a paediatric patient?

A

10%

42
Q

Why is there a lower threshold for % of burns for paediatric patients compared to adults?

A

They have a greater surface area to mass ratio

43
Q

What else do paediatric burns patients require as well as calculated volume of fluids?

A

Background maintenance fluids

44
Q

How do you calculate the Parkland Formula and give the fluids?

A

4ml crystalloid x kg x TBSA %
Half is given in first 8 hours from time of injury , other half to be given over 16 hours

45
Q

How do you works out paediatric maintenance fluids for a burn?

A

100 ml/kg up to 10kg
50ml/kg from 10-20kg
20ml/kg over 20kg

Give over 24 hours

46
Q

What is the expected hourly urine output for adult patients?

A

0.5mls/kg/hr

47
Q

What is the expected hourly urine output for paeds patients?

A

1-1.5 ml/kg

48
Q

What do burn patients need to be observed for?

A

Rhabdomyolysis

49
Q

What are the 7 functions of the skin?

A

Aesthetic & psychological interface
Temperature regulation
Immune response
Protection from bacteria
Control of fluid loss
Metabolic function

50
Q

What is the aim for burn wound management?

A

Minimise the interference both locally and systemically

51
Q

Why should a burn be stopped then cooled?

A

To reduce the production of cytokines and promote viability in the zone of stasis, therefore preventing progression of damage

52
Q

Should ice and iced water be used to treat a burn?

A

No, they cause vasoconstriction which can deepen the tissue injury as well as cause hypothermia

53
Q

Why do you cover a burn with cling film?

A

To prevent heat loss, bacterial invasion, pain and so that the burn can be observed

54
Q

What is an escharotomy?

A

Process of surgically incising burned skin down to the subcutaneous fat

55
Q

What are the indications for an esharotomy?

A

Circumferential burns to the chest
Constructive circumferential neck burns
Circumferential burns of the extremities causing compartment syndrome

56
Q

What are the following objective signs that can aid the decision making to do an escharotomy as well as the indications?

A

Doppler - absence of arterial flow/regressive reduction in flow
Compartmental pressures - >40 mmHg
Pulse oximetry - sats of < 95% in circumferentially burned extremity

57
Q

How are escharotomy performed?

A

With a scalpel or diathermy
If patient not intubated, use local anaesthetic where incision will extend into normal skin - the remaining burnt tissue is likely to be innervated due to depth of the burn
Cut from healthy skin to healthy skin

58
Q

As there can be sever blood loss during an escharotomy, what should you have ready?

A

Celox gauze, alginate dressing and artery forceps

59
Q

Why do you need to de-neutralise a chemical burn?

A

Chemical agents continue to cause progressive damage until it is inactivated

60
Q

How do deactivate a chemical burn?

A

A neutralising agent or diluted with enough water

61
Q

What is the systemic affect of oxalic, hydrofluoric acid and phosphorus burns?

A

Hypocalcaemia

62
Q

What is the systemic affect of tannic, Formic & picric acid, phosphorus injury and petrol

A

Liver and/or kidney damage

63
Q

What is the systemic affect of strong acids or ammonia?

A

Inhalation injuries

64
Q

What is the systemic affect of Cresol?

A

Methemoglobinemia and massive haemolysis

65
Q

What is the systemic affect of chromic acid?

A

Perforation nasal septum

66
Q

What is Diphoterine solution?

A

Hypertonic solution that can effectively prevent the corrosive or irritant action of acids, alkalis, oxidising agents, reducing agents and solvents

67
Q

What are the 3 main function of Diphoterine?

A
  • removal of chemical from the surface of the tissue
  • absorption and encapsulation of the aggressive chemical molecule remaining on the tissue surface
  • attraction, absorption and encapsulation of the aggressive chemical molecule already penetrating the tissue
68
Q

What are the 3 groups that electrical burns are divided into?

A
  • low voltage (below 1000 volts)
  • high voltage (over 1000 volts)
  • lightening strikes (high voltage)
69
Q

What can low voltage burns cause?

A

Significant contact wounds (entrance and exit wounds)
Cardiac arrest
No other deep tissue damage

70
Q

What can high voltage burns cause?

A

Flash burns and current transmission - causing cutaneous and deep tissue damage and internal organ damage. The deep tissue damage can cause compartment syndrome in the limbs and require fasciotomies. These patients need to be observed for rhabdomyolysis

71
Q

What do lightening strikes cause?

A

Direct strike is fatal
Side strike - lightening has bounced from an object onto them on the ground - significant exit wounds on their feet, ruptured tympanic membranes, corneal damage

72
Q

What is heat generation from an electrical injury a function of?

A

Resistance of the tissue
Duration of contact
The square of the current

73
Q

What makes skin resistance variable?

A

Thick and calloused
Wet or dry

74
Q

What is the Joule effect?

A

When electricity conducted through the bone may cause substantial rise in temp which will continue after the current flow has stopped therefore causing secondary thermal damage

75
Q

What do patients require that have had electrical burns?

A

Serial ECGs or continual ECG monitoring as an inpatient

76
Q

When would you suspect your patient has a suspect inhalation injury when assessing the airway of a burns patient?

A

Respiratory distress
Voice changes
Signs of upper airway oedema
Deep facial burns
Sooty sputum
History of burn in enclosed space

77
Q

What should you remove from a burns patient?

A

Hydrogel burn dressing
Loose clothing, jewellery, nappies close to the burn - leave any adherent clothing

78
Q

What affected areas of the body should be considered for a referral to a specialist burns centre?

A

Face, hands, genitals, feet, joints, scalp, ears and any circumferential burns

79
Q

What size burns should be referred to a specialist burns centre?

A

> 1% TSBA in children
3% TBSA in adults

80
Q

What patients should be discussed with specialist burns units?

A

Neonates (<28 days old)
Suspected non accidental injury, mental health history or self harm
Progressive non burn skin loss conditions
Significant co-morbidity or immunocompromised patients
Friction burns with full thickness skin loss
Cold burns with full thickness skin loss
Older patient (+60)
Children unwell with a burn

81
Q

What are the symptoms of Burns Sepsis syndrome/ toxic shock syndrome?

A

Temp > 38 degrees
Rash
Diarrhoea and vomiting
General malaise
Not eating or drinking
Tachycardia/tachypnoea
Hypotension
Reduced urine output

Trauma Course (17 decks)

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