Burns Flashcards
What is the pathophysiology of burns and the different types
- A burn occurs as a result of excess heat effecting the body
- when the body cannot dissipate the heat then it causes burns
What are the immediate complications of a burn
- the depth of burns can increase over the first 48 hours
- hypovolaemia from fluid loss
- increased fluid requirements
What are the long term complications of a burn
- infection
- scarring
Describe the Jackson Burn Wound Model
- Hyperaemia
- Stasis
- Coagulation
Explain the Wallace rule of nines
- Head 9%
- Torso 18% front and 18% back
- Arm 9% each
- Leg 18% each
- Groin 1%
What is the burns calculation formula for adults?
> 15 years with TBSA > 15%
% TBSA x weight (kg) = vol (ml)
administer over 2 hours since time of burn
What is the burns calculation for paeds 12-15?
12 - 15 yo with TBSA >10%
3 x TBSA % x weight (kg) = vol (ml)
Give over 24 hours from time of burn
Administer half of the volume in the first 8 hours
Recite the Burns CPG
How do you assess for airway burns?
- facial and upper airway oedema
- sooty sputum
- burns to upper torse, neck and face
- burns that occured in an enclosed space
- singed facial hair
- Respiratory distress +/- wheeze and associated tachycardia, stridor
- Hypoxia (restlessness, irritability, cyanosis, decreased GCS)
What is the epidermis and what is it made up of?
- the epidermis is the outermost layer of skin
- it is made up of two different types of cells - squamous and basal cells
What is the dermis and what does it contain?
- the layer of skin below the epidermis
- it contains blood and lymphatic vessels, sebaceous and sweat glands - which are responsible for maintaining the moisture and temperature of the skin
How do you assess the severity of a burn injury?
- the depth
- the cause of the burn
- the TBSA %
- the location of the burn
- the age of the patient
- patients underlying health
- other injuries
What are the three different types of burns?
- superficial
- partial thickness (superficial, mid, deep dermal)
- full thickness
What are the three different types of burns?
- superficial
- partial thickness (superficial, mid, deep dermal)
- full thickness
Describe the zone of stasis
- partial thickness
- tissue directly surrounding the burn that is hypo perfused. This may be salvageable with appropriate treatment
Describe the zone of coagulation
- Full thickness
- irreversible damage to cell and coagulation of proteins
What are first degree burns
- Superficial
- Involve the epidermis layer. causing erythema and is painful. This is often caused by sunburn or exposure to moderately hot liquids or radiant heat
- There is no interruption to normal blood flow and healing usually occurs within a few days
- painful up to 72 hours
What are second degree burns?
- Partial thickness
- Can be described as superficial, mid or deep dermal
Superficial (dermal)
- involves the epidermis and upper dermis
- it is characterised by erythema and increased blood flow
- it will blister after some hours and is very painful
- usually takes 2 weeks to heal if uncomplicated
Mid dermal
- involve the epidermis and some of the dermal layer
- results in blotchy red and pink skin with extensive blisters and may be very painful
- there are areas of viable and non viable tissue
- appropriate care can have a large impact on saving viable tissue
Deep dermal
- large blisters from early and usually break within hours causing fluid to leak out
- characterised by decreased capillary return
- usually takes longer than 2-3 weeks to heal and will cause permanent scarring
- large area of tissue is unviable
Describe third degree burns
- full thickness
- epidermis, dermis and possibly the subcutaneous and muscle and bone
- these are generally charred and black, or waxy looking
- they can be painless
- decreased/absent blood flow
- they will not heal without intervention
- excision and skin grafting is required
What are the mechanism of burn injury?
- Scald - contact with a hot liquid
- Contact burns - contact with a hot object e.g. touching a heater
- Chemical burns - contact with skin or ingestion of a chemical (acid/base)
- Radiation burn - contact with radiant heat e.g. sunburn
- Electrical burns - contact with a source of electrical energy e.g. lightening strike
What are the complications of airway burns?
- oedema leading to airway compromise
- may not occur until 12-18 hours post injury
- fluid therapy increases oedema
What are the complications of airway burns?
- oedema leading to airway compromise
- may not occur until 12-18 hours post injury
- fluid therapy increases oedema
What is the surgical intervention for burns called and what does it do?
- Escharotomy
- releases pressure
What are some important factors about electrical burns?
- they can be more severe than they appear
- they will often have entry and exit points
- These patients are at risk of compartment syndrome and cardiac arrythmias
What are circumferential burns?
- burns to the chest, limb or abdomen
- act.as a tourniquet resulting in impeded distal blood flow or impeded respiratory function
- decreases blood flow can result in ischaemia
- Surgical intervention (escharotomy) is required
What are circumferential burns?
- burns to the chest, limb or abdomen
- act.as a tourniquet resulting in impeded distal blood flow or impeded respiratory function
- decreases blood flow can result in ischaemia
- Surgical intervention (escharotomy) is required
When assessing the size of the burn, what burns do we consider in our calculation?
- only partial and full thickness burns
When assessing the size of the burn, what burns do we consider in our calculation?
- only partial and full thickness burns
What is another method of calculating TBSA
- Palmar method
- patients palm = 1%
How do you calculate TBSA for peads?
e.g. older they get head goes down 1% and legs go up by 0.5% until 9yo
What is the management provided by the paramedics for burns?
- rest and reassurance
- cooling the burn if possible (20 mins running water) beware of hypothermia
- analgesia
- consider MICA
- apply clin wrap longitudally
- fluid replacement
- notify recieving hospital
Which patients require a specialised burn service? e.g. the alfred
- Burns >10% total body surface area (TBSA)
- Full thickness burns >5% TBSA
- Circumferential burns
- Burns to special areas (hands, feet, genitalia, major joints).
- Pre-existing medical conditions that may impair recovery.
- Burns to the very old or very young
- Burns associated with trauma
- Non-accidental burns
- Burns with an associated inhalation injury
- Chemical burns
- Electrical burns
