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Trauma > Burns > Flashcards

Burns Flashcards

1
Q

ANZBA criteria for transfer to a Burns Unit:

A

>10% (adult) >5% (child) TBSA
Special area
- Face
- Hands/feet
- Genitals
- Major joints
Circumferential trunk or limb
Chemical
Electrical
Inhalational

Extremes of age
Pregnant
**Associated major trauma/ significant comorbid*

Non-accidental

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2
Q

3 ways to calculate TBSA:

A

NEVER INCLUDE SUPERFICIAL (erythema) BURNS in calculation

Palmar surface = 1%
–> No good >15% TBSA

Rule of Nines
–> ‘Adult’ and <10yo versions
–> Assumes standard-sized body

Lund-Browder
–> Adult and Paeds

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3
Q

Escharotomy in major burns:

A

OT wherever possible
–> Eschars constrict at 6hours +

Circumferential burn:
- Neck
- Chest
- Limb or digit, with NV compromise

________

Prep (chlorhex or povidone-iodine)
Scalpel +/- diathermy
Down to mid-subcut

*MID AXIAL + longitudinal

Chest: “Roman Breastplate”
–> Ant axillary lines and lower ribcage border

Important areas (superficial stuff)
IN FRONT medial epicondyle (ulnar n.)
BEHIND fibular head (peroneal n.)
BEHIND medial malleolus (long saphenous v and n.)

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4
Q

When is Parkland fluid resuscitation indicated in major burns?

A

20% TBSA adult
10% TBSA child

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5
Q

Fluid of choice in major burns:

A

Crystalloid.

N.saline or Hartmann’s both fine.

Warmed if possible.

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6
Q

Modified Parkland Formula:

A

3-4 mlkg x TBSA% in 24 hours
—> HALF in first 8 hours from time of injury
—> HALF over 16 hours

Target 0.5ml/kg/hr + urine output

Choose 4ml if:
- Inhalation
- High voltage electrical
- Trauma
Children <30kg should get routine maintenance fluids PLUS Parkland!!

Don’t count resus boluses

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7
Q

First aid for burns:

A

20 mins
Cool, clean, running water (up to 3hrs)
—> Second line: immersion, wet towels
Plastic wrap
Tetanus cover
Routine antibiotics not indicated

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8
Q
A

SUPERFICIAL DERMAL

Blistering, sloughing
Brisk refill
Painful +

Remove loose skin
Don’t nec need Plastics

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9
Q
A

MID DERMAL

Variable colour- pale or bright
Refill DELAYED
Less painful

Observe 2-3 days - will deepen +-
Silver dressing/ cream
Don’t nec need Plastics

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10
Q
A

DEEP DERMAL

Variable- usually pale
REFILL ABSENT
Pain minimal/ absent

Silver dressings/ cream
Plastics

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11
Q

Minor burn management:

A

-First aid
-Analgesia
-Clean up
-Wash: N saline or 0.1% chlorhex
Remove blisters if >2.5cm or joints
Remove slough
Shave hair

Dress
—> To maintain moist environment
- If wet: foam, alginate, paraffin gauze
- If dry: silicone
- If mid-dermal and beyond (or contaminated):
—> Silver dressing
—> Daily Flaminal cream (anti microbial)

Elevate area
Simple analgesia
Follow up
—> GP/ Burn clinic at 24-48 hours
—> Plastics at outset if deep-dermal or full

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12
Q

Adult rule of 9s:

A
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13
Q

APPROACH TO SEVERE BURNS:

A

History:
- Time of burn
- Duration of exposure
- ?Enclosed space
- ?Cyanide risk
–>wool, silk, plastics, nylon
- ?Trauma
- First aid
- ADT status

___________________

Management:

A
- Assess for airway burns: drooling, stridor, dysphonia, soot, singeing, neck burns
- Intubation:
–> Avoid sux if >24 hours (K+)
–> Higher-dose roc Eg. 1.5mg/kg

B
- Sit up, 15L 100% via NRB
- Check COHb (cherry red, normal sats)
- Consider cyanide (poor GCS, RAGMA)
- ? need for chest escharotomy
- CXR ?ARDS

C
- Dual access
- Send Xmatch
- Modified Parkland fluids(Nsaline or CSL. Extra maint if <30kg)

D
- Analgesia (ketamine)
- EXPOSE, remove jewellery
- TBSA% calc

Additional:
- Keep WARM
- Invasive monitoring
- IDC and strict fluid balance
- NGT and PPI prophylaxis
- ADT
- Antibiotics only if grossly contaminated
- Referral to Burns centre (criteria)

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14
Q

What is a ‘normal’ COHb level?

A

<2% non smoker
<10% smoker

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15
Q

Diagnostic criteria for carbon monoxide poisoning:

A

COHb > 15%
PLUS
Typical symptoms/signs:
1- Neuro
2- CVS
3- Neuro-psych sequelae (more common chronic exposure)

(Chronic may have normal COHb!)

_______________

10-20%- Vague, non-descript
20-30%- Headache, confusion, weakness, N&V, collapse
50-60% - Coma, arrythmia, myocardial depression + shock, Cheyne-Stokes
70%+ - Death

+ Cherry red is uncommon
+ Long-term neuropsych- more common in chronic exposure
–> Personality, concentration, dementia, psychosis, ataxia, hearing loss, neuropathy

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16
Q

Simple O2 therapy in CO poisoning:

A

CO half life:
Nil = 4 hours
100% O2 = 90mins
HBO = 20mins

Give 100% O2
–> HFNP, NRBM, CPAP
At least 8 hours (24 if pregnant)

17
Q

Indications for HBO in CO poisoning:

A

Controversial!!! (conflicting RCTs)

Incl.
LOC at any time
Pregnant
Neurological signs
Age >50
Metabolic acidosis

18
Q

What MUST be arranged post discharge after CO poisoning?

A

Neuropsychiatric testing at 2 months.

19
Q

Pathophysiology of carbon monoxide:

A

240x greater affinity with Hb (HbF especially!!)

–> Tissue hypoxia (normal sats/ PaO2)
Also triggers inflammatory cascade

Normal CO half life 4 hours
100% O2 –> 40 mins
HBO –> 20 mins

20
Q

What is used to remove tar/ bitumen from skin?

A

Do NOT pull off
Dissolve with oil
–> Vegetable oil
–> Paraffin oil
–> Baby oil

21
Q

General management of a chemical burn:

A

PPE
Decontaminate:
–> Remove garments
–> Remove excess agent: brush away powder, dissolve tar with oil etc.
–> Check everywhere: nails, folds etc.
–> Irrigate
- Water or N.saline
- Check for SYSTEMIC TOXICITY
- *Flurosis,

22
Q

Hydrofluric acid burn:

A

Rust remover
Jewellery/ wheel cleaners

Necrotic burn
Tissue precipitates (fluoride bings Ca/Mg)

SEVERE PAIN out of proportion is typical. Often delayed.

SYSTEMIC FLUOROSIS is life threat:
- HypoCa
- HypoMg
- HyperK
–> ventricular arrhythmia

MANAGEMENT:
Decontaminate- PPE, wash patient, bag clothes.
CALCIUM GLUCONATE

FOR PAIN:
–> Topical: Mix 10ml 10% gluconate with lubricant leave on 4 hours
—> Subcut: infiltrate 10% gluconate
—> Biers: with 10ml 10% in 40ml
—> Intrarterial: with 10ml 10% in 40ml, via art line
Then, NORMAL BURN MANAGEMENT

SYSTEMIC:
–> Systemic fluorosis: IV, until Ca normalised
- 1-6g (100mg/kg kids) IV over 10 mins. Repeat Q5min until ionCa >1.1

+Manage K, Mg, acidosis.

23
Q

Paediatric rule of 9s:

A

Under 10yo

  • Head is double (18%)
  • Legs are 14% (not 18)
    —> Buttocks are 5% of this

Trauma (13 decks)

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