Burns Flashcards
What patients should be discussed with specialist burns units?
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 witn full thickness skin lOss
Cold burns with full thickness skin loss
Older patient (+60)
Children unwell with a burn
What size burns should be referred to a specialist burns centre?
> 1% TSBA in children
3% TBSA in adults
What affected areas of the body should be considered for a referral to a specialist burns centre?
Face, hands, genitals, feet, joints, scalp, ears and any circumferential burns
What should you remove from a burns patient?
Hydrogel burn dressing
Loose clothing, jewellery, nappies close to the burn - leave any adherent clothing
When would you suspect your patient has a suspect inhalation injury when assessing the airway of a burns patient?
Respiratory distress
Voice changes
Signs of upper airway oedema
Deep facial burns
Sooty sputum
History of burn in enclosed space
What do patients require that have had electrical burns?
Serial ECGs or continual ECG monitoring as an inpatient
What do lightening strikes
cause?
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
What can high voltage burns cause?
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
What can low voltage burns cause?
Significant contact wounds (entrance and exit wounds)
Cardiac arrest
No other deep tissue damage
What are the 3 groups that electrical burns are divided into?
Low voltage (below 1000 volts)
High voltage (over 1000 volts)
Lightening strikes (high voltage)
What are the 3 main function of Diphoterine?
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
What is Diphoterine solution?
Hypertonic solution that can effectively prevent the corrosive or irritant action of acids, alkalis, oxidising agents, reducing agents and solvents
What is the systemic affect of strong acids or ammonia?
Inhalation iniuries
How do deactivate a chemical burn?
A neutralising agent or diluted with enough water
Why do you need to de-neutralise a chemical burn?
Chemical agents continue to cause progressive damage until it is inactivated
As there can be sever blood loss during an escharotomy, what should you have ready?
Celox gauze, alginate dressing and artery forceps
What are the following objective signs that can aid the decision making to do an escharotomy as well as the indications?
Doppler - absence of arterial flow/regressive reduction in flow
Compartmental pressures - >40 mmHg
Pulse oximetry - sats of < 95% in circumferentially burned extremity
What are the indications for an esharotomy?
Circumferential burns to the chest
Constructive circumferential neck burns
Circumferential burns of the extremities causing compartment syndrome
What is an escharotomy?
Process of surgically incising burned skin down to the subcutaneous fat
Why do you cover a burn with cling film?
To prevent heat loss, bacterial invasion, pain and so that the burn can be observed
Should ice and iced water be used to treat a burn?
No, they cause vasoconstriction which can deepen the tissue injury as well as cause hypothermia
Why should a burn be stopped then cooled?
To reduce the production of cytokines and promote viability in the zone of stasis, therefore preventing progression of damage
What is the aim for burn wound management?
Minimise the interference both locally and systemically
What do burn patients need to be observed for?
Rhabdomyolysis
What is the expected hourly urine output for paeds patients?
1-1.5 ml/kg
What is the expected hourly urine output for adult patients?
0.5mls/kg/hr
How do you works out paediatric maintenance fluids for a burn?
100 ml/kg up to 10kg
50ml/kg from 10-20kg
20ml/kg over 20kg
Give over 24 hours
How do you calculate the Parkland Formula and give the fluids?
4ml crystalloid x kg × TBSA %
Half is given in first 8 hours from time of injury, other half to be given over 16 hours
What else do paediatric burns patients require as well as calculated volume of fluids?
Background maintenance fluids
Why is there a lower threshold for % of burns for paediatric patients compared to adults?
They have a greater surface area to mass ratio
What % is a large burn for a paediatric patient?
10%
What % TBSA is classed as a large burn?
20% and over
What do you use to calculate the total body surface area of paediatric burns patients?
Lund & Browder method
What do you use calculate the total body surface area of an adult patients?
The rule of 9s
Mercy Burns app
What should you have all inhalation injuries?
Low threshold for intubation and a minimum of high flow oxygen
For all burns, what should you aim to exclude?
An inhalation injury
What is the antidote for cyanides poisoning?
Cyanokit or
hydroxocobalamin
What are symptoms of cyanide poisoning?
Loss of consciousness
Neurotoxicity
Convulsions
How do patients with CO poisoning present?
Confused, with similar symptoms to those with head trauma, hypoxia and alcohol intoxication
Why should all patients with suspected carbon monoxide poisoning be treated with high flow oxygen?
It reduces the half life of carboxyhaemoglobin to 40 mins
What happens when carbon monoxide combines with haemaglobin?
It reduced the oxygen carrying capacity causing tissue hypoxia
What is most commonly caused by carbon monoxide and cyanide?
Systemic intoxication injury
What do acids and alkalise produced when compounds from products of combustion combine with respiratory mucous and tissue fluids?
A chemical burn
What can lead to airway obstruction for burns patients?
Oedema
What are inhalation injuries organised into?
Airway injury above the larynx
Airway injury below the larynx
Systemic intoxication injuries
When assessing the patient with severe burns what should be followed and why may specific consideration have to be taken?
<C>ABCDE, considerations have to be made due to the mechanisms of injuries commonly associated with severe burns
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What is the model used to describe the 3 zones of a burn?
Jackson’s Burn Wound Model
Why does a burns patients get oedema?
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
Why does a burns patient get hypovolaemia?
Due to protein and fluid loss into the interstitial space
What is the leading cause of death in burns patients?
Infection - their immune system is suppressed
What are inhalation injuries organised into?
Airway injury above the larynx
Airway injury below the larynx
Systemic intoxication injuries
What is TRIPS?
Multi-system referral for burns
