Burns Flashcards
Presentation of patient with superficial burn
General
Painful distress
Hypovolemic shock (tachycardia, hypotension, decreased urine output)
Anaemia (MM pale, pallor of nail bed)
Specific
I - erythema, hair follicles, no blisters
P - painful to touch, blanchable
Presentation of patient with superficial partial thickness burns
General
Painful distress
Hypovolemic shock (tachycardia, hypotension, decreased urine output)
Anaemia (MM pale, pallor of nail bed)
Specific
I - erythema, blisters with clear fluid, hair follicles
P - painful, sensation intact, blanchable
Presentation of patient with deep partial thickness burns
General
Minimal pain (varies)
Hypovolemic shock (tachycardia, hypotension, decreased urine output)
Anaemia (MM pale, pallor of nail bed)
Specific
I - mottled appearance, blisters, few intact hair follicles
P - sluggishly blanch, minimal pain with deep pressure
Presentation of patient with full thickness burns
General
Hypovolemic shock (tachycardia, hypotension, decreased urine output)
Anaemia (MM pale, pallor of nail bed)
Specific
I - Leathery, stiff, dry appearance, no hair follicles, thrombosed veins
P - painLESS, non blanchable
Heals in 10 days with no scarring
Superficial partial
7 - 14 days
Heals in 14 days with scarring
Deep partial
14 - 35 days
3 zones of a burn wound
Zone of hyperaemia
Zone of Stasis/oedema
Zone of Coagulation/ischemia
Zone where appropriate early intervention has most profound effect in minimizing injury
Zone of stasis/oedema
Entirely viable, cells recover within 7 d; contributes to systemic consequences seen with major burns
Zone of hyperemia
Explain zone of stasis
Decreased perfusion; microvascular thrombosis of vessels results in progressive tissue necrosis and cellular death in 24-48 hrs without proper treatment
Explain zone of hyperaemia
Vasodilation of blood vessels due to inflammation
Cells entirely viable and recover in 7 days
Burn surface area guides
Wallace rule of 9s (2nd and 3rd degrees burns ONLY)
Patients palm for patchy burns (1%)
Lund Browder chart (<10yrs)
Severe burns criteria
TBSA >20%
3rd degree TBSA > 5%
Inhalation Injury
Burn to face, hands, feet, perineum
Pathophysiology of inhalation injury
Smoke inhalation leading to pulmonary injury
Thermal injury
Chemical injury to alveolar BM with pulmonary oedema
Worse prognosis with these factors
Extremes of age (<3 or >60)
Burn size
Inhalation injury
Associated injuries
Comorbidities
General management for all burns
ATLS guidelines
AB - identify life threatening airway and breathing complications
(INHALATION INJURY AND CO POISONING)
Intubate if suspect inhalation injury
Give 100% oxygen via non re breather face mask for CO poisoning
C - Fluid resuscitation
(IVF if TBSA >15%)
Parklands Formula ( CANNOT use if TBSA > 50%)
=
Insert Foley catheter monitor UO (BP and CVP for further monitoring)
Take off bloods for Hb, BUN, Cr, GXM, ABG, U&E, urinalysis
Aim of general management for burns
Clear mental status
HR < 120
MAP > 70
Urine output =>.5ml/kg/hr (adult)
=>1ml/kg/hr (child)
Specific management of superficial and superficial partial burns
Pain management (WHO step up ladder)
Tetanus (.5ml cc tetanus toxoid)
Curling ulcer prophylaxis - Ranitidine H2antagonist
Cleanse, debride, daily dressing
Topical antibiotics
Nutrition
Hyper metabolism: TBSA > 40% have BMR 2-2.5x predicted
Calories, vitamin C, vitamin A, Ca2+, Zn2+, Fe2+
Prevent contractures: Splinting and physiotherapy
Management of deep partial or full thickness burns
Pain mgt
Tetanus
Stress ulcer prophylaxis
Early wound cleaning, debridement of necrotic tissue
Antimicrobial dressing
Early flap or graft coverage (eyelids, hands, feet, joint flexures)
Nutrition
Hyper metabolism: TBSA > 40% have BMR 2-2.5x predicted
Calories, vitamin C, vitamin A, Ca2+, Zn2+, Fe2+
Prevent contractures: Splinting and physiotherapy
Common infections to deep partial and full thickness burn sites
Day 1-3 gram positive
Day 3-5 gram negative (Pseudomonas aureginosa, Klebsiella, Proteus)
