Burns Flashcards
What is TSS?
Toxic Shock Syndrome (TSS) is an acute, multi-system inflammatory response to an exotoxin mediated bacterial infection. It is a rare but life-threatening condition, with rapid progression to septic
shock and multi-organ failure.
What is the pathophysiology of TSS?
The toxin in S. aureus infections is TSS Toxin-1, or TSST-1. It binds non specifically to MHC class II.
What are the Cole and Shakespeare criteria?
Pyrexia ≥39oC, rash, diarrhoea +/- vomiting, irritability and lymphopenia
How would you examine someone with suspected TSS?
A-E principles
Rashes
Other sources of sepsis
Re-examine burn wounds
How would you treat someone with suspected TSS?
According to protocol designed by White et al, 2005:
Well/unwell child
If unwell, discuss early with PHDU and commence resus
Theatre for dressing changes and evaluation of burn
What are the suggested criteria for referral to specialised burn care services?
All burns ≥2% TBSA in children or ≥3% in adults
All full thickness burns
All circumferential burns
Any burn not healed in 2 weeks
Any burn with suspicion of NAI
How can you classify depth of burns?
Superficial epidermal
Superficial dermal
Deep dermal
Full thickness
Name some red flags for NAI
Explanation for the injury is absent or unsuitable.
The person is not independently mobile.
The injury is on any soft tissue area that would not be expected to come into contact with a hot object in an accident (for example, the backs of hands, soles of feet, buttocks, or back).
The injury is in the shape of an implement (for example, a cigarette or iron from a contact burn).
The injury indicates forced immersion, for example, scalds:
To the buttocks, perineum, and lower limbs.
To limbs in a glove or stocking distribution.
To limbs with a symmetrical distribution.
With sharply delineated borders.
Delayed presentation in seeking medical attention. Note that this may be due to effective first aid measures masking the severity of the injury.
An unrelated adult presenting the child to healthcare services.
Evasive or changing history.
A trigger event such as soiling, enuresis, or minor misbehaviour by the person.
History inconsistent with assessed development.
A lack of parental or carer concern.
A lack of appropriate supervision of a vulnerable person (may indicate neglect).
Failure to engage with healthcare appointments or health promotion programmes (may indicate neglect).
What percentage TBSA is required for initiation of the Parkland formula?
> 20% in adults
10% in children
