BURNS Flashcards by Maddie YEAR 3 & 4

Most common type of burn in adults?

Thermal burns - flames

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Most common type of burn in children?

Thermal burns - scalds

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Types of burns?

Thermal
Chemical
Electrical
Cold exposure
Radiation

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Why do chemical burns often cause severe deep dermal burns?

Because the tissue continues to be damaged until the chemical is completely removed

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What voltage of electrical burn is usually fatal?

> 70,000 V

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What can cause radiation burns?

Sunburn
Radiotherapy

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What are considered complex burns?

All chemical and electrical burns
Any thermal burn affecting a critical area (burns to the face, hands, feet, perineum, or genitalia; burns crossing joints; and circumferential burns).
• Any thermal burn covering more than 15% of the TBSA in adults or more than 10% in children (more than 5% in children younger than one year of age).
• Deep partial-thickness burn >1% TBSA

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What % of TBSA has to be affected by burns to cause systemic efefcts?

20-30%

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What is the model for burns?

Jacksons burn model: three zones of a burn
Zone of coagulation - point of maximum damage so irreversible tissue necrosis here due to coagulation of proteins
Zone of stasis - decreased tissue perfusion and potentially salvageable if burn is managed correctly
Zone of hyperaemia - tissue perfusion increased and is likely reversible

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Outline the systemic response to burns?

Release of cytokines and other inflammatory mediators at the site of injury will have a systemic effect once the burn reaches 30% TBSA
• Cardiovascular changes: capillary permeability is increased, peripheral/sphlanchnic vasoconstriction and decreased myocardial contractility = coupled with fluid loss causes systemic hypotension and end-organ hypoperfusion
• Respiratory changes: bronchoconstriction. ARDS in severe burns
• Metabolic changes: basal metabolic rate increases
• Immunological changes: down regulation of immune response

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Complications of burns?

Respiratory distress
Poisoning from noxious gases
Hypovolaemic shock from fluid loss
Hypothermia
Wound infections
Sepsis
TSS - mostly in children
Cardiac arrhythmias
Vascular insufficiency, distal ischaemia or compartment syndrome
AKI
Limb loss
Curlings ulcer
Chronic neuropathic pain and itch
Cars and contractures
Psychosocial and sleep disorders
DeathS

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What causes TSS secondary to a burn and how does it present?

A burn is colonised by group A strep or staph aureus

Fever, rash, diarrhoea, irritability, poor feeding, tachycardia, tachpnoea 2-4 days post-injury

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Which burns are most likely to cause cardiac arrhythmias?

Electrical burns - V fib
Chemical burns - from the electrolyte disturbances

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What is a curlings ulcer

When the burn causes ischaemia to the gastric mucosa leading to an ulcer

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Prognosis of burns?

Superficial epidermal - heal within 7 days conservatively + no scars
Superficial dermal - 14 days conservative + no scars
Deep dermal - may need surgery + some scars and contractures
Full thickness - needs surgical intervention + significant scars and contractures

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3 mechanisms for how burns affect the airway?

Generalised oedema as a systemic response can swell airway and compromise airflow
Localised oedema from direct damage to airway
Inhalation injury

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Symptoms that increase suspicion of airway obstruction or inhalation injury after a burn?

• Hoarseness of voice
• Resp distress or stridor -> an indication for immediate intubation!!
• Facial burns
• Singeing of nasal or facial hairs
• Inflamed oropharynx
• Carbon deposits
• Carbonaceous sputum
• Explosion with burns to head or torso
• History or burns in an enclosed space
• Raised CO levels
• Impaired conscious level

How can burns affect breathing/gas exchange?

Gas exchange surfaces and lower airway damage
CO buildup
Eschar - burnt tissue with loss of elasticity around chest reducing expansion

What % TBSA is usually afefcted to cause circulatory shock?

15% in adults
10% in children

What do you worry about with circumferential limb burns?

Compromise blood flow distally and compartment syndrome

How do we calculate fluids after a burn?

Parkland formula

What is the parkland formula?

4mls x %burn x weight (kg) - in 24 hours
Give half in the first 8 hours and the rest in the next 16 hours

What is an escharotomy?

Careful division of burnt tissue to improve ventilation or relieve compartment syndrome

What is an AMPLE history?

The history you take once you have stabilised the pt

Allergies
Meds
PMHx and tetanus status
Last meal
Events - get a better history

Characteristics of superficial burns (epidermal)?

Painful Bleeds Brisk blanching Red skin

Characteristics of superficial dermal burns?

Very painful Bleeds Slow blanching Pale pink Glistening Blisters

Characteristics of deep dermal burns?

Dull pain Delayed bleeding No blanching Cherry red appearance No blisters

Characteristics of full thickness burns?

No pain No bleeding No sensation No blanching Dry/white/leathery skin

What is a way to differentiate between epidermal and superficial dermal burns?

Nikolsky’s sign - robbing the skin will remove the superficial layer of the skin in superficial dermal burns

Ways to assess the burn area?

Lund and Browder charts Rule of 9s Mersey burns app Using pt palm as 1% TBSA

Whats the most accurate way to assess a burns area?

Lund and Browder charts - because its age matched

Why are alkali burns more serious than acid burns?

As alkali burns cause liquification necrosis whereas acid burns cause coagulative necrosis which acts as a barrier to further burning

Why type of burn can cement cause?

Acid burns as it contains lime

What are the issues with electrical burns?

Often much worse than they first look! Will have an input and an output point They cause deep muscle necrosis and myoglobin release Often cause compartment syndrome so have a high level of suspicion Can cause renal failure

Management of minor burns?

1. Stop the burning - irrigate for 20 minutes, remove loose clothing and jewellery 2. Analgesia 3. Clean wound ans cover 4. Assess size and depth 5. Consider NAI in children 6. Tetanus status 7. Consider the site of burn

What indicates NAI for burns?

• History not consistent • Pt not independantly mobile • Injury is on any soft tissue area that would not be expected to come into contact with a hot object in an accident • Injury the shape of an implement • Lines of demarcation indicating forced immersion - donut sparing, glove & stocking • No splash marks • Sparing of flexor creases - suggests child was in the foetal position when burnt • Circumferential burns • Delayed presentation • Lack of parental concern • Signs of restraint on upper limbs

When should you refer to a specialist burns centre?

• All burns ≥2% TBSA in children or ≥3% TBSA in adults • All full thickness burns • All circumferential burns • Any burn not healed in 2 weeks • Any burn with suspicion of non-accidental injury should be referred to a burn unit/centre for expert assessment within 24 hours Consider… • Any burns to hand, face, feet, perineum or genitalia • Any chemical, electrical burn • Any cold injury • An unwell or febrile child with a burn • Any concerns regarding burn injuries and co-morbidities that may affect treatment or healing or burn

Campaigns for burns?

SafeTea - reducing hot drink scalds on young children and improving first aid National Burn Awareness day from Children’s Burn Trust Skcin - Sun safety and skin cancer prevention

What advice can you give pt and carers of young children to avoid burns at home?

keeping your child out of the kitchen whenever possible testing the temperature of bath water using your elbow before you put your baby or toddler in the bath keeping matches, lighters and lit candles out of young children's sight and reach keeping hot drinks well away from young children

A-E assessment for burns?

A - look for factors that increase suspicion of airway obstruction or inhalation injury. C-spine immobilisation due to high risk from type of injury B - RR, sats, resp exam, ABG, give oxygen C - HR, CRT, BP, Temp, IV access, bloods, ECG Urinary catheter, Give fluids D - AVPU, BMI, pupils, analgesia E - document burns, cover burns, keep pt warm, look for other injuries