BURNS Flashcards
What is the first thing to do when a child is burn
- Wash the wound with cold running water to cool it down to prevent further thermal injury for 20-30min
Use thermal or burn shield
What is the criteria for burn Unit referral
- Partial thickness burns >10%TBSA
- Burns involving face, hands, feet, genitalia, perineum or major joints
- Third degree burns
- Electrical burns including lighting
- Chemical burns
- Inhalation burns
- Burn injury in patients with existing medical conditions that could complicate management, prolong recovery or mortality.
- Any patient with burn injury and concomminent trauma eg fracture, inwhich burn injury poses the greater risk of morbidity or mortality
- Burnt child in hospitals with no qualified personnel or equipment for the care
- Burn injury in patients who will require special social, emotional or longterm rehab intervention.
What are the main functions of the skin
Mechanical barrier (pathogens, trauma)
Thermoregulation (Hypothermia)
Prevents fluid loss (shock)
Cosmesis (scarring)
Excretory
Immunological
Sensory
Vitamin D synthesis
What causes a high incidence of burns in SA
Education and safety
Lack of infrastructure
SES
What is the difference between Wallaces Rule of Nines and Lund&Boders estimation of %TBSA
Lund&Bowders allows adjusments for the patients age
It is more accurate
How do large burns lead to shock?
Inflammatory mediators and cytokines overwhelm the local microenvironment, resulting in systemic effects
-Generalised Oedema
-Raised Haematocrit
-VAsodilatation
-Cardiac dysfunction
burnt shock !
What fluids would you give in a patient presenting with serious burns
Three components
-Bolus for the shocked patient 10-20ml/kg
-Ongoung Rescusc according to TBSA Parkland
-Maintainance (4/2/1 rule with colories): 4ml/kg/h for first 10kg, 2ml/kg/h for next 10kg then 1ml/kg/hr for every kg >20
1st 24 hours: 4ml/kg of isotonic/crystaloids/plasmalyte B per % of TBSA
(1/2 of this for first 8hours then 1/2 in next 16hour)
2nd 24 hours: 2ml/kg per %TBSA over 24 hours
-Aim for 1mg/kg/hr urine output (2mg/kg/hr in myoglobinuria and add NaHCO3 and mannitol)
-Give NG tubes if <30 %TBSA or Nasojejunal if >30% TBSA
-Give 0.5% NaCl &5 % dextrose
What is the criteria for IV rescuscitation in burnt patients
=/>15% TBSA in adults
=/>10% TBSA in children
What is the Parkland formula
4ml/kg/%TBSA crystalloid in the 1st 24hours
-Half in 1st 8hours from time of injury
-Half in next 16 hours
2ml/kg/%TBSA in the next 24 hours
adjusted according to end points of resuscitation
When do you stop fluid rescuscitation (end points of rescusc)
Urine output 0.5-1 ml/kg/hr
Normalising lactate
Continue rescusc if the above hasnt been achieved and there has been numerous invasive measures of limitted usefullness.
Under which circumstances do you overresuscitate the patient
Inhalation injury: massive surface area of lung results in massive fluid shiftt. Add 2ml/kg/TBSA to parklands
Myoglobinuria: Toxic injury and mechanical obstruction of renal nephrons. Aim for 2ml/kg/hr urine output to flush out kidneys
Give the classifications of burns/ what type of burns are there
Superficial/First degree
-Most cases of sunburn, erythemous and very painful
-Doesnt blister
-Peels off 3-4 days and replaced by healed skin
-No need for TBSA
Superficial Partial thickness/Second degree
- Extends into papillary dermis
-blistering
-wet, pink and hypersensitive to touch, very painful
-blanches with pressure
-usually heals within 3 weeks without scarring
Deep partial thickness/ Second degree
-Extends into the reticular dermis
-molted pink and white
-may have areas of hemorrhage
-discomfort and pressure, rather than pain
blanches with pressure but slow capillary refill time
takes longer to heal, often causes scarring.
Full thickness burns/ Third degree
-Extends through entire dermis and into subcutaneous tissue
-Charred or leathery
-No pain
-Does not blanch
-Will not heal
Fourth degree
-Often seen in non-fatal injuries
-Involvement of deeper structures
-Extends through fascia.
-High voltage electrical injuries may have significant deep injuries that are not initially apparent
what is the pathophysiology of burn wound
3 zones - Jackson 1957
Central necrotic zone (non viable tissue=Coagulation)
Stasis zone (maximum oedema around burn=Ischemia)
Hyperaemia (Inflammation occurs here, zone that always survives
When do you do an Escharotomy and when do you do an Ischiotomy
Escharotomy is for circumferential deep chest wounds and deep limb wounds
What is the likely causes of burns in patients trapped in burning buildings with drop in GCS
CO/Cyanide poisoning
