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GMED5002 > Burns > Flashcards

Burns Flashcards

1
Q

Function of the skin

A
  • Protect from infection
  • Senses (pain, touch, temp)
  • Fluid control
  • Temp regulation
  • Insulation from trauma
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2
Q

Electrical burns

A
  • Electrical contact with the skin (live electrical currents, lightning)
  • Low voltage (damage only to point of contact and damage depends on exposure time)
  • High voltage (damage runs full course and usually results in subdermal damage)
  • Greatest heat at points of resistance (entrance and exit, dry skin, muscle & bone) & greatest damage with smaller points of contact
  • Results in vascular & nervous damage, immobilisation of muscle
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3
Q

Chemical burns

A

Skin exposure to a corrosive substance
Acids: forms thick insoluble mass upon contact & causes coagulative necrosis that limits burn damage
Alkalis: destroys tissue by liquefactive necrosis therefore deeper penetration

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4
Q

Radiation burn

A

From transmission of radiation energy (nuclear, UV, visible, heat, sound, XR)

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5
Q

Thermal burns

A

Exposure to heat > 40C that causes protein coagulation and thrombosis (flames, scalds (liquids), vapours, contact)
* Flame most common in adults & result in the most deaths (many die from asphyxiation or CO poisoning before treatment)
* Scalds most common in children

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6
Q

Inhalation injury

A

Associated with thermal burns from fires
* Inhalation of toxic substances (cyanide, hydrogen sulfide)
* CO poisoning from burning carbon products (binds Hb and prevents O2 binding)
* Airway burn (upper airway structures absorb heat from steam and prevent damage to lower airway) - singed facial hair, black sputum, airway obstruction, stridor

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7
Q

Jackons theory of thermal wounds

A

Zone of coagulation: maximum damage, necrotic/dead tissue, clotted blood & thrombosed vessels
Zone of stasis: hypoperfused tissue at risk of ischemia
Zone of hyperemia: hyperperfused tissue, most salvagable

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8
Q

Superficial/1st degree

A
  • Epidermal damage only e.g. sunburn
  • Red, tender, pain, no blistering
  • Heals within a few days, no scarring
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9
Q

Superficial partial/2nd degree

A
  • Epidermis and superficial dermis damage
  • Red, very painful, blisters
  • Heal spontaneously within a few weeks without scarring
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10
Q

Deep partial/2nd degree

A
  • Epidermis and deep dermis damage
  • White/blotchy, less painful, no blisters
  • Heal after 3-4 weeks and may scar depending on time taken for re-epithelialisation
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11
Q

Full thickness/3rd degree

A
  • Entire dermis & subdermal tissue
  • White/brown/black, eschar, lethery
  • Do not heal spontaneously and may require surgical debridement and skin grafts, scarring will happen
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12
Q

Systemic pathophysiology

A

TBSA > 30% = systemic inflammatory response
* Inflammatory mediators lead to increased vascular permeability, causing fluid to shift into interstitial space
* Peripheral vasodilation also occurs
* These both cause major fluid loss, hypovolemia, decreased perfusion
* Perfusion is worsened by release of catecholamines, vasopressin and angiotensin which causes vasoconstriction of arteries supplying organs
* Respiratory distress from bronchospasms, pulmonary oedema & inhalation injury
* Hypothermia from disturbed thermoregulation, evaporative water loss from burned skin, cooling during treatment and cold resus fluids
* Inflammatory mediators and E imbalances from fluid shifts cause cardiac dysfunction & decreased contractility

Hypermetabolic phase
* surge of catecholamines, cortisol, glucocorticoids
* Increased metabolism, CO, HR, O2 requirements
* Insulin resistance & glucose production
* Protein breakdown & skeletal muscle wastage
* Immunosuppression & delayed wound healing
*

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13
Q

Clinical manifestations

A
  • Pain
  • Local damage (blisters etc)
  • Burnt hair, black sputum
  • Dyspnoea, hoarseness, wheezing/stridor
  • Peripheral oedema
  • Oliguria/AKI
  • Reduced LOC
  • Signs of hypovolemia (HoTN, tachy then brady)
  • Arrythmia, chest pain
  • Hypothermia
  • Infection (local, pneumonia, UTI, sepsis)
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14
Q

TBSA Assessment

A

Wallaces rule of 9 (adults): divides sections into 9% for head, 9% each arm, 18% chest, 18% back, 18% each leg, 1% genitalia, 1% palms

Lund & browder (paeds): allows for changes in proportion in children e.g. head is proportionately larger & legs smaller (chart for each age)

NB: superficial burns not included

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15
Q

Patient Assessment

A

Airway: assess patency, signs of inhalation injury (burnt hair, sputum, stridor, inflammation), assess need to O2 tx & intubation

Breathing: full respiratory assessment, consider escharotomy for circumferential burns to allow chest expansion

Circulation: monitor HR & rhythm (ECG), BP (SBP >90, MAP > 65mmHg), SaO2, CRT, IV access & IDC insertion, commence fluid therapy, tranfusion if needed

Disability: GCS, NVO (circumferential burns compromise circulation/compartment syndrome), DVT prophylaxis, IV analgesia

Exposure: remove non-adherent clothing, assess for other injuries, estimate TBSA, wound care

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16
Q

Treatment

A
  • Airway patency (intubation)
  • Oxygenation
  • Fluid resuscitation & IDC insertion
  • Wound care & surgical debridement
  • Analgesia
  • Nutritional therapy - NGT: to aspirate fluid & air to prevent aspiration, nutritional feeding early to diminish hypermetabolic response & prevent bacterial translocation from gut (sepsis)
  • Electrolyte management
17
Q

Fluid resuscitation

A

Parkland formula: 4ml x TBSA x weight (kg) = 1/2 over 8 hours, 1/2 over 16
* Crystalloids (CSL) or colloids (albumin, gelofusin)
* Strict monitoring of UO to 0.5-0.5ml/kg/h to assess for signs of over resusciation and respiratory collapse

Primary purpose is to restore circulating blood volume lost during fluid shifts, in order to maintain organ and tissue perfusion

18
Q

Escharotomy

A
  • Circumferential burns increase interstitial pressure and compromise circulation & cause ischemia & compartment syndrome
  • Indicated when there is a loss of doppler pulses & NV despite elevation & fluid resus
  • Escharotomy is the surgical incision through burnt skin to release oedematous tissue & pressure, restoring circulation
19
Q

Silver nitrate/Acticoat

A
  • Very popular cream/dressing used in burns that are contaminated, infected, deep or full thickness, minor burns with large surface area
  • Broad spectrum antibacterial activity by disrupting bacterial components (DNA) and metabolism, killing microorganisms
  • Acticoat is lined with a soluble silver film that maintains silver ions in a wound for up to 5 days (kills bacteria & allows for less dressing changes)
  • Can cause allergies and skin irritation
20
Q

Complication - infection

A
  • Common in wounds with coagulated proteins and microbial nutrients
  • S&S: spreading erythema, warmth, tender, slough, deepening, purulence, discoloration, fever

Treatment: swab for culture, PO antibiotics that cover staph aureus & strep pyogenes, possibly surgical excision, topical AB (if not invasive infection), systemic AB if confirmed infection & sensitivities

Prevention: regular wound assessment (colour, odour, exudate), aseptic technique, debridement, antimicrobial dressings

21
Q

Complication - Contractures

A
  • Burn scar matures, thickens and tightens, preventing full range of movement
  • Mediated by myofibroblasts that full wound edges together, however in excess this can cause contractures

Prevention
* Splits on the joint to keep it straight
* PT involvement to provide ROM exercises to keep limbs flexible
* Encourage early movement and independence

22
Q

Vancomycin

A

Route: IV, PO
Class: glycopeptide AB
Mechanism: inhibits cell wall synthesis of gram+ bacteria including MRSA
Effect: eliminates systemic infection from the body, improves wound healing
Half-life: 6 hours
SE: abdominal pain, diarrhoea, dizziness, blurred vision, flushing, bloating

23
Q

Oxycodone IR (oxynorm)

A

Route: PO
Class: opioid agonist
Mechanism: binds to opioid receptors (mu, but also k & d) which produces an analgesic and sedative effect
Effect: analgesia from moderate to severe pain
Half-life: 3h
SE: constipation, cramps, drowsiness, resp depression, euphoria, chills/sweats

GMED5002 (9 decks)

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