Burns

Question 1

What are the localized effect of burns

Answer 1

Pain
Vaporization
Increased capillary permeability with loss of albumin into interstitial spaces
Loss of fluid and electrolytes into ISS and environment
Loss of heat due to conduction and evaporation
Loss of protective skin barrier

Question 2

What are the systemic effects of burns?

Answer 2

Hypovolemia
Hypermeability of capillaries (vasodilatation, release of inflamm mediators)
Heat induced (60 degs C) denatured of collagen Fibre
….in interstitial, causes extravasation of fluid
Hypermetabolic state (release of stress hormones)…glucagon, cortisol, catecholamines
Suppression of insulin, growth hormones and anabolic steriods
Immune response to.nurns (infilt of tissue with WBC)…(deficiency of neutrophils may cause fatal infections)
Loss of GIT barrier function
Stress ulceration…curling ulcer
Bonearrow suppression
Widespread whole body changes

Question 3

Explain Jackson’s burn wound model

Answer 3

The burn wound in 3 zones
1. Zone of coagulation (central area. Nonviable tissue)
2. Zone of stasis (surrounding central.area, initial blood flow, subseq. 24hr hypertension and ischemia occurs)
3. Zone of hyperemia (surrounding the Zone of stasis, viable tissue)

Question 4

Tike surface temp threshholds

Answer 4

70 deg c…<1sec
60 degs c…5 secs
50 deg c…2-3 mins
45 degs C…5 hours

Question 5

Wallace’s rule of 9s initial assessment

Answer 5

Adult
18% front and back
9% arms
18% legs
9% head
1% groin

Baby
18% head
9% arms…each
18% front and back
14% each leg

Question 6

Wallace’s rule of 9s initial assessment

Answer 6

18% front and back
9% arms
18% legs
9% head
1% groin

Question 7

Lund & Browder chart
Secondary assessment for resuscitation

Question 8

Fluid resuscitation

Answer 8

Time calculated from time of burn injury and burn extent
Fluid resus adequacy, measured nu urine output
Lactate ringers is most like normal extracellular.fluid and is fluid of choice
If NaCl given to burn patient then potential for Metabolic acidosis

Question 9

Why is fluid containing dextrose NOT given?

Answer 9

Doesn’t contain electrolytes
Large amounts of adrenaline in bloodstream may make thr patients glucose INTOLERANT
BGL will increase causing urine output to increase and resus won’t be efficient

Question 10

Fluid resus and kidney perfusion

Answer 10

If kidneys perfume patient will make enough urine
If patient doesn’t make enough urine they will not be getting enough fluid
….may need iv rate turned up
DO NOT.GIVE DOURETICS
Electrical.burn patients may have myoglobin in urine..Will.need DOUBLE THE YRINE to flush out these large myoglobin cells from kidneys
You can’t just calculate fluid resus by the burn size
If urine dark increase rate of iv fluids…maintain output of 110mL/hour

Question 11

Parkland formula

Answer 11

4ml X TBSA (%) x body weight
●50% given 1st 8 hrs
●50% given nxt 16 hrs

Question 12

Superficial burns
Epidermis, nerve endings exposed

Answer 12

Signs
Pink, blisters.amd moisture, cap refill present, hair present
Healing time <14 days
Very painful

Question 13

Partial thickness
Secondary degree
Supercial partial thickness - top of dermis
Deep dermal - deeper layers, hair falls, sweat gland poss

Answer 13

Mottled red or white
Blisters soft
Cap refill sluggish or absent
Sensation…absent or distant
Few hairs present
Healing >21 days
May req skin grafts

Question 14

Full thickness
Hyperthermia…adipose
Through nerve endings, b/S cooagulated

Answer 14

White, tan, French, black
Dry and leathery
Cap refill absent
Sensation absent
No hairs
Healing time by 2nd intention