Burns Flashcards
Initial mx of burns caused by heat?
1) remove person from sauce
2) irrigate burn with cool (not iced) water for 10-30 mins
3) cover burn using clingfilm (layered, rather than wrapped around a limb)
What rule can be used to assess the extent of a burn?
Wallace’s rule of nines
Describe Wallace’s rule of nines
1) Head + neck = 9%
2) Each arm = 9%
3) Each anterior part of leg = 9%
4) Each posterior part of leg = 9%
5) Anterior chest = 9%
6) Posterior chest = 9%
7) Anterior abdomen = 9%
8) Posterior abdomen = 9%
What is the most accurate method of assessing the extent of a burn?
Lund and Browder chart
What % of total body surface area is the palmar surface roughly equivalent to?
1% (not accurate for burns >15% TBSA)
Depth of burns used to be referred to as first, second & third degree.
What terminology is used now?
1) superficial epidermal
2) partial thickness (superficial dermal)
3) partial thickness (full dermal)
4) full thickness
Appearance of a superficial epidermal burn
Red and painful, dry, no blisters
Appearance of a partial thickness (superficial dermal) burn
Pale pink, painful, blistered.
Slow CRT
Appearance of a partial thickness (deep dermal) burn?
Typically white but may have patches of non-blanching erythema.
Reduced sensation, painful to deep pressure
Appearance of a full thickness burn?
White (‘waxy’)/brown (‘leathery’)/black in colour, no blisters, no pain
What depth burns require referral to 2ary care?
All deep dermal & full thickness burns
What TBSA burns require referral to 2ary care?
> 3% TBSA in adults
> 2% TBSA in children
What burns require referral to 2ary care?
1) all deep dermal and full-thickness burns.
2) superficial dermal burns of more than 3% TBSA in adults, or more than 2% TBSA in children
3) superficial dermal burns involving the face, hands, feet, perineum, genitalia, or any flexure, or circumferential burns of the limbs, torso, or neck
4) any inhalation injury
5) any electrical or chemical burn injury
6) suspicion of non-accidental injury
Mx of superficial epidermal burn?
symptomatic relief - analgesia, emollients etc
Mx of superficial dermal burn?
cleanse wound, leave blister intact, non-adherent dressing, avoid topical creams, review in 24 hours
What is a common cause of death following major burns?
Sepsis
What should you consider if a patient has sustained burns in an enclosed space?
Smoke inhalation injury
What is ‘eschar’?
A collection of tight and leathery dead tissue caused by deep partial or full thickness burns.
What can a complication of eschar be?
When a constrictive eschar forms around the circumference of a limb it may constrict distal circulation causing limb ischaemia.
If eschar forms around the chest it may prevent adequate chest expansion and cause respiratory distress.
What type of shock can burns cause?
Hypovolaemic shock
Describe pain levels in different depths of burns?
Superficial epidermis - painful
Superficial dermal - painful
Deep dermmal - reduced sensation
Full thickness - painless
Cause of hypovolaemia in burns?
In the first 8 to 12 hours after a burn, fluid rapidly shifts from the intravascular to interstitial fluid compartments, meaning that hypovolaemia can quickly occur if fluid resuscitation is inadequate.
When should early intubation be considered in a burn?
If deep burns to the face or neck, blisters or oedema of the oropharynx, stridor etc
What burn % of TBSA indicates fluid resus in:
a) children
b) adults
a) ≥10%
b) ≥15%
What formula is used to calculate the patient’s additional fluid requirement after a burn? (i.e. after clinical hypovolaemic shock has been corrected)
Parkland formula
What is the Parkland formula?
Initial crystalloid fluid requirement for the first 24h:
4ml x body weight (kg) x TBSA (%)
Describe how fluid is given in burns
1) Give the first 50% of the total calculated volume over the first 8 hours since the time of the burn (not the time of hospital arrival or assessment).
2) Give the remaining 50% of the volume over the following 16 hours.5
Should burn patients be catheterised?
Yes - closely monitor & maintain urine output >0.5ml/kg/hr in adults and around 1ml/kg/hour in children
Is there evidence to support the use of anti microbial prophylaxis or topical antibiotics in burn patients?
No
When is an escharotomy indicated?
Indicated in circumferential full thickness burns to the torso or limbs.
Careful division of the encasing band of burn tissue will potentially improve ventilation (if the burn involves the torso), or relieve compartment syndrome and oedema (where a limb is involved)
What is the main aim of fluid resus in burns?
To prevent the burn deepening
Most fluid is lost 24h after injury
How long do superficial and superficial partial-thickness burns usually take to heal?
3 weeks
What are some systemic complications of burns?
1) Acute lung injury: forms secondary to burns and smoke inhalation and can progress to ARDS
2) Rhabdomyolysis
3) Dehydration & shock
4) AKI: may result from SIRS, hypovolaemia, and rhabdomyolysis
5) Electrolyte imbalances: may be caused by third space losses and kidney injury
6) Hypothermia: may be secondary to large volumes of cool fluids being administered.
7) Paralytic ileus
8) Curling’s ulcer
What is Curling’s ulcer?
Forms when significant hypovolaemia from severe burns causes ischaemia of the gastric mucosa.
This creates a gastric ulcer which may lead to gastrointestinal bleeding or perforation.
What can reduce the risk of a Curling’s ulcer forming?
Starting patients on PPI therapy at admission
What are some local complications of burns?
1) Scarring
2) Contractures: abnormal contraction or stiffening of the muscles may reduce the range of motion and ability to move joints.
3) Circumferential eschars
4) Infection
What is an escharotomy?
where a scalpel incision is made down to the level of the subcutaneous fat but not into the muscle or fascia.
