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Y5 ED > Burns > Flashcards

Burns Flashcards

1
Q

What is the definition of a burn ?

A

A type of injury to the skin or other tissues which are mostly preventable.

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2
Q

What can cause a thermal burn ?

A

Flames
Scalds from hot liquid
Contact burns from hot objects

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3
Q

What can cause a chemical burn ?

A

Acids and alkalis found in household chemical products.

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4
Q

Why is it important to treat chemical burns immediately ?

A

They will continue to burn the skin until completely removed.

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5
Q

Why are chemical burns deep ?

A

Chemical products can cause deep burns through coagulative and liquefactive necrosis.

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6
Q

How do electrical burns occur ?

A

As an electrical current runs through the body it creates an entry and exit point damaging tissue along its path as it is converted from electrical to thermal energy.

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7
Q

How do cold exposure burns occur ?

A

These are caused by ice crystals which can form both intracellularly and extracellularly. The subsequent fluid and electrical fluxes cause cell membrane lysis and cell death and a damaging inflammatory process is set up.

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8
Q

How do radiation burns occur ?

A

Radio frequency energy or ionising radiation causes tissue damage.

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9
Q

What is the most common burn in adults ?

A

Flame injuries

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10
Q

What is the most common burn in children ?

A

Scalds

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11
Q

What layer of skin is affected in a first degree burn ?

A

Epidermis

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12
Q

How does a first degree burn present ?

A

Pain, erythema and slight swelling, no blisters
No scarring
Pain resolves in 48-72 hours

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13
Q

What are the differences between superficial to deep second degree burns ?

A

Superificial - entire epidermis and variable dermis
Deep - few dermal appendages left, fluid and metabolic effects

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14
Q

How do second degree burns present ?

A

Vesicles and blisters
Extremely painful due to exposed nerve endings
Heals within 7-14 days without infection

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15
Q

What layers of the skin are affected in a third degree burn ?

A

Entire epidermis and dermis, no residual epidermis

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16
Q

How does a third degree burn present ?

A

Painless, extensive fluid and metabolic deficits

17
Q

How is a third degree burn managed ?

A

Heals only by wound contraction by skin grafting or coverage by a skin flap

18
Q

What groups of people are high risk for burns ?

A

Children
Older adults
Alcoholics
Epileptics
Chronic psychiatric conditions
Low socioeconomic status

19
Q

In children and vulnerable adults what is important to exclude in burns ?

A

Non-accidental injuries

20
Q

What are the 3 major mechanisms that put the airway at risk in burns ?

A
  • generalised oedema as a systemic response from an increasing burn size and depth can cause swelling of the airway and compromise airflow.
  • localised oedema as a result of direct thermal damage to the airway can obstruct airflow.
  • inhalation injury as a result of heat, smoke or toxic chemicals can damage the airways
21
Q

What are some factors that increase the risk of airway obstruction or inhalation injury ?

A

Hoarse voice
Respiratory distress
Carbonaceous sputum
Singed nasal or facial hair
Inflamed oropharynx
Burns to the face/oropharynx
History of burns in an enclosed space
Raised CO on a blood gas

22
Q

What is the management if a burns patient has airway obstruction ?

A

Sit patient upright
Senior anaesthetic review
If indicated early intubation with an uncut tube to prevent the tube moving in the event of further swelling

23
Q

What are some reasons why gas exchange can be compromised in a burns patient ?

A
  • Direct damage from inhalation injury to lower airways and gas exchange surfaces
  • CO can quickly build up impairing oxygen carrying capacity.
  • burnt tissue with significant loss of elasticity causes constriction and when over the the chest/ torso/ neck impairs chest expansion can therefore has subsequent ventilation issues.
24
Q

What is the management of breathing difficulties in a burns patient ?

A

High flow O2
Immediate discussion with burns centre if restriction of chest movement
Suspected inhalation injury may warrant intubation

25
Q

What is important to identify in a burns patient with difficulty breathing ?

A

Rising CO level
Poor ventilation

26
Q

What is a escharotomy ?

A

A life saving procedure that relieves restriction of movement and allows chest expansion.
Removal of constricting tissue

27
Q

What can be common in burns patients with difficulty breathing ?

A

Cyanide poisoning due to exposure to burnt household items.
Consider early administration of cyanokit.

28
Q

What is the management in regards to circulatory issues in a burns patient ?

A

Immediate IV access and fluid resus
Blood tests ( CK is important as assess muscle breakdown )

29
Q

If there is any deterioration in circulation to a limb what could this indicate in a burns patient ?

A

Ischaemia
Compartment syndrome

30
Q

If there is any deterioration in circulation to a limb in a burns patient what management should be performed ?

A

Immediate discussion with a burns centre
Urgent escharotomy or fasciotomy

31
Q

What are burns patients physiologically susceptible to ?

A

Patients with burns are physiologically vulnerable to getting cold so it’s critical to keep them warm and minimise fluid loss.

32
Q

At what TBSA should fluid resus be given ?

A

Adults - over 15%
Children - over 10%

33
Q

What are some common ways to estimate the percentage of the total body surface area in a burns patient ?

A

Lund and Browder charts
Rule of 9’s

34
Q

What is the most frequently used method to calculate fluid resus in a burns patient ?

A

Parkland formula - 2-4ml x weight (kg) x %TBSA

35
Q

What fluid choice is optimal in burns patients ?

A

Warm balances crystalloid such as Hartmann’s solution

36
Q

What is the management of burn wounds ?

A

Remove - loose clothing and jewellery

Irrigate and cool thermal wounds ( run under water for 20 mins )
Irrigate chemicals from skin/eyes immediately by running under warm water for at least 15 mins

Clean the wound with normal saline and cover any skin loss with clingfilm
Cover chemical burns with non-adherent dressing

Tetanus status should be considered

37
Q

What extra factors should be considered in electrical burns ?

A

Increased risk of compartment syndrome
Renal failure
Perform an ECG

38
Q

What is the criteria for a referral to a specialist burns centre ?

A
  • All burns over 2% TBSA in children and 3% TBSA in adults
  • all full thickness burns
  • all circumferential burns
  • any burns that dont heal within 2 weeks
  • non - accidental burns ( should be seen in 24 hours )

Y5 ED (5 decks)

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