Burns Flashcards
What is the definition of a burn ?
A type of injury to the skin or other tissues which are mostly preventable.
What can cause a thermal burn ?
Flames
Scalds from hot liquid
Contact burns from hot objects
What can cause a chemical burn ?
Acids and alkalis found in household chemical products.
Why is it important to treat chemical burns immediately ?
They will continue to burn the skin until completely removed.
Why are chemical burns deep ?
Chemical products can cause deep burns through coagulative and liquefactive necrosis.
How do electrical burns occur ?
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.
How do cold exposure burns occur ?
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.
How do radiation burns occur ?
Radio frequency energy or ionising radiation causes tissue damage.
What is the most common burn in adults ?
Flame injuries
What is the most common burn in children ?
Scalds
What layer of skin is affected in a first degree burn ?
Epidermis
How does a first degree burn present ?
Pain, erythema and slight swelling, no blisters
No scarring
Pain resolves in 48-72 hours
What are the differences between superficial to deep second degree burns ?
Superificial - entire epidermis and variable dermis
Deep - few dermal appendages left, fluid and metabolic effects
How do second degree burns present ?
Vesicles and blisters
Extremely painful due to exposed nerve endings
Heals within 7-14 days without infection
What layers of the skin are affected in a third degree burn ?
Entire epidermis and dermis, no residual epidermis
How does a third degree burn present ?
Painless, extensive fluid and metabolic deficits
How is a third degree burn managed ?
Heals only by wound contraction by skin grafting or coverage by a skin flap
What groups of people are high risk for burns ?
Children
Older adults
Alcoholics
Epileptics
Chronic psychiatric conditions
Low socioeconomic status
In children and vulnerable adults what is important to exclude in burns ?
Non-accidental injuries
What are the 3 major mechanisms that put the airway at risk in burns ?
- 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
What are some factors that increase the risk of airway obstruction or inhalation injury ?
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
What is the management if a burns patient has airway obstruction ?
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
What are some reasons why gas exchange can be compromised in a burns patient ?
- 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.
What is the management of breathing difficulties in a burns patient ?
High flow O2
Immediate discussion with burns centre if restriction of chest movement
Suspected inhalation injury may warrant intubation
