Burns Flashcards
What are the primary functions of the skin?
Barrier function: Prevents infections, fluid loss, and injury.
Thermoregulation: Controls heat loss via sweat and blood flow.
Sensation: Houses nerve endings for pain, touch, and temperature.
Metabolism: Synthesizes vitamin D.
What are the main causes of burns?
🔥 Thermal: Contact with heat, flame, or hot liquids.
⚡ Electrical: High-voltage or low-voltage injuries.
☢️ Radiation: Sunburn, radiation therapy, nuclear exposure.
🧪 Chemical: Acids, alkalis, or industrial agents.
How are burns classified by depth?
Superficial (1st-degree): Epidermis only, red, painful, no blisters.
Partial-thickness (2nd-degree): Blisters, moist, painful, extends into dermis.
Full-thickness (3rd-degree): Dry, leathery, painless (nerves destroyed).
4th-degree: Extends into muscle/bone, often requires amputation.
How do you estimate burn size?
Rule of Nines: Body divided into sections (head = 9%, arm = 9%, leg = 18% each, torso = 36%).
Lund and Browder Chart: More precise, considers age-related body proportion differences.
Palm method: Palm = ~1% of Total Body Surface Area (TBSA).
What are the systemic effects of severe burns?
🔹 Hypovolemia: Fluid loss → ↓ BP, ↑ HR, risk of shock.
🔹 Hypermetabolic state: ↑ Energy demands, protein breakdown.
🔹 Immune suppression: ↑ Infection risk.
🔹 Respiratory distress: Inhalation injury, CO (carbon monoxide) or CN (cyanide) poisoning.
🔹 Renal failure: Myoglobin release from burned muscle → AKI (Acute Kidney Injury).
How do you assess airway involvement in burn patients?
🔹 Signs of inhalational injury:
Facial burns, singed nasal hairs.
Carbonaceous sputum, hoarseness, stridor.
Carboxyhemoglobin (COHb) levels → >10% suggests CO poisoning.
Cyanide poisoning → Consider Cyanokit if lactate >10, high anion gap.
What is the Parkland Formula for fluid resuscitation?
🔹 Formula: 4 mL × %TBSA × body weight (kg)
🔹 Administration:
1st half over 8 hrs, remaining half over 16 hrs.
Use Hartmann’s solution (Ringer’s lactate) as preferred resuscitation fluid.
🔹 End goal: Maintain urine output 0.5 mL/kg/hr.
What are key principles of burn wound management?
🔹 Debridement: Remove necrotic tissue to prevent infection.
🔹 Dressing: Moist wound healing, avoid unnecessary exposure.
🔹 Infection control: No routine antibiotics unless infected.
🔹 Pain management: Morphine + Midazolam preferred over Propofol.
🔹 Temperature regulation: Keep patient warm, even if febrile.
What are key considerations for burn patients in ICU?
🔹 Airway: Early intubation if inhalational injury suspected.
🔹 Cardiovascular: Monitor BP, urine output, lactate levels.
🔹 Gastrointestinal: High risk of gastric stasis → NG feeding early.
🔹 Renal: Monitor for myoglobinuria, risk of AKI.
🔹 DVT Prophylaxis: LMWH (Low Molecular Weight Heparin) to prevent clotting.
What are the indications for escharotomy?
🔹 Circumferential burns on limbs or chest causing compartment syndrome.
🔹 Signs of ischemia: Reduced pulse, pain, tight skin, ↓ capillary refill.
🔹 Respiratory distress: Chest burns restricting breathing.
What are key steps in the initial management of a major burns patient?
🔹 Primary survey (ABCDE approach):
Airway: Check for inhalation injury, consider early intubation.
Breathing: 100% oxygen if CO poisoning suspected.
Circulation: 2 large-bore IVs, begin fluid resuscitation.
Disability: Assess neurological status, pain control.
Exposure: Remove clothing, keep patient warm.
What are key complications of electrical burns?
🔹 Cardiac arrhythmias (monitor ECG, risk of asystole).
🔹 Deep tissue damage (burn may appear minor externally).
🔹 Myoglobinuria (from muscle breakdown → risk of AKI).
🔹 Neurological deficits (delayed onset possible).
What are common late complications of severe burns?
🔹 Hypertrophic scarring & contractures.
🔹 Chronic pain & neuropathy.
🔹 Psychological trauma (PTSD, depression).
🔹 Metabolic derangements (long-term hypermetabolism).
What are the major systemic effects of severe burns?
🔥 Severe burns lead to:
Hypovolemia → Fluid loss → ↓ BP, ↑ HR
Hypermetabolic state → Increased energy demands
Immune suppression → Increased risk of infection
Organ dysfunction (CVS, CNS, Respiratory, Renal, GI)
How do severe burns affect the cardiovascular system (CVS)?
🔹 Burn shock: Hypovolemia due to plasma leakage.
🔹 Tachycardia & Hypotension: ↓ Cardiac output due to fluid shifts.
🔹 Capillary leak syndrome: Leads to massive third-spacing.
🔹 Peripheral vasoconstriction: Increases afterload.
How do severe burns affect the respiratory system?
🔹 Inhalation injury risk:
Upper airway edema → Early intubation needed
CO (carbon monoxide) poisoning → Treat with 100% O₂
Cyanide poisoning → Suspect if high lactate (>10)
🔹 ARDS (Acute Respiratory Distress Syndrome):
Fluid overload can worsen pulmonary edema
Mechanical ventilation may be required
What vascular changes occur in severe burns?
🔹 Increased capillary permeability → Fluid & protein loss into interstitial space.
🔹 Peripheral vasoconstriction → Maintains BP but reduces distal perfusion.
🔹 Splanchnic vasoconstriction → GI ischemia, risk of stress ulcers.
🔹 Microvascular thrombosis → Risk of DIC (Disseminated Intravascular Coagulation).
How do burns affect the central nervous system (CNS)?
🔹 Burn encephalopathy → Due to hypoxia, electrolyte imbalance, sepsis.
🔹 Delirium & agitation → Common in ICU burns patients.
🔹 Pain & stress response → Increases catecholamines → ↑ HR, BP, metabolic demand.
How do severe burns affect the gastrointestinal (GI) system?
🔹 Splanchnic vasoconstriction → Ischemia risk.
🔹 Ileus (paralytic gut): Delayed gastric emptying due to stress response.
🔹 Curling’s ulcers (stress ulcers): Increased acid secretion, risk of GI bleeding.
🔹 Translocation of bacteria → Gut permeability increases risk of sepsis.
How do burns affect the renal system?
🔹 Hypovolemia → Acute Kidney Injury (AKI).
🔹 Myoglobinuria → Rhabdomyolysis risk in electrical burns.
🔹 Prevention:
Aggressive IV fluids
Maintain urine output >0.5 mL/kg/hr
Alkalinization of urine if rhabdo present
