burns Flashcards
what are the 4 classifications of burns
1) superficial epidermal –> erythema and pain
2) superficial dermal –> pale erythema and blister, pain
3) deep dermal –> normally white but may have some erythema, reduced pain but can still feel deep pressure
4) full thickness –> NO PAIN, white/waxy/black
Mx of a superficial epidermal burn
emollient and analgesia
Mx of a superficial dermal (partial thickness) burn
cleanse using saline, emollient, analgesia, leave blisters intact, non adherent dressing
most accurate way to classify TBSA affected by burns
Lund and browder
Wallaces rule of 9s
9 for head and neck, 9 for anterior chest, 9 for anterior abdo, 9 for front of leg and 9 for back, 9 for each whole upper limb
when do burns need to be referred to secondary care
any deep dermal or full thickness, any superficial dermal which is >2% in children and >3% in adults, any electrical burn, any NAI, any affecting critical area like face/genitals/hands
formula for fluid replacement in burns
parklands formula (TBSA x weight in kg x 4) –> give first half of total amount over 8 hours
immediate mx of burns
1) remove source 2) secure airway 3) pain relief 4) aggressive fluid resuscitation
pathophysiology of burns
get progressive tissue loss due to inflammation and big release of cytokines. Get cardiovascular effects due to the fluid loss and third spacing, get immunosuppression
when do you do a escharotomy
circumferential burns
complications of burns
eschar, distributive shock, AKI, rhabdo, scarring, contractures. toxic shock, curlings ulcer
what is curlings ulcer
significant hypovolaemia from burns which causes ischaemia of the gastric mucosa and creates an ulcer and predisposes to bleeding
other mx points of burns
sun protection and tetanus!
what kind of burns require Iv fluids
burns affecting 15% total body surface area (TBSA)
-NOTE –> fluid resus based more upon TBSA covered rather than thickness of the burn, but these still need referral to secondary care as likely to need skin grafting
what is specific about the malar rash in lupus
no papules/pustules and spares the nasolabial folds
what is the main aim of aggressive fluid resus in burns
stop the burns keeping
