Burns Flashcards
4 types of burns (definition of burns)
- Thermal
- Electrical
- Chemical
- Radiation induced
injury to the skin and underlying structures
Depth classification of burns
- Superficial
- Superficial partial thickness
- Deep partial thickness
- Deep/full thickness
How do we quantify the extent of a burn?
Using total body surface area (TBSA%) estimation
Major TBSA burns are associated with … and require …
Major TBSA burns are associated with SEVERE SYSTEMIC RESPONSE and require RESUSCITATION
Mortality from major TBSA burns is estimated using…
the BAUX score
Key features of superficial burns (4)
- red
- painful
- no blisters
- blanching
What layers of the skin are affected by superficial burns?
Epidermis
Key features of superficial partial thickness burns (3)
- pink
- blanching
- blisters
What layers of the skin are affected by superficial partial thickness burns?
Epidermis & papillary dermis
Key features of deep partial thickness burns (3)
- Blotchy red, or pale
- Non-blanching
- Ruptured blisters
What layers of the skin are affected by deep partial thickness burns?
Epidermis, papillary and reticular dermis
Key features of deep/full thickness burns (4)
- White/red/yellow
- Non-blanching
- Leathery
- Asensate
What layers of the skin are affected by deep/full thickness burns?
Epidermis, dermis +/- underlying structures
Differences between superficial and deep partial thickness burns (5)
Superficial partial thickness:
- Blisters with erythematous base
- Adnexal structures are not damaged
- Blanching
- Sensate
- Papillary dermis only
Deep partial thickness:
- Blisters with white base
- Adnexal structures are damaged
- Non-blanching
- Insensate
- Papillary & reticular dermis
Jackson zones (3)
- Zone of coagulation
- Zone of stasis
- Zone of hyperaemia
Point of maximum damage (irreversible tissue loss due to coagulation of constituent proteins)
Zone of coagulation
Zone of decreased tissue perfusion that is potentially salvageable
Zone of stasis
Outermost zone where tissue perfusion is actually increased and where tissue will invariably recover
Zone of hyperaemia
Burn resuscitation aims to…
save the zone of stasis
When is fluid resuscitation required?
Pediatrics: 10% TBSA or more
Adults: 20% TBSA or more
What is the Parkland Formula for fluid resuscitation?
4cc x kg of body weight x TBSA (in %)
What is the timing of fluid resuscitation?
First half within 8 hours of the burn incident, second half within the next 16 hours of the incident.
Make sure to account for delayed resuscitation based on when the patient presented to the ER
What fluid do we administer to resuscitate burn patients?
Ringer’s lactate
What is the target urine output during fluid resuscitation of a burn patient?
0.5-1cc/kg/hour
How do we assess burn size (adults vs peds)?
Adults: Rule of 9s
Kids: Lung Browder chart
Explain the rule of 9s
Head: 9%
Anterior torso: 18%
Posterior torso: 18%
Entire upper extremity: 9% each
Entire lower extremity: 9% each
Genitals: 1%
Palm of hand: 1%
Rule of 9s only applies to…
partial thickness burns and above
Indications for transfer to a burn centre (10)
- Partial thickness burn of over 10% TBSA
- Any full thickness/deep burn (3rd degree)
- Chemical burn
- Electrical burn
- Inhalation injury
- Patients with comorbidities
- Patients who will need social support/rehab
- If the hospital cannot care for the burn patient
- Burns to face, hands, genitalia
- Burns + trauma, if burns>trauma
List the elements of the primary survey of a burn patient (ABCDE)
A: Airways
B: Breathing
C: Circulation
D: Disability (neurologic exam)
E: Exposure
Initial interventions for burn patients
- Early endotracheal intubation (as needed)
- Support oxygenation & ventilation
- Obtain vascular access
- Fluid resuscitation
Also
- Remove clothing and debris
- Immediately cool areas using NS/cool water soaked gauze
- Pain and anxiety management (sedation)
3 factors that affect burn mortality (used to estimate mortality in the Baux score)
- Age
- TBSA
- Inhalation injury
