Burns Flashcards
Why are burns often deeper in children?
Skin is not so thick
What is the most common burn in children?
Thermal (upper body in infant, hot noodles/soup common in older children)
How should chemical burns be treated?
Neutralise then dressings
What additional risks are involved with electrical burns?
Cardiac arrhythmias in first 24hrs (especially if existing cardiac issues)
Compartment syndrome (check circulation in few days)
What should be involved in electrical burn Ax?
Look for entry/exit points (deep burns in bone etc)
Cardiac monitoring for first 24/24
After a fire in an enclosed area, what level of O2 should a patient be on?
Up to 8L/min
Why are petroleum burns more complex? (3)
Mixed depth
Chemical and thermal
Increased risk of infection
What indicates an oil burn?
Splatter pattern
Often deep as oil clings to skin
Why are burns from man-made fibres, such as clothing or furniture, more complex?
- Melts onto patient
- Items may fall on patient
- Toxic fumes
- Risk of inhalation burns
What are combination above/below larynx burns more common in?
House fires
How are inhalation burns classified and when will signs present?
By irritants
4-24 hrs
When is the risk of respiratory obstruction greatest after a house fire?
12-36hrs post burn (time of greatest swelling)
S/S of inhalation burn above larynx
Stridor Hoarseness/weak voice Brassy cough Restlessness Respiratory difficulty/obstruction
How should inhalation burns above the larynx be managed?
- Early intubation if concerned
- Respiratory techniques to aid sputum clearance (mucosa comes off)
- huff/bubble PEP for difficulty coughing
S/S of below larynx inhalation burn (immediate -2; gradual - 4)
Immediate
- Restlessness
- Severe anoxia
Gradual
- Hypoxia
- Pul oedema
- ARDS
- Resp failure
Rx for below larynx inhalation burn
- Supportive ventilation, esp kids, until lung damage repairs
- Humidified 8L O2/min
- Chest PT not that helpful usually… maybe sputum clearance
Results of systemic intoxication of inhaled chemicals (CO, hydrogen cyanide)
Hypoxic brain damage (CO)
Inhibition of cellular oxygenation + Lactic acidosis (cyanide)
S/S of high CO (7)
Forehead tightness Dilation of cutaneous blood vessels Headache Vomiting Dim vision Convulsions Coma
What levels of CO are problematic?
60% is toxic
30% is fatal (will already have been 60% initially)
Rx for CO toxicity
100% O2 ASAP
dependent on O2 availability/CO half-life
S/S of HC toxicity (4)
Lethargy
Nausea
Weakness
Coma (mimic acute MI)
HC toxicity levels
Begins at 0.1
Death likely at 1 microgram/mL
Superficial (epidermal) burn description
Red, painful, no blisters
Sensation present
Good capillary refill
Superficial (epidermal) burn Rx
Full ROM as pain allows
Usually no hospitalisation
Superficial dermal burn description
Pale pink, small blisters
VERY painful
Sensation/cap-ref good
7-10 day heal
Superficial dermal burn Rx
ROM as pain allows
Positioning for oedema
Mid-dermal description (4) and Rx (1)
Dark pink, blisters
Slower cap-ref, sensation +/-
14 day healing
>21 days usually scar
ROM during dressings with pain relief
Deep dermal description
Blotchy red/white, +/- blisters
No cap-ref/sensation
Deep dermal Rx
Needs graft if no healing within 21/7
ROM during dressings
Resting splints
Full thickness description
White/black
Leathery
NO cap-ref, sensation, blisters, healing
Full thickness Rx (4)
- Needs grafting
- Escharotomy if oedema develops?
- ROM during dressings
- Care with extensors (tendons at risk of rupture)
Larger the burn… (Rx) (5)
- Quick fluid resuscitation
- More oedema
- More calories needed
- Increased infection risk
- Increased risk of ARDS (even with no inhalation burn
Positioning for burns (i.e. axilla, elbows)
Extended (don’t lose ROM)
Axilla = 90 abd, 10-15 horiz flex Elbows = full ext
Oedema - what does 25% TBSA give, and when is oedema worst/peak?
Generalised oedema
Peak = 12-36/24 Worst = first 72hrs
Pain relief - kids vs adults
Kids
- Nitric oxide
- Ketamine for larger burns
Adult
- PCA +/- nitric oxide
- Ketamine
Main PT Rx for burns
Maintain ROM
- splint
- exercise
- positioning
Respiratory
CV fitness
Early mobilisation where possible
Grafts Mx
Same day/next day
- Gentle stretches
- Dangle legs
Dressing (day 5-7)
- Fixamull over graft
- 1 layer of tubigrip over all burns
Following
- increase walking, watch for oozing
Metabolic changes
Abnormal up-take of Ca
Prtn breakdown
High prtn demand
Fluid and electrolyte imbalance
Systemic changes
Increased periph resistance Kidney failure Sepsis Nerve damage Sweat gland loss (thermoreg)
Scar Mx - healing of graft
Fixamull + tubigrip (immediate)
Silicone gel/garments (later) and avoid chlorine
6-12 months
- Pressure garments 23/24
- Replace 1-3/12
Hypertrophic scarring Mx
Not keliod scars (restrict ROM but no pain)
Rx
- Prevent contracture
- Max fn
- Decrease need for reconstruction
New skin protection (6)
- hygiene
- dressings
- moisturise
- massage
- protect from sun
- move
What pressure should tubigrip NOT exceed?
40mmHg
When is PT/OT needed for scar Mx?
Needs ROM/strength
encourage continual as graft tighten up, esp 2-3/12
When to splint (4)
Oedema
Contracture/deformity
Immobilisation/protection
Improve ROM
