Burns Flashcards
Inflammatory agents and their actions in response to burns?
Histamine - Leakage and fluid loss
Prostaglandins - attract WBCs - release thromboxane & interleukins - local vasodilatation and increased capillary permeability
Thromboxane - vasoconstriction in undamaged tissue adjacent to burn - burn extension
Catecholamines - reduce capillary pressure in unburnt tissue - burn extension
Free radicals - damage endothelial membranes - more leakage
Amount to give when resuscitating with crystalloids?
4x weight (kg) x % burn
How much fluid should you give within the first 8 hours of a burn?
Half in the first 8hrs, rest in the next 16hrs
What percentage burn needs IV fluids?
> 10% BSA in children, >15% in adults
What is the rule of 9s when referring to burn surface area?
Each arm is 9%
Head is 9%
Torso is 36%
Each leg is 18%
ABCDE approach in burns?
Airway: intubate early, hight conc humidified o2, stabilise c-spine
Breathing: expose chest, assess chest sounds, escharotomy
Circulation: pulse, BP, cap refill, peripheral pulses, bloods, FLUIDS, haematocrit
Disability: AVPU, GCS
Exposure: Remove jewellery & clothes, at risk of hypothermia.
What is an escharotomy?
a prophylactic surgical measure to release pressure, facilitate circulation and combat burn-induced compartment syndrome. Incisions are made along the eschar.
Difference in burns in children?
Airway softer and narrower
More likely to have laryngo/tracheomalacia due to smaller and softer cartilage
Diaphragmatic respiration - so abdominal burns alone may warrant an escharotomy
Limited physiological circulatory reserve, increased fluid requirements
Difference in the rule of 9 for children?
Each leg is worth 14% and the head is worth 18% at newborn, taking 1% off head to add to legs per year of age between years 0-10
E.g. age 5, head is worth 13%, legs are worth 16.5% each
Potential burn complications in acute phase?
- Hypothermia
- Compartment syndrome
- Hypoglycaemia
- Increased haematocrit
- Acidosis/shock
- Haemo/myoglobuinuria
- ARDS
- AKI
- Contamination of the wound
- Delirium and psych problems
- High Na, Low Ca, Low PO4, Low Mg
High and low voltage burns voltage definition?
1000v = high, found in high tension transmission cables
Complications of deep tissue damage from electrical burns?
- Thrombosis
- Internal organ/muscle damage
- Neurological damage
- Ischaemia
- Compartment syndrome
- Heart damage
What surgical procedure is required in full thickness burns?
Full excision of burnt skin.
Common causes of burns?
Carelessness/accidental
Associated with extremes of age - inattention/poor reflexes and co-ordination
Epilepsy/strokes
Alcohol/substance abuse
Psychiatric/psychological problems
What three things do you use to classify burns?
Area
Depth
Cause
The three classifications of depth of burns in the UK?
Erythema
Partial thickness
Full thickness
Features of partial thickness burns?
Blistered
Painful
Tissue paper appearance
Wet
Features of full thickness burns?
Loss of skin integrity
Swelling
Fluid loss
Acute pain relief in burns patients?
Entonox
Whats a fasciotomy?
relieve compartment syndrome by cutting fascia after RTA, explosion, fall or electrical injuries
Difference in surgical management with a partial thickness and complete thickness burn?
Partial - aim to preserve dermis
Full - aim for removal of all necrotic/infected tissue
