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SBOMs > Burns > Flashcards

Burns Flashcards

1
Q

6 functions of the skin

A 
Sensory organ
Endocrine
Thermoregulatory
Immunotherapy
Barrier to fluid loss
Social
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2
Q

6 causes of burns

A 
Heat
cold
electrical
chemical
radiation
mechanical (eg friction)
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3
Q

Who is more at risk of burns?

A 
Mad (psychological/pyschiatric problems, drugs)
Bad (Violence)
Glad (arson)
Sad (self harm, substance misuse)
Epilepsy/stroke
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4
Q

Why are the extremes of age more at risk of burns?

A

Poorer reflexes and spatial awareness
Inattention/carelessness
Inability to fend for themselves
Thinner and more frail skin

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5
Q

5 types of shock

A 
Hypovolaemic (burns)
Septic
Anaphylactic
Vasovagal
Cardiogenic
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6
Q

How do burns cause hypovolaemic shock?

A 
Tissue damage
Inflammatory mediators
Leaking vessels
Increased vascular resistance
Hypovolaemia
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7
Q

Name the 3 zones of a burn

A

Centre: Zone of coagulation/necrosis
Zone of stasis
Outer: Zone of hyperaemia

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8
Q

Role of histamine in the inflammatory response

A

Released by mast cells
Creates large endothelial gaps
Leakage

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9
Q

Role of prostaglandins in inflammatory response

A

Released from damaged tissue
Attract neutrophils and macrophages
Release thromboxane and interleukins
Local vasodilation and capillary leakage

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10
Q

Role of thromboxane in inflammatory response

A

Produced by platelets in the zone of injury
Vasoconstriction in undamaged tissue adjacent to the burn
Results in damage extension

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11
Q

What inflammatory mediator is released by platelets

A

Thromboxane

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12
Q

What inflammatory mediator causes thromboxane and interleukins to be released?

A

Prostaglandins

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13
Q

Role of catecholamines in the inflammatory response?

A

Reduces capillary pressure in unburnt tissue

Causes burn extension

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14
Q

Role of oxygen free radicals in the inflammatory response?

A

Produced by neutrophils and macrophages
Damage endothelial cell membranes
Increase capillary leakage

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15
Q

What is found in the urine after a burn?

A

Haemaglobin
Red cells lost
Intensifies the effect of plasma loss
50% burn, 10% loss of red blood cells

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16
Q

What is the rule of nines?

A 
Body surface area can be estimated using 9%
Each leg 18%
Torso 18%
Each arm 9%
Head 9%
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17
Q

How do you classify depth of burns?

A

Erythema
Partial thickness
Full thickness

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18
Q

How do you recognise a partial thickness burn?

A

Painful
Blistered
Tissue paper appearnace
Wet

19
Q

How do you recognise a full thickness burn?

A 
Painless
Thick and leathery
Dark red/brown/balck/white
No blisters
Swelling in limbs
Dry
Non blanching
20
Q

When do you need to IV fluid resuscitate someone after a burn?

A

If adult>15% BSA affected

In children>10%BSA

21
Q

What is the aim for adequate fluid balance?

A

Urine output of 0.5-1 ml/kg/hour

22
Q

What type of fluid should be used in IV fluid resus after burns? And rate?

A

Crystalloid (Ringer’s lactate)

4ml/kg/%burn for 1st 24hrs

23
Q

When would more fluid need to be replaced?

A

In myoglobinuria, electrical injury or associated skeletal injury

24
Q

How much fluid needed for a 70kg man with 45% BSA burns?

A

4 x 70 x 45 = 12600ml in 24hours
6300ml in first 8 hours
6300ml in next 16 hours

25
Q

When would you intubate early in emergency burns management?

A

Facial burns
Singeing of facial/nasal hair
Inflammation of oropharynx
Carbonaceous sputum

26
Q

What would you do to manage circumferential full thickness burns?

A

Escharotomies

Slice through lengthways to allow breathing

27
Q

What blood test is needed after being in a fire?

A

HbCO

28
Q

How do you estimate BSA in children with burns?

A 
Head 18%
Torso 18%
Each arm 9%
Each leg 14% at aged 0
For each year between 0 and 10 take 1% off head and add 0.5% to each leg
29
Q

How do you stop the burning process immediately after a burn?

A

25ºC water for 10 mins

Beware of hypothermia

30
Q

Causes of electrical burns?

A 
Improper insulation
Intense curiosity of children
Occupation hazards
DIY maintenance attempts
Illegal attempts to obtain electricity
High voltage wire exposure
31
Q

What counts as a low voltage burn & causes

A

Below 1000 volts
Household and industrial
Not usually associated with deep tissue damage

32
Q

What counts as high voltage burns & common causes

A 
>1000volts
10000-40000
High tension transmission cables
Flash burns or damage due to transmission of current
Cutaneous and deep damage
33
Q

What are the concerns with high voltage burns?

A

Internal organ damage (cardiac/brain)
Release of haemochromatogens?
Vessel thrombosis (ischaemia, peripheral circulation)
Compartmental pressure

34
Q

Treatment of electrical burns?

A 
Turn off electrical current and remove victim from source
Primary survey (CPR?)
Associated skeletal injury?
Fluid resus
Monitor (ECG for hyperkalaemia?)
Heparinisation?
Fasciotomies/debridement surgery
35
Q

What happens in chemical burns?

A

Alkalis-> saponification

Acids-> coagulative damage

36
Q

Treatment of chemical burns?

A

Decontaminate
Dilute
Antidote

37
Q

Treatment of mustard gas burns?

A

Dilute hydrochlorite

38
Q

Treatment of phosgene Burns?

A

Irrigation/water

39
Q

Treatment of Lewisite burns?

A

Dilute hypochlorite

40
Q

Treatment of white phosphorus burns?

A

Water/1% CuSO4

41
Q

Caustic soda burn treatment?

A

1% acetic acid

42
Q

Treatment of hydrofluoric acid burns?

A

1% Calcium gluconate

43
Q

What is used in burn excision/debridement?

A

Repeated shaving of burn in very thin layers until visible dermic & punctate bleeding
Done using Watson knife or Dermatome

SBOMs (18 decks)

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