Burns Flashcards
6 functions of the skin
Sensory organ Endocrine Thermoregulatory Immunotherapy Barrier to fluid loss Social
6 causes of burns
Heat cold electrical chemical radiation mechanical (eg friction)
Who is more at risk of burns?
Mad (psychological/pyschiatric problems, drugs) Bad (Violence) Glad (arson) Sad (self harm, substance misuse) Epilepsy/stroke
Why are the extremes of age more at risk of burns?
Poorer reflexes and spatial awareness
Inattention/carelessness
Inability to fend for themselves
Thinner and more frail skin
5 types of shock
Hypovolaemic (burns) Septic Anaphylactic Vasovagal Cardiogenic
How do burns cause hypovolaemic shock?
Tissue damage Inflammatory mediators Leaking vessels Increased vascular resistance Hypovolaemia
Name the 3 zones of a burn
Centre: Zone of coagulation/necrosis
Zone of stasis
Outer: Zone of hyperaemia
Role of histamine in the inflammatory response
Released by mast cells
Creates large endothelial gaps
Leakage
Role of prostaglandins in inflammatory response
Released from damaged tissue
Attract neutrophils and macrophages
Release thromboxane and interleukins
Local vasodilation and capillary leakage
Role of thromboxane in inflammatory response
Produced by platelets in the zone of injury
Vasoconstriction in undamaged tissue adjacent to the burn
Results in damage extension
What inflammatory mediator is released by platelets
Thromboxane
What inflammatory mediator causes thromboxane and interleukins to be released?
Prostaglandins
Role of catecholamines in the inflammatory response?
Reduces capillary pressure in unburnt tissue
Causes burn extension
Role of oxygen free radicals in the inflammatory response?
Produced by neutrophils and macrophages
Damage endothelial cell membranes
Increase capillary leakage
What is found in the urine after a burn?
Haemaglobin
Red cells lost
Intensifies the effect of plasma loss
50% burn, 10% loss of red blood cells
What is the rule of nines?
Body surface area can be estimated using 9% Each leg 18% Torso 18% Each arm 9% Head 9%
How do you classify depth of burns?
Erythema
Partial thickness
Full thickness
How do you recognise a partial thickness burn?
Painful
Blistered
Tissue paper appearnace
Wet
How do you recognise a full thickness burn?
Painless Thick and leathery Dark red/brown/balck/white No blisters Swelling in limbs Dry Non blanching
When do you need to IV fluid resuscitate someone after a burn?
If adult>15% BSA affected
In children>10%BSA
What is the aim for adequate fluid balance?
Urine output of 0.5-1 ml/kg/hour
What type of fluid should be used in IV fluid resus after burns? And rate?
Crystalloid (Ringer’s lactate)
4ml/kg/%burn for 1st 24hrs
When would more fluid need to be replaced?
In myoglobinuria, electrical injury or associated skeletal injury
How much fluid needed for a 70kg man with 45% BSA burns?
4 x 70 x 45 = 12600ml in 24hours
6300ml in first 8 hours
6300ml in next 16 hours
When would you intubate early in emergency burns management?
Facial burns
Singeing of facial/nasal hair
Inflammation of oropharynx
Carbonaceous sputum
What would you do to manage circumferential full thickness burns?
Escharotomies
Slice through lengthways to allow breathing
What blood test is needed after being in a fire?
HbCO
How do you estimate BSA in children with burns?
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
How do you stop the burning process immediately after a burn?
25ºC water for 10 mins
Beware of hypothermia
Causes of electrical burns?
Improper insulation Intense curiosity of children Occupation hazards DIY maintenance attempts Illegal attempts to obtain electricity High voltage wire exposure
What counts as a low voltage burn & causes
Below 1000 volts
Household and industrial
Not usually associated with deep tissue damage
What counts as high voltage burns & common causes
>1000volts 10000-40000 High tension transmission cables Flash burns or damage due to transmission of current Cutaneous and deep damage
What are the concerns with high voltage burns?
Internal organ damage (cardiac/brain)
Release of haemochromatogens?
Vessel thrombosis (ischaemia, peripheral circulation)
Compartmental pressure
Treatment of electrical burns?
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
What happens in chemical burns?
Alkalis-> saponification
Acids-> coagulative damage
Treatment of chemical burns?
Decontaminate
Dilute
Antidote
Treatment of mustard gas burns?
Dilute hydrochlorite
Treatment of phosgene Burns?
Irrigation/water
Treatment of Lewisite burns?
Dilute hypochlorite
Treatment of white phosphorus burns?
Water/1% CuSO4
Caustic soda burn treatment?
1% acetic acid
Treatment of hydrofluoric acid burns?
1% Calcium gluconate
What is used in burn excision/debridement?
Repeated shaving of burn in very thin layers until visible dermic & punctate bleeding
Done using Watson knife or Dermatome
