Burns

Question 1

What is the first aid for burns?

Answer 1

• 20mins cool running water (within 1st 3 hour)
• Analgesia (intranasal fentanyl in ambo)
• Referring - clingfilm (but not on face/head) - clean and prevents air contact.
• Dressing - face = paraffin, neck/trunk = anticoat
• Tetanus status

Question 2

What is a system for Primary Survery? What is the Overview of treatment for Burns?

Answer 2

• DR ABCDE
• Burn Assessment
• Adjuvants
• Secondary Survey

Question 3

What is an overview of the key things to go through in Burns?

Answer 3

1. Airway
   
   • c-spine
   • maintain airway
     
     • assessment:
       
       • extra sounds
       • fluid from scald (swallowing)
       • stridor/wheeze
     • intubation?
       
       • concious state
       • inhalation injury (ARDS) - high flow O2
       • need to transport?
     • adjuncts
       
       • jaw thrust
       • gaudel
       • Nasopharyngeal airway
       • intubation
     • avoid straps
2. Breathing (assess look at chest and moving equally, listen)
   
   • expose chest
   • ventilation
     
     • RR, SaO2, O2 mask
   • circumferential burns?
     
     • eschar (solid dead tissue doesn’t expand) - escharotomy
3. Cardiac
   
   • haemorrhagic shock usually in trauma
     
     • abdomen
     • limbs (femur) - thigh
     • pelvis (entire blood supply)
     • external bleeding
     • retroperitoneal
   • Pulse + CRT = central + 4 limbs
   • IV access = fluid resus, lose fluid usually not straight away
   • elevate limbs +/- escharotomy (decrease restriction)
4. Disability + neuro
   
   • AVPU/GCS
   • pupils
     
     • uncal herniation (optic nerve)
   • check for - head injury, intoxification
5. Exposure - easy to miss things
   
   • burns come in, don’t get distracted worry about other
   • temperature control - hypothermia bad in trauma (clot, chemical reactions, cool over burn)
   • environment
     
     • warm room
     • blankets - bair hugger
     • cover wound
   • the back (irrigating it gets wet, change sheets, warm blanket under) and elevate limbs

Question 4

What is the way to Classify burns?

Answer 4

• Superficial
  
  • epidermal (sun)
    
    • heal in 7 days
  • superficial dermal (blisters - pink with cap refill)
    
    • painful haven’t gone deep enough to hit nerve
    • heal well but couple of weeks
  • mid dermal
    
    • less painful, LOS
    • lag cap refill
    • variable, some scar
• Deep (need grafts)
  
  • Deep dermal
    
    • loss of sensation
    • scar
    • no capillary refill
  • full thickness
    
    • into underlying tissue - muscle and further
    • white waxy leathery appearance and charred
    • not painful - still have pain because not uniform

Question 5

What is a way to Describe Burns?

Answer 5

• depth (see other card)
• circumferential (escharotomy)
• TBSA of burn
  
  • discount erythema (ignore epidermal burn)
  • Rule of 9 (each bit is in 9)
    
    • head 9%, front/back respectively 18%.
    • Kids are different - bigger head
      
      • 18%
      • legs 14%
  • Palmar method (palm is 1%) - must be patients hand
  • Lund and Browder Chart (accurate)
    
    • burn CPG more accurate.
    • proportion at different ages.
    • colour in and sum up different areas.

Question 6

What is the treatment of the burns?

Answer 6

F A T T (fluids, Analgesia, tubes, tests)

Fluid Resus:

• %TBSA used to guide
  
  • crystalloids and colloids - use crystalloids
    
    • ambulance give N/S, here give plasmalyte
  • 20ml/kg - in burns give more Modified Parkands formula:
    
    • 3ml/kg x TBSA % in first 8 hours from injury for 24 hours
    • e.g. 13kg child qith 18% burn 3 hours ago, divide figure by 5 (3 hours not fiven any).
  • too much fluid?
    
    • pulmonary oedema, RHF
    • deep muscle, abdomen brain
• Maintenence Fluids
  
  • plasmalyte dextrose - 2:1:1 (in ED use 4:2:1)
  • start 4:2:1 rule and look at electrolytes
• Burn shock
  
  • >10% TBSA in kids
  • >20% adults
  • kids need dextrose - poor glycogen storage and prone to hypoglycemia

Analgesia

Ix

• trauma bloods
• temp
• ECG in electrical
• traumatic XR

Tubes

Question 7

What is the Secondary survery in a burns victim?

Answer 7

• AMPLE history:
  
  • Allergy
  • Medications
  • PMHx
  • Last ate?
  • event = what happened?
• Head-to-toe
• Tetanus
• Wound care
  
  • saline
  • plastic film
• Reassess
• Documentation
• emotional support
• Refer - burns centre (TBSA >10% or >5% FTB) better outcomes
• Non-accidental injury?

Question 8

What is an acronym for burns management?

Answer 8

AT SASS SCAR

• assessment (age/size/site/depth)
• transfer
• shock (IV fluids) - 3-4mls x kg x %TBSA with Hartmann’s (50% within 8 hours of time of injury) + maintenance
• analgesia
• sepsis
• skin cover
• scar prevention (escharotomy)
• cosmetic
• acident prevention (advice)
• non-accidental injury consideration