Burns Flashcards
What is really important when considering the airway in the primary survey in ED? What are options to achieve this?
- cervical spine control
- cervical collar, but often younger kids don’t tolerate
What is an escharotomy and why is it done?
Eschar occurs with full-thickness burns, which if on the chest, may prevent chest expansion
When doing capillary refill assessments in major ED situations e.g. trauma, where should you assess and how?
• Central and all 4 limbs
○ Central on forehead or sternum
• Must raise hand to above level of heart
• Press and hold for > 5 seconds
What must you remember affects coagulopathy in trauma and burns situations? How can you combat this?
Hypothermia!:
• Warm room, blankets
• Bair hugger(warm air blanket)
What are the three major components to a burns assessment?
- Depth
- Circumferential?
- %TBSA
How do you manage a circumferential burn?
Always elevate!! +/- escharotomy
Compare different types of superficial burns:
- Appearance
- Sensation
- Cap refill
- Healing
- Epidermal (typical sunburn)
- Pink
- Painful
- Good
- Well (7 days) - Superficial dermal
- Pink, small blisters
- Painful
- Good cap refill
- Well - Mid dermal
- Variable, typically blisters
- Variable, some loss of sensation
- Variable, may be sluggish
- Variable, heal well/scar
Compare different types of deep burns:
- Appearance
- Sensation
- Cap refill
- Healing
Deep dermal
- Moist white slough, red mottled
- No sensation (painful edges!)
- Sluggish/absent cap refill
- Probably requires grafts
- Scar
Full thickness
- Waxy/white
- May be charred, leathery
- No sensation (painful edges!)
- Absent cap refill
- Grafting
%TBSA: what types of rules are there to calculate SA affected in a burn? Which are most accurate?
- Rule of 9’s, Palmar method:
○ rule of 9’s in child: front 18%, back 18%, head 18%, legs 14%, arms 9%
○ 1% SA = patient’s palm - Lund and Browder chart more accurate: considers age, reduces % BSA for head, inc % BSA for limbs
Outline some first aid management of a burn.
- 20 min cool, running water (within 1st 3 hrs)
○ Never put ice on a burn because it is going to increase the depth of the burn - cool running water is first-line first aid - Analgesia
○ Ambulances have intranasal fentanyl - Referring: cling film - but not on face/head
○ Keeps clean and reduces air contact (which causes a lot of the pain) - Dressing: face = paraffin, neck/trunk = acticoat
- Tetanus status
How do we approach fluid resuscitation in burns?
- Hartmann’s
- Burns different to normal paeds fluids - use Modified Parkland’s Formula:
□ = 3 ml x weight (kg) x TBSA (%)
□ = Volume for 24 h
□ Commence rate with aim of giving half volume in first 8h from time of !injury
□ Thereafter ongoing rate determined by UO and HR
In the ED, what is the best indicator of fluid status, and what are the target levels for this?
Urine output:
Target = 0.5ml/kg/hr (age <2y) or 1ml/kg/hr (age ≥ 2y)
What referral criteria should you refer to when considering referring a patient to a burns centre, and what is this criteria?
ANZBA referral criteria to a burn centre:
□ Circumferential
□ Inhalation injury
□ Chemical/electrical burns
□ Sensitive areas e.g. perineum, face, hands, feet, major joints, chest
□ >5% TBSA for paeds or >5% in full thickness
□ Major trauma
□ Pre-existing co-morbidity
When do children require fluid resusc in burns cf adults?
Children require burns resuscitation fluid at a lesser TBSA % than adults (10% in children as opposed to 20% in adults).
What should you not include in burn BSA calculations?
Epidermal burns - those with erythema only
