Burns Flashcards
What are the main categories of burns?
- Scalds
- Chemical
- Thermal
- Radiation
- Electric
Which chemicals are worse for burns; acids or alkalis?
Alkalis - penetrate deeper
What are the local effects of burns?
Jackson’s burn model
- Zone of Coagulation - irreversible process
- Zone of Stasis - reduced blood flow
- Zone of hyperaemia
What is the systemic pathophysiology seen in burns?
https://www.youtube.com/watch?v=j4v7PFw5wA0
- Fluid loss
- Increased metabolic rate
- Infection
What layer does a superficial burn affect?
Epidermis
What is the appearence of a superficial burn?
Red
Why do you get fluid loss in burns?
Due to dramatically increased vascular permeability and protein loss
What layers does a partial thickness superficial burn affect?
Epidermis and superficial dermis
What is the appearence of partial thickness superficial burns?
- Red
- Blistering - closed blister
How long does it take to heal a superficial burn?
5-7 days
How painful is a superficial burn?
Mild/moderate - due to exposure of sensory nerve endings
Do superficial burns scar?
No
What layers do partial thickness deep burns affect?
Epidermis down to deep dermis
How long does it take for superficial partial thickness burns to heal?
Up to 3 weeks
How painful is a partial thickness superficial burn?
Moderate/severe
Which skin layers are involved in full thickness burns?
Into subcutaneous layer
What is the appearence of a full thickness burn?
Dense white, waxy or even charred appearance; note the white leathery appearance of the burnt skin which shines on exposure
Do partial thickness superficial burns scar?
Partially
What is the appearence of a partial thickness deep burn?
- Brown blisters
- White tissue
- Non-blanching
How long does it take for partial thickness deep burns to heal?
3+ weeks
How much pain would someone be in with a partial thickness deep burn?
Pain to pressure - The dermal nerve endings are also damaged and hence sensation to pinprick is also lost
Do deep partial thickness burns scar?
Yes
Do full thickness burns heal?
No
Are full thickness burns painful?
No - There is total loss of sensation as all sensory nerve endings within the dermis are destroyed.
How would you calculate surface area for burns?
- Rule of 9’s
- Hand surface area is 1%
- Lund and Browder assessment
What are first aid measures for managing burns?
- Run under cold water - 20 minutes
- Remove rings and jewellery
- Anti-inflammatory drugs
- Apply cling film/appropriate dressing
- For chemical burns - irrigate
What problems with breathing can burns cause?
- Inhalation of combustion products/toxic fumes
- CO poisoning
- ARDS
What circulation problems can occur due to burns?
- Fluid loss resulting in shock
- Cardiac arrhythmias
- Decreased urine output
Why can acute kidney injury occur in burns?
In serious burns:
- Hypovolaemia
- Vasoconstriction in response to shock
- Red cell haemolysis
- Myoglobin release
Are you more likely to be hypothermic or hyperthermic in severe burns?
Hypothermic
What pain medication would you give to someone with severe burns?
10mg morphine and titrate to effect +/- NSAIDs
What vaccination should perople with severe burns recieve?
Tetanus booster
What is a scald?
Wet heat burns
What happens in the zone of coagulative necrosis?
Inability to conduct heat away from site quick enough -> immediate coagulation of intraceelular proteins which leads to necrosis
What happens in the zone of stasis?
Damage to dermal microcirculation -> tissue ischaemia
This area is DAMAGED but potentially VIABLE
What happens in the zone of hyperaemia?
Reversible increase in blood flow and inflammation - caused by inflammatory mediators released by damaged tissue
What vascular changes occur both locally and systemically in burns victims?
- Vasodilatation
- Increased vascular permeability
- Loss of protein and fluid
- Cell death
- Hypoperfusion
Why does the body enter a hypermetabolic state after a burn?
Profound catabolic state
- Release of stress hormones - cortisol, glucagon, various catecholamines
- Suppression/resistance of anabolic hormones - insulin, GH
This state results in muscle protein breakdown, making amino acids available for tissue repair