BURNS Flashcards
What are the three zones of injury that occur with burns?
Zone of coagulation – closest to the source of the burn, its called zone of coagulation because of coagulation of cellular proteins and destruction of the microcirculation which results in rapid cell death, necrosis.
Zone of stasis – around the zone of coagulation is called zone of stasis due to slow blood flow to the area and characterized by decreased tissue perfusion
Zone of hyperaemia - increased tissue perfusion, where healing takes place.
- Discuss the systemic responses that occur with a major burns injury.
Systemic damage caused by burns exceeding 20% of the total surface body area is considered major burns and will have systemic effects. (Hypovolemic shock, electrolyte shifts)
Cardiovascular – reduced cardiac output, increased afterload, decreased contractability
Respiratory – lung inflammation, hypoxemia, pulmonary arterial and vascular hypertension
Metabolic – hyper metabolic state leads to increased oxygen consumption, the release of adrenalin and cortisol which is a stress hormone resulting in a higher body temperature
Immunological – immune function is supressed which increases susceptibility to wound infections and potential sepsis.
Explain how burns are classified.
Epidermal burns – involves the epidermis, the skin is pink, red and painful, heals in 7 days
Superficial partial thickness – involves the epidermis and the superficial dermis, it blisters, is red or mottled, painful with exudate and heals in 14 days
Mid-dermal partial thickness – involves the epidermis, large zone of non-viable tissue, less painful with exudate, pale to dark pink.
Deep partial thickness – involves deep into the dermis, pink to pale ivory colour, the skin does not blanch, hair falls out, surgically removed
Full-thickness – the epidermis and dermis is destroyed, may penetrate underlying structures, dense white, waxy, charred, skin often feels leathery (eschar)
Outline the problems that can arise as a result of the loss of skin integrity caused by a burn injury.
The normal protective from invasion of harmful substances, loss of fluids and electrolytes and regulation of the body temperature are altered. Following a burn the normal protective defence mechanisms including defensives derived from the kerstinocytes and acis secreations from sweat and sebaceous glands are lost, resulting in wounds becoming colonised and invaded by microorganisms.
Identify the criteria for fluid resuscitation in a burns patient and the formula used to calculate fluid requirements.
Adult: >15%TBSA
Children:>10% TBS
FORMULA:
4ml x TBSA (%) x body weight (kg); CSL
50% given in first eight hours;
25% given in second eight hours.
25% given in third eight hours.
Add daily intake 83mls on top
Which two factors determine the extent of the systemic effects of a burn?
The total body surface area burnt and the depth of the burn
Describe and compare a superficial partial thickness burn to a deep partial thickness burn.
superficial partial thickness: epidermis and superfcial dermis blister, red or motted painful, exudate heals 14days
deep partial thickness burn: deep into the dermis pink to pale ivory colour skin does not blanch hair falls out suergly excised
Complete the following table using Wallace’s Rule of Nines – Adults TBSA%
Fingers and hands-1% Head: 9%-4.1/2%) Chest (anterior trunk): 18% -9% top and bottom half Back (posterior trunk): 18%-9% top and bottom half Right arm: 9%-41/2% front and back Left arm: 9%-41/2% front and back Genitalia-1% Right leg: 18%-9% front and back Left leg: 18%-9% front and back
What is a circumferential burn?
When the burn is a circumferential (burned all the way around). In full-thickness burns, both the epidermis and the dermis are destroyed along with sensory nerves in the dermis. The tough leathery tissue remaining after a full-thickness burn has been termed eschar.
An 80kg patient has suffered Thermal burns to his entire thorax and back (circumferential).:
Calculate the percentage of burns this patient has sustained using the ‘rule of nines’.
Thorax – 18%
Back – 18%
Total body surface area affected by burns is 36%
An 80kg patient has suffered Thermal burns to his entire thorax and back (circumferential).:
Using the adult formula for fluid resuscitation, calculate the fluid requirements for this patient in the:
4mls / x 80kg x 36% (TBSA) = 11520mls
50% of 11520mls is required in the first 8 hours post burn. 5760 / 8hrs = 720mls / per hr + 83mls
25% of 5760mls is required in the second 8hrs post burn. 2880 / 8hrs = 360mls / per hr + 83mls
25% of 5760mls is required in the third 8hrs post burn. 2880 / 8hrs = 360mls / per hr + 83mls
Note: on top of this fluid quantity the patient will also require the ‘normal’ daily intake of hydration over 24 / 24. Average intake 2000mls thus 2000mls over 24/24 = 83mls / hr
In the first 8 hours 720mls + 83mls = 803mls /ph
In the second 8 hours 360mls + 83mls = 443mls / ph
In the third 8 hours 360mls + 83mls = 443mls / ph
An 80kg patient has suffered Thermal burns to his entire thorax and back (circumferential).:
Discuss in detail why intravenous fluid resuscitation is required for this patient? Please also include an example of the type of IV fluid likely to be administered to this patient in the first 24 hours, and why this choice of fluid is appropriate?
Indication of TBSA is above 15% therefore this patient requires fluid resus. The patient will have sustained systemic effects causing adverse effects such as fluid loss, dehydration. The IV fluid likely to be administered in CLS / Hartman’s solution. The reason for this choice of fluid is because it is the most physiologically adaptable fluid and because its electrolyte content is most closely related to the body’s blood serum and plasma.
You are caring for a 20 year old female patient that has partial thickness burns to the anterior aspect of her left leg and full thickness burns to her perineum. What percentage of body surface area is burned?
10%
A 47 year old male has been admitted with circumferential burns of both his legs and genitals. What percentage of his body has been burned?
37%
A 20-year-old male presented to ED after he tripped and fell into a small camp fire. He has burns to his hands, anterior aspect of his arms and upper chest. What percentage of his body has been burned?
20%???
