Burns Flashcards
What are the functions of skin?
sensation (sensory organ)
Vit D synthesis (endocrine)
Thermoregulation
Immune response- enzymes secreted in sweat and sebum
Barrier to fluid loss
Social interaction (flushing and blushing)
How do burns affect a patient socially?
social interaction aesthetic function occupations interpersonally sexual effects and society
what is a burn?
an injury to body tissues as a result of extremes of energy causing cell death
What types of burns can you name?
Heat (dry flame, sunstroke, wet scalds) Mechanical e.g. friction Electrical Chemical (alkali worse than acidic) Radiation Cold injuries
Why do patients with extremes of age have more problems with burns?
poor reflexes and understanding of spacial and situational awareness
inattention or carelessness
inability to fend for themselves
thinner and more frail skin- loss of collagen
How does a burn lead to shock?
Hypovolaemia (due to oedema) and tissue damage–>increase in inflammatory mediators–> leaking vessels–> increased resistance and BP
What is the Jackson’s burn wound model?
Zone of coagulation nearest the source- this zone has irreversible necrosis
Zone of ischaemia- there is reduction on the dermal circulation- damaged but viable- without resuscitation ischaemia will worsen
Zone of hyperaemia- reversible increase in blood flow in inflammation
Describe the haemodynmics of burns?
Decreased cardiac output–>decreased venous return–>catecholamine release–>decreased urine output–>hypovolaemia–>inflammatory mediator release
What does a burns assessment involve?
Area- Rule of 9s (head 9%, torso 18%, each arm 9%, each leg 18% and each hand 1%)- do not include erythema in classifying surface area burn as the barrier function is not lost so no fluid loss
Depth- based on which layers are affected-
Erythema (e.g. sunburn- red, painful, blanches when pressed, vascularity maintained)
Partial thickness- blistered, painful, tissue paper appearance, fluid loss
Full thickness- no blanching, dry, leathery, no blisters, hair will come out easily, painless as nerve endings destroyed
Cause
How do you know if the skin will re-epithelialise after a burn?
If the dermis is unaffected it will re-epithelialise. The dermis contains all the organs of the skin.
Which burn victims require fluid resuscitation?
adults with >15% burn
Children with >10% burn
How do you calculate the volume of fluid required for a burn patient?
4ml/kg/%burn in the first 24hrs
community management of burns
maintain personal safety
remove burn source
cool burn and keep patient warm
provide barrier to area e.g. longitudinal strips of clingfilm (do not wrap!–>constriction)
Primary survey ABCDEF (F for fluids) (CPR)
How can you treat compartment syndrome?
escharotomies and fasciotomies- relieves pressure on the vascular bundles
What are the 5 Ps in compartment syndrome?
Pain, pallor, paralysis, paraesthsia, pulselessness
name 2 respiratory adjuncts?
oropharyngeal airway e.g. guedel airway- only if no gag reflex present
nasopharyngeal airway
