Burns Flashcards

1
Q

List the three zones of burn injury.

A
  1. Central zone of coagulation - irreversible cellular injury
  2. Zone of stasis -> vasoconstriction and coagulation - potentially salvagable
  3. Zone of hyperaemia
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2
Q

Describe the classification of burn severity.

A
  • Superficial thickness - epidermal layer only - pain and swelling - full healing in ~7days
  • Partial thickness - epidermis and some proportion of the dermis - characterised by blister formation
    • Superficial partial - bright red, moist, exquistely tender, heal in 2-3wks with minimal scarring
    • Deep partial - dark red, yellow/white, take >3wks to heal, often hypertrophic scarring
  • Full thickness - epidermis + full dermis including all epidermal appendages (hair follicles, sweat and sebaceous glands. White, waxy and insensate. Healing by scar tissue (or grafts) only.
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3
Q

Describe the “rule of nines” for the assessment of burns BSA.

A
  • 9% for head and neck
  • 18% front of torso
  • 18% back of torso
  • 9% for each arm
  • 18% for each leg
  • 1% for groin
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4
Q

What is the name of the chart that calculates BSA burns in children?

A

Lund and Browder chart.

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5
Q

List the management priorities in a walk-in patient with severe burns.

A

Primary survey:

  • Airway assessment and definitive mgt if required. C-spine precautions if mechanism suggests injury.
  • Breathing assessment w/ supplemental O2 and venitlatory support if req’d
  • Circulation - IV access, assessment of HR and BP, signs of additional trauma, FAST scan
  • Disability - GCS assessment with definitive mgt of airway if req’d
  • Exposure - Expose patient, remove burnt clothing, keep the patient warm

Simultaneous administration of opioid analgesia

Provide first aid if not already completed - 20mins cool running water.

Administration of IVFs - pending accurate calculation of fluid req’ts

Dressing of wounds - cling wrap esp’lly if trf to burns centre req’d

Remember: bronchospasm, CO or cyanide poisoning, trauma

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6
Q

List the signs of CO poisoning.

A
  • Headache
  • Nausea + vomiting
  • Tachycardia
  • Confusion
  • Irritability
  • Dec’d LOC
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7
Q

What % of COHb suggests CO poisoning? How is it measured?

A

>15%

VBG

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8
Q

What is the dissociation half life of CO?

How can this be reduced (treated)?

What is the dissociation half life with this treatment?

A
  • 3-4hrs
  • High FiO2
  • ~50mins
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9
Q

What is the biochemical finding common to cyanide poisoning.

A

HAGMA w/ persistent lactic acidosis.

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10
Q

What is the antidote treatment for cyanide poisoning?

A
  1. Hydroxocobalamin 2.5g in 100ml normal saline over 15mins
  2. Repeat above dose again over 15mins
  3. If no improvement:
    1. Repeat above dose OR
    2. consider Sodium thiosulphate 200mg/kg over 10mins
    3. can repeat Na thiosulphate dose if no improvement
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11
Q

Name and describe the formula for calculating fluid resuscitation in burns.

What %TBSA does this formula apply to?

What type of fluid?

A
  1. The Parkland Formula = 4ml/kg x TBSA % X Wt (kg)
    1. Give 50% over first 8h
    2. Give 2nd 50% over next 16h
    3. Add maintenence in paeds
    4. Monitor and titrate against
      1. BP, HR
      2. UO (0.5-1ml/kg/hr in adults; >1ml/kg/hr in paeds)
  2. >15% TBSA in adults, >10% in kids
  3. Hartmann’s
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12
Q

List the criteria for referral to a Tertiary Burns Centre.

A
  • >20% TBSA partial thickness in any age group
  • >10% TBSA partial thickness in <10y or >50y
  • >5% TBSA full thickness in any age group
  • Involvement of special areas:
    • face (inc’g eyes, ears)
    • hands or feet
    • genitalia or perineum
    • major joints
  • Inhalational injury
  • Other sig’t injuries
  • Electrical burns
  • Sig’t co-morbidities
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