Burns Flashcards by Tim Resch

What are the four main types of burn?

Thermal
Electrical
Chemical
Radiation

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What are the key features of a thermal burn?

Burn due to direct contact w/ hot object/vapour

-depth determined by temp, duration, relative thickness of skin

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What are the key features of an electrical burn?

Severity depends on strength of voltage & duration of contact
-associated deep tissue damage

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What are the key features of a chemical burn?

May penetrate deep into skin & cause continued damage

-alkali burns are worse

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What are the key features of a radiation burn?

Due to radiation exposure

-associated w/ cancer

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How is the severity of a burn assessed?

Depth
Amount of skin involved
Associated clinical features

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How can the depth of a burn be classified?

Full

Partial thickness

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What defines partial thickness burns?

Epithelial elements spared

-allows spontaneous healing

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How can partial thickness burns be classified?

Superficial erythema
Superficial partial thickness
Deep partial thickness

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What clinical features suggest a partial thickness burn?

Erythema that

blanches on pressure
retains sterile pinprick sensation
bleeds on irritation

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What is superficial erythema?

Superficial burn that leads to blanching erythema

due to capillary dilation
w/ or w/o blistering
germinal layer intact
heals w/i few days

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What is a superficial partial thickness burn?

Burn involving germinal layer

dermal appendages preserved
blistering & sloughing of skin
heals w/i 10 days

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What is a deep partial thickness burn?

Burn involving germinal layer & dermis/dermal appendages

slow healing
associated scarring

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What is a full thickness burn?

Complete destruction of skin & germinal layer

initial blistering replaced by slough
separates over 3-4wks
leaves granulation tissue
heal by dense scar tissue
contracture & deformity common

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What clinical features suggest a full thickness burn?

Non-blanching
Do not bleed on needle testing
Sensation absent

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What is the Lund & Bowder chart?

Chart allowing for accurate estimation of burn surface area

What is the rule of 9’s?

Used to estimate body surface area

9% = head & neck, each arm
18% = each leg, front & back of trunk
1% = perineum/groin

How much of a patient’s body area does the palm/fingers represent?

What are the clinical features of an airway burn?

Hx of fire in enclosed space
Stridor
Tachypnoea
Dyspnoea
Singed nasal hair
Facial burns
Harsh cough
Carbonaceous sputum

What are the main complications of an airway burn?

Laryngeal/pharyngeal oedema

Airway obstruction

What are the main complications of a burn?

Airway
Hypovolaemic shock
Anaemia
Pain

What factor determines the severity of hypovolaemic shock in a burn?

Area of burn

What causes hypovolaemic shock in a burn?

Loss of epidermis plus intense plasma exudation

What causes anaemia in a burn?

Destruction of RBCs in involved capillaries

What causes pain in a burn?

More severe in superficial burns | -deep burns relatively painless

What is the immediate management of a burn?

``` Immediate first aid -remove overlying clothing -apply cool running water -cling film Resuscitation -if burn area >15% admit for IV fluids Assess severity ```

What is the systemic management of a burn?

``` IV opiates Fluid replacement -Hartmann's as per Parkland formula Systemic a/b -only if invasive infec Nutritiona management ```

What is the Parkland formula?

Determines initial fluid replacement w/ Hartmann's - 4ml x Total Burn Surface Area x wt (kg) - half given in first 8hrs - half given in hrs 8-24 - catheterise

What is the local management of a partial thickness burn?

Simple, non-adherent dressing Topical a/b if infec suspected Sulfadiazine cream -for hands if involved

What is the local management of a full thickness burn?

Total excision of burn wound - smaller defects close primarily - larger defects require skin grafts

What is the local management of a full thickness circumferential burn?

Incise acutely w/ escharotomy | -can constrict to restrict blood flow/breathing

What is the local management of burns to the hand?

Splint in position of function Elevate Early excision of burn Graft

What are the early complications of a burn?

``` Wound sepsis -S. pyogenes in 1st week -Pseudomonas after 1st week Wound contractures -in circumferential burns ```

What are the late complications of a burn?

Sepsis (wound & inhalation chest infec) Acute peptic ulceration (Curling's) AKI (hypovolaemia, precipitation of haemo/myo globin) Psych disturbances

What are the requirements for tissue grafting?

<5 days since burn | Wounds must be free of infection

What is the best graft covering for burns?

Autograft split skin from unburnt areas

What are the indications for referral to a specialist burns centre management?

``` Burns >30% TBA Partial thickness burns >10% (5% in paeds) Full thickness burns >1% Circumferential injury Associated inhalation injury Chemical/electrical injury Extremes of age ```

What is the outpatient management of minor burns?

Reassurance & analgesia Blister deroofing & dressing w/ paraffin gauze Refer if not healed <3wks

What are the indications for hospitalisation with a burn?

Adults w/ partial thickness burns <10% Children w/ partial thickness burns <5% Full thickness burns <1%