Burns Flashcards
What is occurring during a hypermetabolic response to burns?
- The stress caused by the burn increases the nutritional and metabolic need of the body, this can be characterised by the following.
o Increase oxygen need
o Increase glucose use
o Protein and fat wasting - Heat production is also increased to balance heat loss from the burned areas.
Why may renal failure occur in the burn victim?
- Haemolysis (destruction or rupture of red blood cells)
- Rhabdomyolysis
- Decreased fluid volume
- Drugs
What GIT issue may occur in the burn’s patient?
- Gastric dilation (may lead to ischemia, its bad news)
- Decreased peristalsis (moving of food and stomach content) caused by drugs.
What Nervous system dysfunctions may be caused by burns?
- Periods of hypoxia
- Fluid volume deficits
- Electrical burns
What 3 considerations need to be made in regards to burns classification?
- Depth
- Surface area
- Location
What layer of the skin is involved in superficial burns and are they included in total body surface area calculations?
- Only the epidermis is involved, example of these burns would be sunburn. Superficial burns are not included in the total body surface area calculation.
What layer of the skin is involved in Partial thickness burns?
- They involve the destruction of the epidermis and superficial dermis. Blistering will occur in these burns.
What are the two forms of partial burns and how do they present?
- Superficial partial thickness
o Will present bright red and moist - Deep partial thickness
o Will present dark red or yellow white
What layers of the skin are involved in a full thickness burn and how do they present?
- Full thickness burns involve the epidermis, dermis and dermal appendages.
- They appear charred or pearly white, brown or black colour and feel dry and leathery.
How does healing occur in full thickness burns?
- Because of the depth only able to heal through scarring or skin grafting.
What causes relative fluid loss in burns patients?
- Tissue oedema
What are the causes of absolute fluid loss in burns patients?
- Evaporation due to the exposed dermis
- Cardiac output may drop by 30-50% resulting in a shock response
What are the two-surface area of burn classification calculations?
- Wallace rule of nines
- Lund and Browder Charts
What are the classifications for Minor Burns
- <10% TBSA in adults
- <5% TBSA in 10yo or >50yo
- <2% full thickness burns
What is true about the dermal layer in paediatrics and geriatrics in regards to burns?
- Their dermal layer is much thinner and has a greater capacity for more sever burn and fluid loss.
What are the classifications for moderate burns?
- 10-20% TBSA in adults
- 5-10% TBSA in <10yo or >50yo
- 2-5% full thickness burns
- Suspected inhalation injury
- Circumferential burn
What are the classifications of Major burns?
- Partial or full thickness burns with. o TBSA >10% in patients <10yo or >50yo o TBSA >20% in patients of any age group - High voltage burn - Known inhalation injury - Significant burn to face, hands, feet, genitalia, perineum or major joints
What types of burns are there?
- Thermal
- Chemical
- Electrical
- Radiation
What is the most common type of burn and what age group is at the highest risk for this burn type?
- Thermal burns are the most common type of burn,
- The 18-35yo age group is at most risk
What temperatures need to be present for a thermal burn to occur?
- The soft tissue is burned when temperatures reach >45 degrees c or with a lower temperature that are in constant contact with the soft tissue for >6 hours.v
What are the causes of coagulation of soft tissue in thermal burns (the denaturation)?
- Capillary permeability increases
- Fluid loss occurs
- Plasma viscosity increases
- Resultant microthrombi formation
Describe Jackson’s burn wound model 1?
Zone of coagulation
Zone of status
Zone of Hyperamia
What is the zone of coagulation in Jacksons burn model?
- Centre of the wound, the area of most intense contact
- Coagulation and necrosis of cells, this tissue is nonviable
What is the zone of stasis in Jackson’s burn model?
- This zone surrounds the coagulation zone and this tissue is potentially viable.
What is the zone off Hyperaemia?
- This is seen at the periphery of the wound; the tissue of this site is viable.
- There is an increase blood flow due to inflammatory response.
- This site will recover within 7-10 days if no infection or shock is present.
What are complications associated with thermal burns?
ccelerated evaporation of fluid, 5 -15 x regular rate.
- Fluid loss due to shock occurs between 8 -12 hours
o Decreased venous return
o Decreased cardiac output
o Increased vascular resistance
What is the parkland formula?
- 4mls/Kg x BSA% given over 24hours
What is AV initial fluid administration?
% of Burn surface area x Weight in KG to be given over 2 hours from time of burn.
- 50% TBSA x 80kg = 4000mls
What is the initial fluid administration for paediatrics?
- 3x % of BSA x Weight in KG, given over 24 hours.
- 3 x 50% BSA x 20kg = 3000mls with half does to be given in first 8 hours.
