Burns Flashcards
What is the pathology of a burn?
Proteins in the cells becoming denatured
What zone is the damage the worst in?
Zone of coagulation
What happens to the proteins in the zone of coagulation?
They are irreversibly damaged
Pathology of the zone of stasis
If there if infection or oedema etc and so won’t heal as well
Recovery of the zone of hyperemia
Do tend to recover
Apart from in
- sepsis
- hypoxia etc
Effects of burns
Fluid loss Bronchoconstriction (smoke inhalation) Increased K+ Decreased Ca+ Na can increase or decrease Increased cortisol Prone to infection Increased CO so have to work harder to get O2 to the Hb ARDS -> fluid build up from the lungs Circumferential burns - e.g. around chest - chest cannot expand as much - compartment syndrome Increased myoglobin leading to AKI Increased capillary permeability
Why is there increased cortisol from a burn?
Due to the stress
Why is there fluid loss from a burn?
Increased basal metabolic rate
Why is there an increased BMR in burns?
Increased catabolism of fats and sugars to provide energy to heal the burns
Types of burns
Chemical
Thermal
Electrical
Radiation
What do chemical burns look like?
Shiney
Lose top layer so red appearance
What do electrical burns look like?
Can have a round entrance
Can have an exit wound
Deeper
Can be black on the outside
What level do electrical burns go to?
At least subdermal
Who are thermal burns common in?
People who drink a lot
Epilepsy
Where are radiation burns commonly seen?
Iatrogenic e.g. after mastectomy
3 causes of damage of electrical injury
Conversion to thermal energy
Blunt trauma from muscle contraction
Direct effect
Classification of the extent of burns
Superficial Superficial dermal Deep dermal Full thickness 4th degree
What does a superficial burn effect?
The epidermis
Presentation of a superficial burn
Sore
Red but still blanches (still got cap refill)
No blistering
How long would a superficial burn take to heal?
A week
What is another name for a superficial dermal burn?
Partial thickness
What layers of the skin does a superficial dermal burn effect?
Epidermis
Upper dermis
Presentation of superficial dermal burns
Blisters
Still blanches (still got cap refill)
Will leave a scar
Painful
How long will superficial dermal burns take to heal?
Up to 2 weeks
What layers of the skin are affected in deep dermal burns?
Reticular dermis
Presentation of deep dermal burns
No pain
Red and white
Non blanching (no cap refill)
How long do deep dermal burns take to heal?
2 weeks
What layers of the skin are effected in full thickness burns?
Fat layers
Can go further
Presentation of full thickness burns
White or charred appearance
Non blanching
Not painful
Healing of full thickness burns
Will not heal on own - grafts or surgery needed
Why in some thickness of burns would you get no pain?
As pain receptors are burnt off
What does a 4th degree burn affect?
Muscle
Fat
Bone
What tells us how much fluid is lost from a burn?
The surface area of the burn
What is the rule of 9s? (fluid loss)
Different scores for different parts of the body
Everything adds up to 9 apart from the groin (1)
What is used to measure fluid loss from smaller burns?
Hand method
In the hand method, how much does a palm equate to?
1%
What is used to measure the surface area of burns in children? Why?
Lunder and Browder charts
Kids with disproportionate bodies
Treatment for superficial burns
Remove clothing from area Cold water for 20 mins OTC pain relief Do not burst blisters Cover with cling film / bandage
What must be considered when dealing with the airway of ABCDE of a burn?
Singed eyebrows / nose hairs
Hoarseness
Carbon deposits in nasopharynx / sputum
If have been in big fire think about intubating quite early as can become oedematous and also tongue swelling
What must be considered when dealing with the breathing of ABCDE of a burn?
Respiratory compromise / effort
Expansion
CO poisoning
What must be considered when dealing with the circulation of ABCDE of a burn?
Hypovolaemic shock from fluid loss
HR, BP, Cap refills
Bilateral large bore access or central access as can be hard to get IV access with burns
What is the thresholds for bilateral large bore access or central access due to burns in adults and children?
Adults > 15%
Children > 10%
What does parklands formula tell you about? What does it not?
Tells you about need for replacement fluid
Not maintenance
What is parklands formula?
4ml x body weight (kg) x surface area of the burns (%)
When is replacement fluid given?
50% in 1st 8 hours
50% over the next 16 hours
What are the fluids of choice for replacement fluids?
Saline
Hartmans
What does hartmans contain?
Electrolytes
What would you consider doing in dirty injuries / burns?
A tetanus booster
What symptom can circumferential burns cause?
Tightness
Treatment of circumferential burns?
Escharotomy
What presentation can circumferential burns have?
Scarring
Sooty appearance
No pink
What must be considered with the D and E of ABCDE when dealing with burns?
Glucose
Temperature
Expose to reveal other injuries
What happens to the glucose levels with burns?
Increased BMR can lead to hypoglycaemia
What happens to the temperature in burns?
Not the same barrier function so can become hypothermic
2 main things to be worried about in burns
Infection
Shock
What threshold of adults and children are used when transferring to burn care services?
> 10% adults
> 5 % children
Criteria to transfer to burn care services
> 10% adults > 5% children Not healed within 2 weeks Suspicion of NAI All full thickness and circumferential burns
Long term consequences of burns
Scarring
Psychological - depression / PTSD
Contractures
What are contractures as a consequence of burns?
Limb cant work as well due to scarring
Complications of electrical burns
Rhabdomyolysis
Peripheral nerve injuries
Osteonecrosis (long bones)
Compartment syndrome
What is important to do when treating chemical burns?
Important to irrigate to get it out - > usually using plenty of water (some exceptions)
What is paramount when dealing with chemical burns?
Personal safety
What do chemical burns caused by alkali metals need to be irrigated with?
Oil
Which of alkalis or acids tend to penetrate deeper?
Alkalis
