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Plastics > Burns > Flashcards

Burns Flashcards

1
Q

What is the pathology of a burn?

A

Proteins in the cells becoming denatured

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2
Q

What zone is the damage the worst in?

A

Zone of coagulation

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3
Q

What happens to the proteins in the zone of coagulation?

A

They are irreversibly damaged

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4
Q

Pathology of the zone of stasis

A

If there if infection or oedema etc and so won’t heal as well

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5
Q

Recovery of the zone of hyperemia

A

Do tend to recover
Apart from in
- sepsis
- hypoxia etc

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6
Q

Effects of burns

A 
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
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7
Q

Why is there increased cortisol from a burn?

A

Due to the stress

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8
Q

Why is there fluid loss from a burn?

A

Increased basal metabolic rate

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9
Q

Why is there an increased BMR in burns?

A

Increased catabolism of fats and sugars to provide energy to heal the burns

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10
Q

Types of burns

A

Chemical
Thermal
Electrical
Radiation

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11
Q

What do chemical burns look like?

A

Shiney

Lose top layer so red appearance

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12
Q

What do electrical burns look like?

A

Can have a round entrance
Can have an exit wound
Deeper
Can be black on the outside

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13
Q

What level do electrical burns go to?

A

At least subdermal

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14
Q

Who are thermal burns common in?

A

People who drink a lot

Epilepsy

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15
Q

Where are radiation burns commonly seen?

A

Iatrogenic e.g. after mastectomy

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16
Q

3 causes of damage of electrical injury

A

Conversion to thermal energy
Blunt trauma from muscle contraction
Direct effect

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17
Q

Classification of the extent of burns

A 
Superficial 
Superficial dermal 
Deep dermal 
Full thickness
4th degree
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18
Q

What does a superficial burn effect?

A

The epidermis

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19
Q

Presentation of a superficial burn

A

Sore
Red but still blanches (still got cap refill)
No blistering

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20
Q

How long would a superficial burn take to heal?

A

A week

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21
Q

What is another name for a superficial dermal burn?

A

Partial thickness

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22
Q

What layers of the skin does a superficial dermal burn effect?

A

Epidermis

Upper dermis

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23
Q

Presentation of superficial dermal burns

A

Blisters
Still blanches (still got cap refill)
Will leave a scar
Painful

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24
Q

How long will superficial dermal burns take to heal?

A

Up to 2 weeks

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25
Q

What layers of the skin are affected in deep dermal burns?

A

Reticular dermis

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26
Q

Presentation of deep dermal burns

A

No pain
Red and white
Non blanching (no cap refill)

27
Q

How long do deep dermal burns take to heal?

A

2 weeks

28
Q

What layers of the skin are effected in full thickness burns?

A

Fat layers

Can go further

29
Q

Presentation of full thickness burns

A

White or charred appearance
Non blanching
Not painful

30
Q

Healing of full thickness burns

A

Will not heal on own - grafts or surgery needed

31
Q

Why in some thickness of burns would you get no pain?

A

As pain receptors are burnt off

32
Q

What does a 4th degree burn affect?

A

Muscle
Fat
Bone

33
Q

What tells us how much fluid is lost from a burn?

A

The surface area of the burn

34
Q

What is the rule of 9s? (fluid loss)

A

Different scores for different parts of the body

Everything adds up to 9 apart from the groin (1)

35
Q

What is used to measure fluid loss from smaller burns?

A

Hand method

36
Q

In the hand method, how much does a palm equate to?

A

1%

37
Q

What is used to measure the surface area of burns in children? Why?

A

Lunder and Browder charts

Kids with disproportionate bodies

38
Q

Treatment for superficial burns

A 
Remove clothing from area
Cold water for 20 mins
OTC pain relief 
Do not burst blisters
Cover with cling film / bandage
39
Q

What must be considered when dealing with the airway of ABCDE of a burn?

A

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

40
Q

What must be considered when dealing with the breathing of ABCDE of a burn?

A

Respiratory compromise / effort
Expansion
CO poisoning

41
Q

What must be considered when dealing with the circulation of ABCDE of a burn?

A

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

42
Q

What is the thresholds for bilateral large bore access or central access due to burns in adults and children?

A

Adults > 15%

Children > 10%

43
Q

What does parklands formula tell you about? What does it not?

A

Tells you about need for replacement fluid

Not maintenance

44
Q

What is parklands formula?

A

4ml x body weight (kg) x surface area of the burns (%)

45
Q

When is replacement fluid given?

A

50% in 1st 8 hours

50% over the next 16 hours

46
Q

What are the fluids of choice for replacement fluids?

A

Saline

Hartmans

47
Q

What does hartmans contain?

A

Electrolytes

48
Q

What would you consider doing in dirty injuries / burns?

A

A tetanus booster

49
Q

What symptom can circumferential burns cause?

A

Tightness

50
Q

Treatment of circumferential burns?

A

Escharotomy

51
Q

What presentation can circumferential burns have?

A

Scarring
Sooty appearance
No pink

52
Q

What must be considered with the D and E of ABCDE when dealing with burns?

A

Glucose
Temperature
Expose to reveal other injuries

53
Q

What happens to the glucose levels with burns?

A

Increased BMR can lead to hypoglycaemia

54
Q

What happens to the temperature in burns?

A

Not the same barrier function so can become hypothermic

55
Q

2 main things to be worried about in burns

A

Infection

Shock

56
Q

What threshold of adults and children are used when transferring to burn care services?

A

> 10% adults

> 5 % children

57
Q

Criteria to transfer to burn care services

A 
> 10% adults
> 5% children
Not healed within 2 weeks
Suspicion of NAI
All full thickness and circumferential burns
58
Q

Long term consequences of burns

A

Scarring
Psychological - depression / PTSD
Contractures

59
Q

What are contractures as a consequence of burns?

A

Limb cant work as well due to scarring

60
Q

Complications of electrical burns

A

Rhabdomyolysis
Peripheral nerve injuries
Osteonecrosis (long bones)
Compartment syndrome

61
Q

What is important to do when treating chemical burns?

A

Important to irrigate to get it out - > usually using plenty of water (some exceptions)

62
Q

What is paramount when dealing with chemical burns?

A

Personal safety

63
Q

What do chemical burns caused by alkali metals need to be irrigated with?

A

Oil

64
Q

Which of alkalis or acids tend to penetrate deeper?

A

Alkalis

Plastics (4 decks)

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