Burns Flashcards
What are the 4 different types of burn?
Thermal
Chemical
Frictional
Electrical
What are the three zones of a burn?
Coagulative necrosis
Stasis
Hyperaemia
What is the zone of coagulative necrosis?
In the middle of the burn
Irreversible cell death
What is the zone of stasis?
Compromised circulation
Potentially salvageable if treated
Progresses over the first 3-5 days
What is the zone of hyperaemia?
Widespread erythema around the burn
Will recover
What are the CV effects of a large burn?
Widespread release of inflammatory mediators–>
Leaky capillaries –> loss of protein and fluids (third spacing)
–> hypotension and reduced organ perfusion
What other systemic effects occur following a large burn?
ARDS
Increased BMR –> hypermetabolism
Immunosuppression
Loss of gut barrier function –> bacterial translocation and sepsis
Which two rules are used to calculate % total body surface area (TBSA) of a burn?
Wallace rule of 9s
Palmar rule
What does Wallace rule of 9s state?
9% for head, each arm
18% of each leg, front of trunk, back
–> different in children
What does the palmar rule state?
Palm surface (including fingers) = 1% of TBSA
What are the different depths of burn?
Epidermal Superficial dermal Mid dermal Deep dermal Full thickness
Describe an epidermal burn in terms of colour, blistering, capillary refill, sensation and healing:
Red No blistering Brick cap refill Painful Heals < 7 days
Describe a superficial dermal burn in terms of colour, blistering, capillary refill, sensation and healing:
Pale pink Small blisters Slow cap refill Very painful Heals <14 days
Describe a mid dermal burn in terms of colour, blistering, capillary refill, sensation and healing:
Dark pink Blistering Slow cap refill Reduced sensation May or may not heal
Describe a deep dermal burn in terms of colour, blistering, capillary refill, sensation and healing:
Blotchy red May or may not blister No cap refill No sensation Required surgery to heal
Describe a full thickness burn in terms of colour, blistering, capillary refill, sensation and healing:
White eschar No blistering No cap refill No sensation Requires surgery to heal
What is the system for managing a large burn?
ABCDE
FATT - fluids, analgesia, tests, tubes
Secondary survey
How do you work out how much fluids to give in burn management?
Parkland’s formula: use Hartmann’s
3-4ml x TBSA x weight (kg)
- give half of fluid in first 8 hours from burn
- give next half in next 16 hours
*different for children
Which analgesia should you give?
Morphine
Which bedside tests should be done?
Observations Urinalysis --> myoglobin, protein Glucose (increased metabolism) ECG --> hypokalaemia --> arrhythmia ABG --> hypoxia, CO poisoning, acidosis
Which blood tests should be done?
Standard baseline bloods Group and save Clotting Bone profile (calcium) CK Cardiac enzymes
Which imaging should be done?
CXR for ARDS
Which tubes need to be put in and why?
NG tube –> empty bowel as low of barrier function can lead to sepsis
Urinary catheter –> monitor output
Which aspects should be included in your secondary survey?
AMPLE history
Tetanus jab (large wound)
Photograph injuries
