Burns Flashcards
What are the four main types of burn?
Thermal
Electrical
Chemical
Radiation
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
What are the key features of an electrical burn?
Severity depends on strength of voltage & duration of contact
-associated deep tissue damage
What are the key features of a chemical burn?
May penetrate deep into skin & cause continued damage
-alkali burns are worse
What is the cause of a radiation burn?
Due to radiation exposure
-associated w/ cancer
How is the severity of a burn assessed?
Depth
Amount of skin involved
Associated clinical features
How can the depth of a burn be classified?
Full
Partial thickness
What defines partial thickness burns?
Epithelial elements spared
-allows spontaneous healing
How can partial thickness burns be classified?
Superficial erythema
Superficial partial thickness
Deep partial thickness
What clinical features suggest a partial thickness burn?
Erythema that
- blanches on pressure
- retains sterile pinprick sensation
- bleeds on irritation
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
What is a superficial partial thickness burn?
Burn involving germinal layer
- dermal appendages preserved
- blistering & sloughing of skin
- heals w/i 10 days
What is a deep partial thickness burn?
Burn involving germinal layer & dermis/dermal appendages
- slow healing
- associated scarring
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
What clinical features suggest a full thickness burn?
Non-blanching
Do not bleed on needle testing
Sensation absent
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?
1%
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
4ml X SA of Burn X Kg
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%
