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CP3 Crit Care > Burns > Flashcards

Burns Flashcards

1
Q

What are the four main types of burn?

A

Thermal
Electrical
Chemical
Radiation

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2
Q

What are the key features of a thermal burn?

A

Burn due to direct contact w/ hot object/vapour

-depth determined by temp, duration, relative thickness of skin

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3
Q

What are the key features of an electrical burn?

A

Severity depends on strength of voltage & duration of contact
-associated deep tissue damage

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4
Q

What are the key features of a chemical burn?

A

May penetrate deep into skin & cause continued damage

-alkali burns are worse

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5
Q

What is the cause of a radiation burn?

A

Due to radiation exposure

-associated w/ cancer

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6
Q

How is the severity of a burn assessed?

A

Depth
Amount of skin involved
Associated clinical features

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7
Q

How can the depth of a burn be classified?

A

Full

Partial thickness

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8
Q

What defines partial thickness burns?

A

Epithelial elements spared

-allows spontaneous healing

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9
Q

How can partial thickness burns be classified?

A

Superficial erythema
Superficial partial thickness
Deep partial thickness

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10
Q

What clinical features suggest a partial thickness burn?

A

Erythema that

  • blanches on pressure
  • retains sterile pinprick sensation
  • bleeds on irritation
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11
Q

What is superficial erythema?

A

Superficial burn that leads to blanching erythema

  • due to capillary dilation
  • w/ or w/o blistering
  • germinal layer intact
  • heals w/i few days
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12
Q

What is a superficial partial thickness burn?

A

Burn involving germinal layer

  • dermal appendages preserved
  • blistering & sloughing of skin
  • heals w/i 10 days
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13
Q

What is a deep partial thickness burn?

A

Burn involving germinal layer & dermis/dermal appendages

  • slow healing
  • associated scarring
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14
Q

What is a full thickness burn?

A

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
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15
Q

What clinical features suggest a full thickness burn?

A

Non-blanching
Do not bleed on needle testing
Sensation absent

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16
Q

What is the Lund & Bowder chart?

A

Chart allowing for accurate estimation of burn surface area

17
Q

What is the rule of 9’s?

A

Used to estimate body surface area

  • 9% = head & neck, each arm
  • 18% = each leg, front & back of trunk
  • 1% = perineum/groin
18
Q

How much of a patient’s body area does the palm/fingers represent?

A

1%

19
Q

What are the clinical features of an airway burn?

A 
Hx of fire in enclosed space
Stridor
Tachypnoea
Dyspnoea
Singed nasal hair
Facial burns
Harsh cough
Carbonaceous sputum
20
Q

What are the main complications of an airway burn?

A

Laryngeal/pharyngeal oedema

Airway obstruction

21
Q

What are the main complications of a burn?

A

Airway
Hypovolaemic shock
Anaemia
Pain

22
Q

What factor determines the severity of hypovolaemic shock in a burn?

A

Area of burn

23
Q

What causes hypovolaemic shock in a burn?

A

Loss of epidermis plus intense plasma exudation

24
Q

What causes anaemia in a burn?

A

Destruction of RBCs in involved capillaries

25
Q

What causes pain in a burn?

A

More severe in superficial burns

-deep burns relatively painless

26
Q

What is the immediate management of a burn?

A 
Immediate first aid
   -remove overlying clothing
   -apply cool running water
   -cling film
Resuscitation
   -if burn area >15% admit for IV fluids
Assess severity
27
Q

What is the systemic management of a burn?

A

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

28
Q

What is the Parkland formula?

A

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
29
Q

What is the local management of a partial thickness burn?

A

Simple, non-adherent dressing
Topical a/b if infec suspected
Sulfadiazine cream
-for hands if involved

30
Q

What is the local management of a full thickness burn?

A

Total excision of burn wound

  • smaller defects close primarily
  • larger defects require skin grafts
31
Q

What is the local management of a full thickness circumferential burn?

A

Incise acutely w/ escharotomy

-can constrict to restrict blood flow/breathing

32
Q

What is the local management of burns to the hand?

A

Splint in position of function
Elevate
Early excision of burn
Graft

33
Q

What are the early complications of a burn?

A 
Wound sepsis
   -S. pyogenes in 1st week
   -Pseudomonas after 1st week
Wound contractures
   -in circumferential burns
34
Q

What are the late complications of a burn?

A

Sepsis (wound & inhalation chest infec)
Acute peptic ulceration (Curling’s)
AKI (hypovolaemia, precipitation of haemo/myo globin)
Psych disturbances

35
Q

What are the requirements for tissue grafting?

A

<5 days since burn

Wounds must be free of infection

36
Q

What is the best graft covering for burns?

A

Autograft split skin from unburnt areas

37
Q

What are the indications for referral to a specialist burns centre management?

A 
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
38
Q

What is the outpatient management of minor burns?

A

Reassurance & analgesia
Blister deroofing & dressing w/ paraffin gauze
Refer if not healed <3wks

39
Q

What are the indications for hospitalisation with a burn?

A

Adults w/ partial thickness burns <10%
Children w/ partial thickness burns <5%
Full thickness burns <1%

CP3 Crit Care (11 decks)

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