burns Flashcards
immediate first aid for burns
airway, breathing, circulation
burns caused by heat: remove the person from the source. Within 20 minutes of the injury irrigate the burn with cool (not iced) water for between 10 and 30 minutes. Cover the burn using cling film, layered, rather than wrapped around a limb
electrical burns: switch off power supply, remove the person from the source
chemical burns: brush any powder off then irrigate with water. Attempts to neutralise the chemical are not recommended
how to assess the extent of the burn
Wallace’s Rule of Nines: head + neck = 9%, each arm = 9%, each anterior part of leg = 9%, each posterior part of leg = 9%, anterior chest = 9%, posterior chest = 9%, anterior abdomen = 9%, posterior abdomen = 9%
Lund and Browder chart: the most accurate method
the palmar surface is roughly equivalent to 1% of total body surface area (TBSA). Not accurate for burns > 15% TBSA
how to assess the depth of the burn
1) Superficial epidermal - First degree-Red and painful
2) Partial thickness (superficial dermal) Second degree-Pale pink, painful, blistered
3) Partial thickness (deep dermal)-Second degree Typically white but may have patches of non-blanching erythema. Reduced sensation
4) Full thickness-Third degree White/brown/black in colour, no blisters, no pain
when to refer to secondary care
all deep dermal and full-thickness burns.
superficial dermal burns of more than 3% TBSA in adults, or more than 2% TBSA in children
superficial dermal burns involving the face, hands, feet, perineum, genitalia, or any flexure, or circumferential burns of the limbs, torso, or neck
any inhalation injury
any electrical or chemical burn injury
suspicion of non-accidental injury
initial management of burns
initial first aid as above
review referral criteria to ensure can be managed in primary care
superficial epidermal: symptomatic relief - analgesia, emollients etc
superficial dermal: cleanse wound, leave blister intact, non-adherent dressing, avoid topical creams, review in 24 hours
what is the most common malignancy associated with acnathosis nigricans
gastrointestinal adenocarcinoma
what is acanthosis nigricans
Describes symmetrical, brown, velvety plaques that are often found on the neck, axilla and groin.
causes of acanthosis nigricans
- type 2 diabetes mellitus
- gastrointestinal cancer
- obesity
- polycystic ovarian syndrome
- acromegaly
- Cushing’s disease
- hypothyroidism
- familial
- Prader-Willi syndrome
- drugs: oral contraceptive pill, nicotinic acid
pathophysiology of acanthosis nigricans
insulin resistance → hyperinsulinemia → stimulation of keratinocytes and dermal fibroblast proliferation via interaction with insulin-like growth factor receptor-1 (IGFR1)
whats is nickel dermatitis
llergic contact dermatitis and is an example of a type IV hypersensitivity reaction. It is often caused by jewellery such as watches
how to diagnosie nickel dermatitis
allergic contact dermatitis and is an example of a type IV hypersensitivity reaction. It is often caused by jewellery such as watches
tender, erythematous nodules over her forearms.
hypercalcaemia
sarcoidosis
what is erythema nodosum
inflammation of subcutaneous fat
usually resolves within 6 weeks
lesions heal without scarring
causes if erythema nodosum
1) infection
- streptococci
- tuberculosis
- brucellosis
- chlamydia
- leprosy
2) systemic disease
- sarcoidosis
- inflammatory bowel disease
- Behcet’s
3) malignancy/lymphoma
4) drugs
- penicillins
- sulphonamides
- combined oral contraceptive pill
- amoxicillin
5) pregnancy
features of pyoderma gangrenosum
typically on the lower limbs
initially small red papule
later deep, red, necrotic ulcers with a violaceous border
may be accompanied systemic symptoms e.g. Fever, myalgia
causes of pyoderma gangrenosum
idiopathic in 50% inflammatory bowel disease: ulcerative colitis, Crohn's rheumatoid arthritis, SLE myeloproliferative disorders lymphoma, myeloid leukaemias monoclonal gammopathy (IgA) primary biliary cirrhosis
management for pyoderma gangrenosum
the potential for rapid progression is high in most patients and most doctors advocate oral steroids as first-line treatment
other immunosuppressive therapy, for example ciclosporin and infliximab, have a role in difficult cases
if meninngococcal septicaemia is suspect what do you do
parentral ABx
what is purpura
describes bleeding into the skin from small blood vessels that produces a non-blanching rash.
Smaller petechiae (1-2 mm in diameter) may also be seen. It is typically caused by low platelets but may also be seen with bleeding disorders, such as von Willebrand disease.
why should you be cautious if a child comes with new purpuric rash
meningococcal septicaemia or acute lymphoblastic leukaemia.
causes of purpura in childre
Meningococcal septicaemia
• Acute lymphoblastic leukaemia
- Congenital bleeding disorders
- Immune thrombocytopenic purpura
- Henoch-Schonlein purpura
- Non-accidental injury
causes of purpura in adulrs
Immune thrombocytopenic purpura
- Bone marrow failure (secondary to leukaemias, myelodysplasia or bone metastases)
- Senile purpura
- Drugs (quinine, antiepileptics, antithrombotics)
- Nutritional deficiencies (vitamins B12, C and folate)
petechia or purpura in raised SVC pressure
Raised superior vena cava pressure (e.g. secondary to a bad cough) may cause petechiae in the upper body but would not cause purpura.
