burns

Question 1

causes of burns

classification of burns

Answer 1

thermal
electrical
chemical

superficial - epidermis 1st degree burn
dermis - superficial dermal
deep dermal - second degree burn

full thickness - sub-cutaneous
third degree burn

Question 2

assessment of burn area

Answer 2

palmer surface
palm is .8% of total body surface area
estimate small burns
or large burns

rule of nines
lund and Browder chart - most accurate

Question 3

pathophysiology of burns

Answer 3

3 zones
coagulation - mx point of damage. irreversible tissue loss due to coagulation of the constituent proteins

stasis - surrounding coagulation
decreased tissue perfusion
potentially salvageable
resuscitation is to increase tissue perfusion here and prevent any damage becoming irreversible. Additional insults such as prolonged hypotension, infection, or oedema can convert this zone into an area of complete tissue loss.

Zone of hyperaemia—In this outermost zone tissue perfusion is increased. The tissue here will invariably recover unless there is severe sepsis or prolonged hypoperfusion

• limit risk of infection
• hypotension
• hypoperfusion
• limit risk of sepsis

Question 4

pathophysiology

Answer 4

systemic response 
Skeletal muscle
Cardiovascular
Renal
Respiratory 
Neurological
Hepatic
Gastrointestinal

Question 5

respiratory response

Answer 5

associated inhalation injury

second most common cause of death in first week

Question 6

inhalation injury

Answer 6

Suspect if:
history of burned in close space
singed nasal hairs
facial burns
carbonaceous sputum (indication of exposure to smoke)
abnormal breath sounds (Hypoxia, crackles, and wheezes are seldom present on admission, occurring only in those with the most severe injury and implying an extremely poor prognosis)
bronchoscopy

Upper airway obstruction and bronchospasm is caused by direct thermal injury as well as chemical irritation.
Burned biological materials are caustic to the airways and induce an initial response to trigger proinflammatory response. There is a 10-fold increase in bronchial blood flow within minutes of an inhalation injury which is sustained and causes increased permeability and destruction of the bronchial epithelium.
Early in the injury, the secretions, from goblet cells, are copious and foamy in nature. In hours to days these secretions solidify forming casts and airway obstruction.

Question 7

pathophysiology

Answer 7

Direct thermal damage/secondary inflammation
Paralysis of ciliary function
Coagulation necrosis of mucosa
Laryngospasm/Bronchospasm
Debris in airways (medium for infection)
Pulmonary oedema
Inactivation of surfactant
↓ lung compliance (V/Q mismatch)
Disruption of the epitheal tracheobronchial lining,

Question 8

escharotomy

Answer 8

The burnt skin is incised down to the subcutaneous fat and into the healthy skin (up to 1cm). The incisions should be deep enough to release all restrictive effects from the eschar (tough leathery tissue remaining after a full-thickness burn).

Question 9

management of inhalation injury

Answer 9

Endotracheal intubation if upper airway obstruction is suspected.
Cricothyrotomy
Physiotherapy 
Pharmacology
Ventilation

Question 10

physiotherapy treatment

Answer 10

Aims: (i) remove any excess secretions (ii) improvement of gas exchange (iii) prevent/treatment of atelectasis
Therapies/techniques/modalities
Precautions: avoid suctioning if patient not intubated; care with wound (s), risk of infection; pain management “Good pain control is linked to better wound healing, sleep, participation in activities of daily living, quality of life and recovery”