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Acute > Burns > Flashcards

Burns Flashcards

1
Q

What are the bone zones?

A
  1. Zone of coagulation: area of maximum damage, irreversible tissue loss due to coagulation of proteins
  2. Zone of stasis: decreases tissue perfusion, tissue is possibly salvageable
  3. Zone of hyperaemia/ inflammation: adequate perfusion due to patent blood vessels
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2
Q

What are the types of burns?

A
  • Thermal
  • Chemical
  • Electrical
  • Radiation
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3
Q

What to ask when taking a burn hx

A

Explosion? Risk of blast injuries

Fire in enclosed space? Risk of CO poisoning/ smoke inhalation

What was the burning material? Burning plastics release cyanide

How long was patient exposed to fire and smoke

Loss of consciousness?

Fall to escape fire?

PMHx and tetanus status

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4
Q

Initial assessment following burns

A

ABCDE

Problems associated with burns

- Airway burns: suggested by hoarseness, stridor, dysphagia, facial and mouth burns, singed nasal hair, soot in nostrils or palate

- Spinal injury: seen in blast injuries or those who have jumped to escape buildings

- Breathing problems: contracting full thickness circumferential burnt of the chest wall may restrict breathing due to lack of movement

- Circulatory problems: hypovolaemic shock is a feature of severe burns

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5
Q

ABCDE in burns

A

Airway: consider burn of airway in setting of facial burns, eyebrows singed, carbons deposites, carbonaceous sputum, explosion with burns to head or torso

  • Do we need to intubate? Hoarse voice, stridor - indications for immediate intubation because the airway will close very quickly, aim is to avoid need for surgical pathway

Breathing : as for other major trauma attach oximeter, listen to chest, exclude traumatic chest injuries

Circulation: cap refill, BP, IV access

Disability: AVPU, BM, pupils, analgesia (IV)

Exposure: document burn depth and area, cover burn, keep patient warm

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6
Q

How do we stop the burning process?

A

Remove clothing

Remove chemicals

Rinse with water +++

Keep patient warm

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7
Q

What is the parkland formula?

A

Used to calculate the total fluid requirement in 24hrs

4ml fluid x total burn surface area (as a % of total) x kg

1/2 fluid given in first 8hrs

1/2 given over next 16hrs

Example

Patient has burns to 30% body and weighs 75kg

= 4ml x 30 x 75

=9000mL or 9L

Therefore: 4.5L given during first 8hrs

4.5L given over next 16hrs

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8
Q

What is a superficial burn?

A

AKA 1st degree, epidermis only

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9
Q

What is a superficial partial thickness burn?

A

AKA 2nd degree burn

Affects epidermis and dermis

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10
Q

What are deep partial thickness burns?

A

AKA 2nd degree

Affects dermis

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11
Q

What are full thickness burns?

A

AKA 3rd degree

Full thickness - hypodermis

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12
Q

Describe a superficial/ 1st degree burn

A

Brisk bleeding on pinprick

Painful

Red but no blisters

Blanches when pressed, colour returns quickly

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13
Q

Describe a superficial partial thickness burn

A

Brisk bleeding upon pinprick

Painful

Pale pink, glistening, blisters

Blanches when pressed, colour returns slowly

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14
Q

Describe a deep partial thickness burn

A

Delayed bleeding following pinprick

Dull sensation - not pain

Cherry red colour

Does not blanch

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15
Q

Describe a full thickness burn

A

No bleeding upon pinprick

No sensation

Dry, why, leathery appearance

Does not blanch

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16
Q

Acid vs alkali burns

A

Acid burns are less dangerous

Acid burns: form a coagulation necrosis and the burns tend to form a hard layer and stop burning

Alkali burns: form liquid necrosis and continue burning

17
Q

Important to remember regarding electrical burns

A

Can look small from the outside but deep muscle necrosis and myoglobin release can occur

Important to monitor ECG

18
Q

Indicators of NAI burns

A

Hx not consistent

Lines of demarcation

No splash marks

Sparing of flexor creases

Delayed presentation

Attributing injury to another child

Uniform burn depth/ full thickness

19
Q

Systemic pathophysiology of burns

A

Release of inflammatory mediators at the site of injury has a systemic effect if the TBSA is 20-30%

Cardiovascular changes: capillary permeability is increased >> loss of intravascular protein >> fluid in interstitial compartment >> myocardial contractility decreased >> hypotension occurs >> possible end organ hypoperfusion

Respiratory changes: inflammatory mediators cause bronchoconstriction and ARDS can occur

Metabolic: basal metabolic rate increases up to 3x - combined with splancnic hypoperfusion warrants early and aggressive neteral feeding to decrease catabolsim and maintain gut integrity

Immunological changes: non-specific down regulation of immune response

20
Q

When are burns classified as severe?

A

When >10% BSA affected in children

When >15% BSA affected in adults

21
Q

Are epidermal burns/ 1st degree burns included when calculating size of burn?

A

No

22
Q

How to work out how much BSA affected by burn

A

Lund Browder chart

Or

Mersey burns app

Or

Rule of 9s:

Head = 9

Arms = 9%

Legs = 18%

Torso = 18%

Back = 18%

Genitals = 1%

23
Q

How can the depth of a burn be assessed?

A
  1. Epidermal burn: skin is red and painful but not blistered - think sunburn
  2. Superficial partial thickness burn: epidermis and dermis affected, skin is pale pink and painful with blistering, capillary refill - blanches and rapidly returns
  3. Deep partial thickness: epidermis, upper and deeper layers of dermis, skin appears dry or moist, blotchy and cherry red, may be painful or painless, may be blisters, capillary refill - blanches with a sluggish return or does not blanch
  4. Full thickness: burn extends through all layers to subcutaneous tissues, skin is dry and white/ brown/ black with no blisters, leathery or waxy, painless, capillary refill - does not blanch
24
Q

Rule of 5s when calculating burns

A

Used to quickly estimate burn surface area in children

Head = 20%

Earm arm = 10%

Each leg = 20%

Front of trunk = 10%

Back of trunk = 10%

25
Q

Pre-hospital first aid measures for burns

A
  • Remove patient from burning environment
  • If clothes smouldering apply cold water and remove, unless they are stuck
  • Provide high flow oxygen
26
Q

Major burns resuscitation

A

Airway + c-spine: treat obstruction, immobilise neck if any possibility of c-spine injury, any evidence of impending airway ovstruction immediately call in order to allow for urgent GA and tracheal intubation

Analgesia: IV access (2x wide bore cannulae), send blood for cross match, U&E, glucose and coagulation, provide analgesia (IV morphine) + anti-emetic

Fluids: follow parkland formula 0.9% sodium chloride (4mlxTBSA%xkg) & give 1/2 during 1st 8hrs, check vitals every 10-15mins

Urinary catheter : satisfactory output = >50mL/hr in adults

Full thickness burns across >10% may require red cell transfusion

Breathing: check for COHb (carboxyhaemaglobin in blood) and ABG, full thickness chest burns require escharotomy, obtain CXR

27
Q

Management of burn area

A

Measure area as % of TBSA

Irrigate chemical burns with warmed water

Cover burn with cling film or dry sterile sheets - not to be dressed until seen by specialist

Involve burns specialist early on

Ensure tetanus prophylaxis

28
Q

Patient has been in a fire where plastic was burning - what do we do?

A

Burnt plastic = cyanide release

Give dicobalt edetate - the antidote

29
Q

Most common cuse of inhalation injury

A

Smoke inhalation due to house fires

30
Q

Common components of inhalation injury

A
  • Direct thermal injury
  • Soot particles causing damage to cilia + obstruct small airway
  • 85% fire deaths are due to carbon monoxide
  • Gas products of combustion: some react with water and cause strong acids which can damage resp tract
31
Q

Clinical features of smoke inhalation

A

Confusion, loss of consciousness, oropharyngeal burns, hoarseness, loss of voice, signed nasal hairs, soot in nostroils/ sputum, wheeze, dysphagia, drooling, stridor

32
Q

First aid measures for smaller burns

A

Separate patient and burning agent

Cool affected area with lots of cold water

*Be aware of hypothermia in infants and young children

33
Q

Which organisation can search for an appropriate bed for a burns patient?

A

National burns bed bureau

34
Q

Which patients to refer to a burns specialist

A
  • Airway burns
  • Significant full-thickness burns, especially over joints
  • Burns >10% TBSA

Significant burns of special areas e.g. hands, face, perineum, feet

35
Q

Recommended covering of burns on the hands

A

Cover with soft parrafin inside a polythene bag or glove sealed at wrist & change after 24hrs

Elevate to minimise swelling

36
Q

Ideal burns dressing

A

Sterile +non-adherent

Dressings often need to be changed after 48hrs due to accumulation of fluid - if patient has been discharged this is done at GP

Acute (22 decks)

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