Burns Flashcards
Immediate first aid for burns caused by heat after ABCDE
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
Immediate first aid for electrical burns after ABCDE
switch off power supply, remove the person from the source
Immediate first aid for chemical burns after ABCDE
brush any powder off then irrigate with water.
Attempts to neutralise the chemical are not recommended
Assessing the extent of the burn most accurate chart?
Lund and Browder chart
Assessing the extent of the burn includes wallace’s rules of 7
false
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%
the palmar surface is roughly equivalent to ?% of total body surface area (TBSA)
the palmar surface is roughly equivalent to 1% of total body surface area (TBSA)
the palmar surface rule is not accurate in
Not accurate for burns > 15% TBSA
Appearance of Superficial epidermal
Red and painful
Appearance of Partial thickness (superficial dermal)
Pale pink, painful, blistered
Appearance of Partial thickness (deep dermal)
Typically white but may have patches of non-blanching erythema. Reduced sensation
Appearance of Full thickness
White/brown/black in colour, no blisters, no pain
Referral to secondary care is for all deep dermal and full-thickness burns.
true
Referral to secondary care is for superficial dermal burns involving the
face, hands, feet, perineum, genitalia, or any flexure, or circumferential burns of the limbs, torso, or neck
Referral to secondary care is for superficial dermal burns of more than ?% TBSA in adults, or more than ?% TBSA in children
superficial dermal burns of more than 3% TBSA in adults, or more than 2% TBSA in children
Referral to secondary care is for any exhalation injury
false
any inhalation injury
Referral to secondary care is for suspicion of non-accidental injury
true
Referral to secondary care is for any electrical or chemical burn injury
true
Initial management of burns
superficial epidermal
symptomatic relief - analgesia, emollients etc
Initial management of burns superficial dermal
cleanse wound, leave blister intact, non-adherent dressing, avoid topical creams, review in 24 hours
Pathophysiology of severe burns cardiovascular effects
cardiovascular effects resulting from fluid loss and sequestration of fluid into the third space
Pathophysiology of severe burns increased/decreased catabolic response
increase
Pathophysiology of severe burns Immunosupression
Immunosupression is common with large burns and bacterial translocation from the gut lumen is a recognised event. Sepsis is a common cause of death following major burns.
Management of more severe burns
The initial aim
stop the burning process and resuscitate the patient
Management of more severe burns - when is IV fluids required?
children with burns greater than 10% of total body surface area.
Adults with burns greater than 15% of total body surface area
Management of more severe burns
The fluids are calculated using the which formula
Parkland
volume of fluid= total body surface area of the burn % x weight (Kg) x4
Management of more severe burns
how is fluid administered?
Half of the fluid is administered in the first 8 hours.
A urinary catheter should be inserted.
Analgesia should be given.
Which burns should be transferred to a burns unit?
Complex burns, burns involving the hand perineum and face and burns >10% in adults and >5% in children
which burns require escharotomy?
Circumferential burns affecting a limb or severe torso burns impeding respiration
Conservative management is appropriate for superficial burns and mixed superficial burns that will heal in 2 weeks.
true
More complex burns may require excision and primary closure
false
More complex burns may require excision and skin grafting. Excision and primary closure is not generally practised as there is a high risk of infection.
anti microbial prophylaxis or topical antibiotics are indicated in burn patients.
false
Escharotomies help burns by?
Careful division of the encasing band of burn tissue will potentially improve ventilation (if the burn involves the torso), or relieve compartment syndrome and oedema (where a limb is involved)
Burns pathology - Extensive burns Extravasation of fluids results in?
Extravasation of fluids from the burn site causing hypovolaemic shock (up to 48h after injury)- decreased blood volume and increased haematocrit
Burns pathology - Extensive burns causes curlings ulcer, what is this?
acute peptic stress ulcers
Danger of full thickness circumferential burns in an extremity as these may develop
compartment syndrome
ARDs, protein loss and haemolysis are complications in extensive burns
true
Burns pathology Healing
Superficial burns
keratinocytes migrate to form a new layer over the burn site
Burns pathology Healing - Full thickness burns
dermal scarring. Usually need keratinocytes from skin grafts to provide optimal coverage.
Fluid resuscitation burns
main aim
resuscitation is to prevent the burn deepening
Fluid resuscitation burns
Most fluid is lost when?
24h after injury
First 8-12h fluid shifts from intravascular to interstitial fluid compartments
fluid resuscitation avoided in first 8-24h due to?
Starting point of resuscitation is time of injury
fluid resuscitation causes more fluid into the interstitial compartment especially colloid (therefore avoided in first 8-24h)
Fluid resuscitation end point
Urine output of 0.5-1.0 ml/kg/hour in adults (increase rate of fluid to achieve this)
fluid resuscitation after 24 hrs - colloid infusion rate
Colloid infusion is begun at a rate of 0.5 ml x(total burn surface area (%))x(body weight (kg))
Colloids used include albumin and FFP
fluid resuscitation after 24 hrs Maintenance crystalloid
Maintenance crystalloid (usually dextrose-saline) is continued at a rate of 1.5 ml x(burn area)x(body weight)
fluid resuscitation after 24 hrs what can be used to minimize oxidant-mediated contributions to the inflammatory cascade in burns
Antioxidants, such as vitamin C
fluid resuscitation after 24 hrs Monitor:
packed cell volume, plasma sodium, base excess, and lactate
High tension electrical injuries and inhalation injuries require more fluid
true
