Burns and smoke inhalation

Question 1

How do you differentiate between local burns and severe burns?

Answer 1

Local is <20% BSA

Question 2

When combined with smoke inhalation injury, what are severe burn injury patients predisposed to?

Answer 2

airway obstruction, hypoventilation, acute respiratory distress syndrome (ARDS), and pneumonia

Question 3

What is suggestive of smoke inhalation?

Answer 3

Facial burns, singed nasal vibrissae, oropharyngeal blistering, and carbonaceous sputum

Question 4

Smoke injury can cause oedema and bronchospasm within the first few hours - what does this mean?

Answer 4

Immediate intubation may be necessary
haryngeal edema resulting in acute airway obstruction typically occurs within the first 24–48 hours after injury and resolves over a few days

Question 5

Outline lower airway disease from smoke inhalation

Answer 5

Lower airway and pulmonary complications including sloughing of tracheal membrane and cast formation lead to obstruction of lower airways. This results in segmental atelectasis, which typically occurs 48–72 hours after smoke inhalation.

Question 6

Outline hypoventialtion due to issues that are outside the lungs

Answer 6

Watch for decreased pulmonary and chest wall compliance. Decreased pulmonary compliance can be attributed to bronchospasm, atelectasis, and pulmonary edema. Reduced chest wall compliance can result from torso burns or significant pain

Question 7

What may be seen on radiographs of smoke inhalation patients?

Answer 7

Signs may only become apparent up to 36 hours post inhalation, therefore initially there may be nothing
Radiographs should be re‐evaluated based on the progression of clinical illness.
Radiographic abnormalities such as a diffuse interstitial pattern, focal alveolar pattern, and lung lobe collapse due to obstruction of main stem bronchi have been reported in dogs and cats after smoke exposure

Question 8

How can the CVS be affected in a fire?

Answer 8

Severe burn injury, smoke inhalation, and carbon monoxide (CM) toxicity can cause significant cardiovascular abnormalities such as hypotension and cardiac arrhythmias.
Monitor with CV status monotring, BP and ECGs

Question 9

How can fires affect the nervous system?

Answer 9

agitation, confusion, ataxia, loss of consciousness, and seizures likely indicate CM or cyanide toxicity
These clinical signs are likely related to the hypoxic effects on the cerebral cortex. Cellular hypoxia leads to an increase in intracranial pressure and cerebral edema formation
The nature of clinical signs on initial evaluation may indicate the severity of exposure to both CM and cyanide.
Use blood gas and pulse ox to assess

Question 10

When may SPO2 be wrong?

Answer 10

CO poisoning - the machine cannot tell the difference between oxyhaemoglobin and carboxyhaemoglobin

Question 11

How do you treat CO poisoning

Answer 11

oxygen therapy

Question 12

How should the eyes be cared for?

Answer 12

Can get ulceration or keratopathies
Flush liberally with saline
Watch out for Orbital compartment syndrome, which results from progressive periorbital tissue swelling and eyelid contracture resulting in increased intraocular pressure and subsequent optic neuropathy and blindness - may need lateral canthoplasty

Question 13

How should paw pad burns be treated?

Answer 13

daily debridement, application of topical antimicrobial medications, and bandaging.38-40 During debridement, any viable pad tissue should be conserved.41 Superficial wounds will heal via epithelialization and contracture, whereas deeper wounds may require reconstruction and paw pad transposition

Question 14

What is the initial management of smoke inhalation patients

Answer 14

02 therapy - intubate if needed
If patient not improving within 30 mins may need ventilation
Initial venous access is obtained
To prevent ongoing tissue damage, dermal decontamination can be attempted to remove debris and toxin‐laden soot from the patient, being careful to avoid excessively stressing the patient.
Ideally, a complete blood count, serum biochemistry, coagulation profile, arterial blood gas, plasma lactate, and CO‐Hgb concentration (if available) are evaluated

Question 15

Why cool the wounds?

Answer 15

Cooling burn wounds within 30 minutes of thermal injury prevents ongoing tissue damage, reduces edema formation, increases the speed of re‐epithelialization, and improves cosmetic appearance.
Cooling the burn wound contributes to the analgesic regimen and improves wound healing by preventing progressive cellular necrosis that contributes to the zone of coagulation and zone of stasis

Question 16

How do you cool a burn?

Answer 16

20 mins running cold tap water

Question 17

How do you fluid resuscitate a burn patient

Answer 17

4 mL/kg per percentage TBSA in the first 24 hours, with half of this amount administered in the first 8 hours
Crystalloids

Question 18

Should colloids be used?

Answer 18

Controversial
Due to the concern for leakage of proteins and large molecules through compromised capillary membranes, it is recommended to wait at least 8–12 hours postburn injury before utilizing colloids.
However, in the presence of hemodynamic instability, the use of colloids in the first 24 hours may be necessary

Question 19

How do you treat wounds?

Answer 19

1:40 dilution of chlorhexidine or 1:9 dilution of povidone iodine to debride devitalised tissue
Keep superfial counds clean and moist and will heal on their own
Surgical excision and grafting is recommended for burn wounds that are estimated to take longer than 2–3 weeks to heal with conservative management.
If these wounds are allowed to heal conservatively, patients experience longer hospital stays, accentuated pain, functional impairment, and significant hypertrophic scarring
Topical Abs better than systemic as penetrate better, flamazine a good , or honey

Question 20

What other thins should be considered in long term burn treatment

Answer 20

Enteral nutrition within 48 hours
pain management
vitamin c as an antioxidant
monitor for infections, hypothermia, intra abdominal hypertension