Chapter 9 - Thermal Injuries

Question 1

how are burn injuries related to their consequences

Answer 1

the consequencs of burn injuries are directly related to the extent of inflammatory response - bigger burn = bigger inflammatory response

Question 2

how can you stop the burn on first assessment

Answer 2

remove all clothing brush dry chemical powders from the skin and decontaminate by rinsing with copious amounts of warm saline

Question 3

how can airway compromise occur from thermal injury

Answer 3

from direct injury eg inhalation and from massive oedema resulting from the injury

Question 4

how common is thermal injury to the lower airway

Answer 4

very rare. the larynx protects the subglottic airway from direct thermal injury. this only occurs during exposure to superheated steam or ignition of inhaled fammable gases.

Question 5

what are the three concerns from direct thermal injury to the airway

Answer 5

1 hypoxia - inhalation injury, poor compliance following circumferential burns, thoracic trauma

2. carbon monoxide poisoning
3. smoke inhalation injury - products of combustion eg smoke particles settle into airways - damage and death of mucosal cells.

Question 6

how is bronchoscopy useful in inhalation injuries

Answer 6

helping to remove debris and sloughed off necrotic tissue

Question 7

how can you treat CO poisoning

Answer 7

100% Fi02 therapy for 4-6 hours

Question 8

what is the cause of fluid depletion due to thermal injury

Answer 8

ongoing losses due to capillary leak secondary to inflammation

Question 9

how much fluid should we give in burns, and how fast

Answer 9

2ml of hartmanns x kg x % TBSA burn
half of that olume goes in over the first 8 hours
the second half goes in over the next 16 hours
titrated to urine output

Question 10

Name some of the American Burn Life Supports indications for early intubation

Answer 10

• signs of airway obstruction
• extent of the burn
• extensive and deep facial burns
• burns inside the mouth
• significant oedema or risk of oedema
• difficulty swallowing
• signs of resp compromise e.g. fatigue, poor ventilation
• decreased GCS compromising airway
• anticipated transfer of patient

Question 11

How can we monitor CO poisoning

Answer 11

Baseline HbCO levels should be taken.

We should monitor oxygenation using ABGs rather than sats probes.

Question 12

What is the equation for resuscitation of paediatric burn patients

Answer 12

3ml/kg/%TBSA

Question 13

why do we assess peripheral circulation in burns patients

Answer 13

to rule out compartment syndrome.
CS results from an increase in pressure inside a compartment that disrupts perfusion to structures within that compartment. in burns this is due to decreased skin elasticity and soft tissue oedema

Question 14

which is worse: acid or alkali burns

Answer 14

alkali burns as as they penetrate more deeply.

They require longer irrigation

Question 15

Why do electrical burns often look less severe than they are

Answer 15

because of different rates of heat loss from superficial and deep tissues. normal overlying skin can coexist with deep tissue necrosis.

Question 16

what condition can occur as the result of electrical burns

Answer 16

Rhabdomyolysis. electrical travel through muscle can cause myoglobin release causing acute renal failure

Question 17

what are the two types of cold injury

Answer 17

frostbite and non-freezing injury

Question 18

what damage does frostbite cause

Answer 18

damage can result from freezing of tissue, ice crystal formation causing cell membrane injury, microvascular injury and subsequent tissue anoxia

Question 19

how does non-freezing injury cause damage

Answer 19

damage is form microvascular endothelial damage, stasis and vascular occlusion. e.g. trench foot

Question 20

how do we manage cold injuries

Answer 20

by immediately trying to decrease duration of tissue freezing. place injured part in 40’C circulating water.

Question 21

which burns are included when calculating burn surface are

Answer 21

partial and total thickness burns

Question 22

why are trauma patients susceptible to hypothermia

Answer 22

hypothermia < 36’C
severe hypothermia <32’C
hypothermia is common in severe injuries but may be worsened by administration of cold fluid and products, exposure and cold environments. This can worsen coagulation and organ function

Question 23

what might we consider for a patient with circumferential burns

Answer 23

patients may require escharotomy

Question 24

what else should we be mindful of in electrical burns

Answer 24

MSK injuries due to muscle contraction including spinal fracture