Chapter 9 - Thermal Injuries Flashcards
how are burn injuries related to their consequences
the consequencs of burn injuries are directly related to the extent of inflammatory response - bigger burn = bigger inflammatory response
how can you stop the burn on first assessment
remove all clothing brush dry chemical powders from the skin and decontaminate by rinsing with copious amounts of warm saline
how can airway compromise occur from thermal injury
from direct injury eg inhalation and from massive oedema resulting from the injury
how common is thermal injury to the lower airway
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.
what are the three concerns from direct thermal injury to the airway
1 hypoxia - inhalation injury, poor compliance following circumferential burns, thoracic trauma
- carbon monoxide poisoning
- smoke inhalation injury - products of combustion eg smoke particles settle into airways - damage and death of mucosal cells.
how is bronchoscopy useful in inhalation injuries
helping to remove debris and sloughed off necrotic tissue
how can you treat CO poisoning
100% Fi02 therapy for 4-6 hours
what is the cause of fluid depletion due to thermal injury
ongoing losses due to capillary leak secondary to inflammation
how much fluid should we give in burns, and how fast
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
Name some of the American Burn Life Supports indications for early intubation
- 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
How can we monitor CO poisoning
Baseline HbCO levels should be taken.
We should monitor oxygenation using ABGs rather than sats probes.
What is the equation for resuscitation of paediatric burn patients
3ml/kg/%TBSA
why do we assess peripheral circulation in burns patients
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
which is worse: acid or alkali burns
alkali burns as as they penetrate more deeply.
They require longer irrigation
Why do electrical burns often look less severe than they are
because of different rates of heat loss from superficial and deep tissues. normal overlying skin can coexist with deep tissue necrosis.
what condition can occur as the result of electrical burns
Rhabdomyolysis. electrical travel through muscle can cause myoglobin release causing acute renal failure
what are the two types of cold injury
frostbite and non-freezing injury
what damage does frostbite cause
damage can result from freezing of tissue, ice crystal formation causing cell membrane injury, microvascular injury and subsequent tissue anoxia
how does non-freezing injury cause damage
damage is form microvascular endothelial damage, stasis and vascular occlusion. e.g. trench foot
how do we manage cold injuries
by immediately trying to decrease duration of tissue freezing. place injured part in 40’C circulating water.
which burns are included when calculating burn surface are
partial and total thickness burns
why are trauma patients susceptible to hypothermia
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
what might we consider for a patient with circumferential burns
patients may require escharotomy
what else should we be mindful of in electrical burns
MSK injuries due to muscle contraction including spinal fracture
