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Pete FFICM SOE/OSCE > Derm - Burns > Flashcards

Derm - Burns Flashcards

1
Q

What are the main pathophysiological processes in burns

A

1) systemic inflammatory repsonse
2) inhalational lung injury
3) Hypermetabolic state

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2
Q

Describe the inflammatory response

A

Activbation of inflammatory cascade
Increased vascular permeabilityy
Generalised oedema
WOUND HEALING AFFECTED
IMMUNOSUPPRESSION
INCREASED INFECTION

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3
Q

Patholgical features of inhalation injury

A

Air obstruction
Oedema
Poor gas exhange
ARDS

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4
Q

Features of hypermetabolic state

A

Increase protein catabolism
Increased gluconeogenesis
Decreased protein synth
DECRESAED WOUND HEALING
IMMUNOSUPPRESION
INFECTION

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5
Q

Ways of estimating burn area

A

Lund Browder Chart as % total bodt surface areaRule of ninesUsing palm print and fingers to represent 1%

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6
Q

Assessing burn depth

A

Superficial, partial and full thickness

Superficial - epidermis Erythema and painful, dry
Partial - (can be superficial or deep dermal) Erythema, pain, oedeam, blisters

Full - All layers and even sub cut structures Painless, white

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7
Q

Concerning features of airway in burns patient

A

Burns to face
Carbonaceous sputum
Singing of nasal and facial hairs
Oropharyngeal oedeam
Stridor
Voice changes
ALSO Neck burns
Resp failure
Low GCS
To give analgesia or do a procedure

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8
Q

Things to consider for intubation in burns

A

Use at least a size 8 tube
Uncut tube - oedema!
Lung protective vent
ABG, CO and cyanide levels

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9
Q

What determines fluids in burns?

A

Parkland formula
Volume = 4ml x weight x TBSA
Half in first 8 hours, half over 16 hours
(Minus anything already given)

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10
Q

Management priorities

A

AirwayC-spine (depending on mechanism)
Breathing and ventilation
C - fluids and iv access, catheter and CVPD
- temperature - set point reset to 38.5C
- avoid hypothermia
- analgesia - opiates and ketamine
E - Surgical management - debride, escharotomy

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11
Q

Features of the history of concern

A

When was the fire
Did the patient self extricate (duration of exposure)
Other injuries (blast, jumping from a window)
Nautre of the fire - outdoor/indoor/contained
Chemical/plastics
Patients condition at the scene - GCS, injuries, CPR

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12
Q

What is inhalation injury

A

Prolonged smoke exposure in a confined space

Composed of UPPER AIRWAY THERMAL INJURY CHEMICAL IRRITATION OF THE RESP TRACT
Upper airway Oedema of the tonuge, lips, pharynx etc Tube early and prophylactically

Chemical Direct injury to epithelium by acidic/alkaline compounds in smoke Causes tracheobronchitis Poor mucociliary clearence Loss of surfactant —> atelectasis

Early inflmaation, and capilary leak - exudate —> ARDS

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13
Q

Management of inahlation injury

A

Early bronch - confirms
BAL and pulmonary toilers
Neb therapy (poor evidence) —> Bronchodilators, Heparin (reduce fibrin), NAC (mucolysis)
Lung protective Vent
ECCO2R,
ECMO

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14
Q

Burns mortality without and with inhalation injury

A

13.9 to 27.6%

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15
Q

Define Burn Shock

A

Combination of: Hypovolaemia Distributive shock Cardiogenci shock In a patient with major burns
Refractory to fluid resus

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16
Q

American Burn Association criterial for sepsis

A

Documented infection plus:
Temp >39 or < 36.5
RR > 25 (or MV with min vol > 12 l/min)
HR > 110/min
Glucose >12.8 (non DM)
Intolerance of enteral feed in 24 hours
Plts < 100

17
Q

When to refer to a burns unit

A

Age < 5Age > 60

Comorbidities that affect healing DM, immunosuppression, Pregnancy, Liver disease/cirrhosis

Site face, hands, feet, perineum flexures - neck/axilla circumferential burns of the torso, limbs, neck
Inhalational injury

Mechanism - Chemical with greater than 5% area Ionising radiation Pressure steam injury Electrical and cold injuries Suspicious/NIA

Dermal/full thickness burns > 5% in under 16 or >10% if >16

18
Q

Complications of major burns

A

Over resuscitation Oedema, limb and abdo compartment syndrome Pulmonary oedema, prolonged MV

Resp Obstructions, ARDS
CVS Arrythmias MI, failure, vasoplegia
Neuro PAIN Opioid tolerance (Consider ket, gaba, amitrpyt)
Renal AKI - under resusc ACS/Rhabdo
GI Increased nutrition requirement - hypermetabolism Increased protein catabolism
Haem - VTE
Metabolic - rhabdo, compartment syndromeInfections - burn wound, pneumonia, sepsis (lines and cathter)
MSK - contractures/amputation

19
Q

Pathophys of Carbon Monoxide

A

CO is 20x more affinity for Hb than O2
Impaired O2 delivery, reduced carrying capacity
Curve to the LEFT
Additional - impaired cytochrome oxidase, so poor utilisation at mitochondira

20
Q

Presentation of CO poisoning

A

N and V, headache
Hypotension
Neuro - mild confusion to seizures
Cherry red skin (rare)

21
Q

Tests in CO poisoning

A

Carboxy Hb on a co-oximerter on ABG
(Normal <1%, smokers <5%)
SpO2 goes to 100% (absorption spectra of HbCO similar to HbO2)
Normal PaO2

22
Q

Management of CO poisoning

A

100% O2Half life from 4 hours to 1 hour.I &V is HbCO>25%Hyperbaric O2. —> 15-20 minutes half life If: HbO2 >40% Pregnant (HbCO>15%) Coma

23
Q

Prognosis of CO

A

Poor relationship betwen HbCO level and the presence/absence of symptoms or outcomes
BUT
HbCO > 60% likely to be fatal

24
Q

Mechanism of cyanide poisoning

A

Inhibits cytochrome oxidase at mitochondria
Blocks oxidative phosphoryl.
Leads to anaerobic metabolism

25
Q

Symptoms of CO poisoning

A

Breathless
Hypotension
Vomiting
Agitation
LOC
Unexplained metabolic acidoss and high SvCO2

26
Q

Ix for CO

A

Lactic acidosis
High ScvO2 —-> low AV gradient
Cyanide level (takes 3 hours)

27
Q

Tx for cyanide

A

100% O2
Intubate if needed
ANTIDOTES:
Hydroxycobalamin
Dicobalt edetate
Sodium thiosulphate (converts cyanide to thiocyanide —> renal excretion)

28
Q

Prognosis of cyanide

A

Good if rapid therapy and antidotes
Poor if cardiac arrest due to cyanide
Risk of post survival anoxic enceph
Acute/delayed manifestations of neuro
Parkinson type symptoms

29
Q

What is the difference between a Burn centre, a burn unit and a Burn facility?

A

Burn Centre: This level of in-patient burn care is for the highest level of injury complexity and offers a separately staffed, discrete ward. The facilities are up to the highest level of critical care and have immediate operating theatre access

Burn Unit: This level of in-patient burn care is for the moderate level of injury complexity and offers a separately staffed, discrete ward

Burn Facility: This level of in-patient burn care equates to a standard plastic surgical ward for the care of non-complex burn injuries

30
Q

What is a chemical burn?

A

Chemical burn is a burn to internal or external organs of the body caused by a corrosive or caustic chemical substance that is a strong acid or base

31
Q

What causes a chemical burn?

A

The main cause of chemical burn is contact with strong acids or bases.

The strength of acids and bases is defined by the pH scale, which ranges from 1–14.
A very strong acid has a pH of 1 and may cause a severe burn.
A very strong base has a pH of 14 and may also cause a severe burn.

32
Q

What are some of the common chemical burns?

A

Sulphuric acid
Nitric acid
Hydrochloric acid
Phosphoric acid
Sodium hydroxide and potassium hydroxide
Ammonia

33
Q

What are some of the features you would want to illicit from the history?

A

pH of the agent
Concentration of the agent
Length of contact time
Amount of agent involved
Physical form of the agent (ie: solid, liquid, gas)
Site of contact (e.g. eye, skin, mucous membrane)
Whether swallowed or inhaled
Whether or not skin is intact.

34
Q

How would you manage a chemical burn?

A

Basic first aid should be administered as soon as a chemical burn has occurred.

Remove contaminated clothing
Irrigate the affected area with copious amounts of water. Wash for at least 20 minutes, taking care not to allow runoff to contact unaffected areas. It has been shown that irrigation received within 10 minutes of the burn reduces the severity of the wound and time of stay in hospital.

Chemical burns involving elemental metals (lithium, potassium, sodium and magnesium) should not be irrigated with water as this can result in a chemical reaction that causes burns to worsen. These types of chemical burn should be soaked with mineral oil while waiting for medical attention.

Pete FFICM SOE/OSCE (199 decks)

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