Essentials of Burn Management Flashcards
Types of burn
- Scald
- Flame
- Flash
- Contact
- Chemical
- Electrical
- Friction
Respiratory response to burn
- Bronchoconstriction
- Adult respiratory distress syndrome
Metabolic response to burn
Basal metabolic rate increased threefold
Immunological response to burn
Reduced immune response
Cardiovascular response to burn
- Reduced contractility
- Increased capillary permeability
- Peripheral and splanchnic vasoconstriction
General principles of any burn
- Rescue
- Resuscitate
- Resurface
- Reconstruct
- Rehabilitate
First aid for a burn
- Stop burning process
- Cool the burn
- Cover the burn
- Keep warm
What approach is used to assess a burn?
ABC approach:
- Airways
- Breathing
- Circulation
What is an escharotomy?
Cutting of hardened and constricting skin to allow expansion
What type of burn is an escharotomy used in?
Circumferential burns in chest, neck, limbs and digits
What is total body surface area?
% of body burnt
How is % mortality after a burn calculated?
TBSA + age (+17 if inhalation injury)
Methods of assessing burn size
- Rule of nines
- Lund and Brower chart
How does the rule of nines work?
- Head = 9%
- Arms = 9% each
- Back = 18%
- Chest = 18%
- Legs = 18% each
- Perineum = 1%
Types of burns by depth (and what layers they are in)
- Erythema (epidermis)
- Superficial partial thickness (epidermis + dermis)
- Deep partial thickness (epidermis + dermis)
- Full thickness (epidermis, dermis + subcutaneous)
Features of erythema
- Red
- Blanching
- Painful
Features of superficial partial thickness burn
- Skin loss
- Blistering
- Wet
- Red
- Blanching
- Painful
Features of deep partial thickness burn
- Drier
- Paler
- Cherry red appearance
- No blanching
- Reduced sensation
Features of full thickness burn
- Dry
- Leathery
- Painless
What TBSA value for fluid resuscitation?
- Adult = >15%
- Child = >10%
What is the Parkland formula used for?
Calculating the fluids to be given in the first 24h (first half in 8h, second in 16h)
Parkland formula
Fluid (ml) = 4 x weight (kg) x TBSA (%)
Target urine output in adults when using fluid resuscitation
0.5ml/kg/hour
3 zones in Jackson’s burn model
- Zone of hyperaemia
- Zone of stasis
- Zone of coagulation
Which zone is lost when fluid resuscitation is insufficient?
Zone of stasis
When would a burn need to be referred?
- Burns to hands, face, feet, perineum
- Age <5 or >60
- Inhalation injury
- TBSA >10% (5% in child)
- Full thickness burn >5% TBSA
- Complex burns (eg. pregnancy)
- Suspected non-accidental injury
Pros of excising a burn
- Potential source of infection
- Burn stimulates inflammatory effects
- Early excision and grafting may leave better scars
Cons of excising a burn
- Non-full thickness burns may heal spontaneously
- Burn surgery can be hazardous
- Leaves additional wound (donor site)
Priority areas for burn surgery
- Neck
- Central line sites
- High functional importance
- Protective (eg. eyelids)
