Essentials Of Burns Management Wk11 Flashcards
What is a burn?
- thermal, coagulative injury to the skin
- causes physical and psychological trauma
Name types of burns
Scald Flame Flash Contact Chemical Electrical Friction
Epidemiology of burns
- 250,000 burns in UK each year
- 1% of A&E attendances
- Males > females (industrial, more likely to be idiots)
- Predisposing factors - elderly, medical conditions, alcohol, carelessness
- Flame (adult) and scald (children) most common
What is the cost of a burn?
- acute hospital care
- out patient care
- rehabilitation care
- loss of vocational activities
- loss of recreational activities
What is the systemic response to major burns?
Respiratory - bronchoconstriction - adult respiratory distress syndrome Cardiovascular - reduced myocardial contractility - increased capillary permeability - peripheral and splanchnic vasoconstriction Metabolic - basal metabolic rate increased threefold Immunological - reduced immune response
General principles of burns
Rescue Resuscitate Resurface Reconstruct Rehabilitate
First aid of burns
Stop the burning process
Cool the burn
Cover the burn
Keep warm
ABC
Airway (facial burns, singed nasal hair, carbonaceous sputum, hoarse voice, altered consciousness, respiratory distress, stridor)
Breathing (o2, assess for possible airway burns, anaesthetic review (intubation?), look and listen to chest, arterial blood gas, chest x ray)
Circulation (IV access and replacement of lost fluid, peripheral pulses, capillary refill, check for circumferential burns, monitoring (urine output, pulse, BP))
Escharotomy
- circumferential deep burns
- restricts distal circulation + mechanical effect on ventilation
- taking diathermy and cut through burn tissue to allow to spring open
Secondary survey
Disability
Exposure - log roll etc.
(Check for other injuries, imaging/investigations, catheter, lines, burns dressing, tetanus toxoid, keep warm)
How do you assess size of burns?
- total body surface area + age + 17 (if inhalation injury)
= % mortality
Size of burn, rule of 9s
- rough estimate for percentages that each burn affects body
What is the standard method of assessing burns
Lund and Browder
Erythema
- e.g. sunburn
- epidermis only
- red, blanching (rapidly refills)
- very painful: nerve endings exposed
- heals rapidly without scarring
- exclude from TBSA calculations
Superficial partial thickness
- skin loss and blistering
- wet
- red
- blanches with pressure
- painful: nerves exposed and damaged
