FN: Burns Flashcards
RF
Age: children and elderly
Co-mobidities: epilepsy, CVA, dementia, mental illness
Occupation
Classification
Superficial
Partial thickness
Full thickness
Superficial
Erythema
Painful
e.g. sunburn
Partial thickness
- heal w/i 2-3 weeks if not complcaited
Superficial partial thickness
No loss of dermis
Painful
Blisters
Deep partial thickness
Loss of dermis but adnexae remain
Healing from adnexae e.g. follicles
V. painful
Full thickness
- complete loss of dermis
- charred, waxy, white, skin
- Anaesthetic
- Heal from the edges - scar
Complications early
- Infection: loss of barrier function, necrotic tissue, SIRS, hospital
- hypovolaemia: loss of fluid in skin + raised cap permeability
Metabolic syndrome: hyperkalaemia, hypermyoglobin, raised Hb - AKI - Compartment syndrome: circumferential burns
- Peptic ulcers: Curlings ulcers
- Pulmonary: CO, poisoning, ARDS
Intermediate complications
VTE
PRessure sores
Late complications
Scarring
Contractures
Psychological problems
Assessment
Wallace rule of 9s: % BSA burnt
- head and neck:9%
- Arms: 9% each
- Torso: 18% front and back
- Leg: 18% each
- Perineum: 1%
- (Palm:1%)
N.B. may also use Lund and Browder charts
Management
- Based on ATLS principles
- Specific concerns with burns
Specific concerns with burns
- Secure airway
- Manage fluid loss
- Prevent infection
Airway management
Examine for respiratory burns
- soot in oral or nasal cavity
- burnt nasal hairs
- hoarse voice, stridor
Flexible laryngoscopy can be helpful
Consider early intubation + dexamethasone (reduced inflammation)
Breathing management
- 100% oxygen
- Exclude constricting hours
- Signs of CO poisoning
- ABG
Signs of CO poisoning
Headache
n.v
confusion
Cheery red appearance
ABG results
CoHb level
SpO2 unreliable of CO poisoning
Circulation
- Fluid losses may be huge
- 2x large-bore cannulae in each ACF
- Bloods: FBC, U+E, G+S/XM
- Start 2L warmed - Hartmann’s immediately
Parkland Formula to guide replacement in 1st 24 hrs
- 4 xwt. (kg) x % burn = mL of Hartmann’s in 24h
- replace fluid from time of burn
- Give half in 1st 8h
- Best guide is UO:30-50mL/h
Muir and Barclay Formula to guide fluid replacement
- (wt, x % burn)/2 = mL of Colloid per unit time
- Time units: 4,4,4,6,6,12 = 36 hours
- may need to use blood
Partial thickness burns
- Analgesia: morphine
- Dress partial thickness burns
- Biological e.g. cadaveric skin
- Synthetic
- Cream e.g. Flamazine (silver sulfadiazine) + sterile film
Full thickness burn Rx
- Tangenital excision debridement
- Split-thickness skin grafts
- Anti-tetanus toxoid (0.5ml ATT)
- Consider prophylactic Abx: esp. anti-pseudommonal
Circumferential burns
May require excharotomy to prevent compartment syndrome
