General Burns Flashcards
How is the rule of 9’s applied to adults and children?
How is Parklands formula applied differently to children and adults?
- Modified Parkland formula is 3-4mls x kg x TBSA
- Children generally use 3mls, adults generally use 4mls
- Use 4mls if they have an inhalational injury, electrical injury or other traumatic injuries
- Parklands is a guide, titrate to UO of 1ml/kg/hr, Hr, BP and cap refill
- If deep burns or Rhabdomyolsys are suspected, titrate to UO 2ml/kg/hr
- Hartmanns is the preferred solution but N. Saline can be used if not available
Generally this is only started if TBSA is >20% for adults and >10% for children (under 16)
How is the Parklands formula implemented?
Parkland: 4mls x TBSA% X Kg’s
- So 15% burns X 10kgs X 4mls = 600mls
- 1/2 in the first 8hrs, 1/2 next 16hrs
So 300mls/8hrs then 300mls/16hrs
If a child then add maintenance fluids (10-20kg range) = 1000 + 50 x (weight minus 10) = 1000mls
- mls/hr calc gives = 40mls/hr
so total = 600 + 1000mls aka 1600mls/24hrs
633 in 1st 8hrs them 966mls 2nd 16hrs
Beyond resuscitation what is the basic management for burns?
- Adequate analgesia
- If possible run burns under cool or lukewarm running water for 20mins (but prevent hypothermia)
- Update ADT vaccine
- Gently debride and deroof blisters, clean with saline
- Dress wounds with occlusive non-adherent dressing (ie cling wrap)
- Don’t apply silver based dressings to face or neck (can stain skin)
- Referral to burns unit as required
- Consider prophylactic ABx in special cases
What is the Wallace rule of 9s method for burns % calculation?
Wallace rule of 9s
- efficient but often overestimates burn % area
- Excludes superficial burns
- Most accurate in normal sized (not obese or cachectic) people between 10-80kgs, inaccurate in young children
What is the Lund and Browder method for burn percentage calculation?
Lund and Browder chart
- Gold standard but inefficient for use in a timely manner
- Requires accurate estimation of burn depth as excludes superficial burns
- More accurate in children (than rule of 9s or palmar method) but still inaccurate in the obese
What is the Palmar method for % burns calculations?
Palmar method
- patients palm represents 1% of their body surface
- Best for small and scattered burns
- Highest inter-user variability
What are the main risk factors for a fatal sized burn?
- Burn >40 TBSA%
- Age >60 with large burn
- Associated inhalational injury
What does being trapped in a closed environment put people at risk of with burns?
Cyanide poisoning
- significant lactataemia
CO poisioning
- CNS dysfunction, blood gas
Supraglottic airway burns
- airway oedema, stridor, facial/neck burns
Infraglottic airway burns
- Pneumonitis
- black sputum, bronchospasm
What are some general rules of thumb regarding high voltage electrical injury?
- More dangerous in wet environments (ie rain) as decreased resistance = higher currents
- AC is 3x more dangerous than DC due to tetanic contractions
- Parkland formula underestimates fluid requirements
- High voltage has a 17% chance of delayed arrhythmias, should be observed with telemetry
What injuries mandate transfer to a specialist burns centre?
- TBSA >20%
- Any inhalational injuries
- Any high voltage electrical injuries including lightning strikes
What adult injuries should you consider transfer to a burns centre?
- > 10% TBSA
- Full thickness >5% TBSA
- Full thickness burns to special areas (ie feet, hands, genitals, neck etc)
- Electrical burns
- Chemical burns
- CIrcumferential burns
- Burns + trauma
- Extremes of age
- Severe co-morbidities
- Pregnant women
- Slow healing burns
What are the important factors on history when assessing severity of an isolated burn?
- Time of incident
- What caused the burn
- What was the duration of burn contact
- Were clothes/jewellry removed
- Was first aid applied
- Was cool water used, if so what temperature and for how long
- Was the water contaminated or did it have added chemical agents
What is a quick way to differentiate different depths of burns?
Blisters/Cap refill/Sensation
Epidermal
- No/Brisk/Painful
Superficial Dermal
- Yes/Brisk/Very painful
Mid Dermal
- Maybe/Sluggish/Mild pain
Deep Dermal
- Yes/Sluggish to nil/Minimal
- Tend to be dry
Full Thickness
- Eschar/Absent/Anaesthetic
When should paediatric patients be transferred to a burns centre?
- > 10% TBSA
- All full thickness burns
- Suspected NAI
- Burns in requiring ongoing Mx in kids with social problems
- Special areas (face, ears, neck, hands, feet, genitalia, perineum or over a major joint)
- Circumferential
- Chemical/Electrical
- Inhalational/Airway burns
- <12months old
- Associated other significant trauma
