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Anaesthetics, ED and Plastics > Management of Burns > Flashcards

Management of Burns Flashcards

1
Q

What is important in the Hx of burns

A 
Time injury occurred
Circumstances e.g. open or closed fire, RTA, explosion
Co-existing injury - e.g. if jumped to escape 
Any first aid received
How long in water 
Date of last tetanus 
PMH e.g. DM 
DH e.g. steroid / anti-coagulant 
Allergies
Any analgesia given
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2
Q

What do you do as first aid

A

Stop burning process
Cool the burn
Cover the burn

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3
Q

How do you stop burning

A

Extinguish flame
Switch of power
Remove clothing
Diluate acid or alkali

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4
Q

How do you cool the burn

A

Cold running water for 20 minutes

Not ice cold as will cause vasoconstriction worsening

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5
Q

How do you cover burn

A

Wrap in cling film or place limb in plastic bag

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6
Q

How do you assess

A

Primary survey

ABCDE

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7
Q

A

A

Airway and C-spine

Low threshold for intubation esp if suspect inhalation as swelling will obstruct quickly

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8
Q

B -

A

Breathing
High flow O2 applied
Look for evidence of CO poisoning - cherry pink skin
Assess chest for circumferential burns

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9
Q

C

A 
Direct pressure if bleeding 
Ensure limb perfusion / any eschar
Pulse 
IV access
2 large bore cannula through unburned skin
Start fluid resus - bolus immediate 
Catheter to monitor 
FBC, U+E, clotting, G+S, X-match, glucose 
Carboxy-Hb if suspect CO 
bHCG in female to ensure not pregnant 
Haematocrit - if high suggests more fluid needed 
ABG
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10
Q

D

A 
AVPU
GCS
PEARL
Consider head injury if any abnormal
Beware of hypoxaemia / shock - causing restlessness and reduced GCS
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11
Q

E

A

Remove clothing and fully expose
Remove jewellery / piercing
Maintain temp as skin not working
Log roll

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12
Q

What is a big risk in burns

A

Hypothermia

Heat is lost as blister evaporates and normal capillary control is lost

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13
Q

F

A

FLUIDS

- Parkland formula

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14
Q

What are extra’s

A 
X-ray for injury / bilateral infiltrate in ARDS
May get trauma CT if blast injury 
Tetanus immunisation 
PPI for stress ulcers 
Mannitol / diuretic - excrete myoglobin
NG
Catheter to monitor UO 
Ax
Arterial line for invasive BP monitoring
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15
Q

What is given as tetanus immunisation

A

Full 3 doses

Human IM Ig if never had before

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16
Q

Why is PPI given

A

Reduce risk of stress ulcer

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17
Q

What is mannitol / diuretic given for

A

Increase myoglobin excretion and prevent renal damage

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18
Q

When do you give Ax

A

If look infected

NOT in acute phase

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19
Q

What is NG for

A

If gastroporesis

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20
Q

What happens in secondary survey

A 
AMPLE 
- Allergies
- Medication
- Past illness
- Last meal
- Events leading up to
Examine for evidence of smoke inhalation 
Full body exam
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21
Q

What do you do think of after resus

A

Managemen to Burns

22
Q

What are options for burns not going to 2nd care

A

Analgesia
Leave open + cover with emollient
Dress with non-adherent gauze and review in 24 hours
Cover with silver sulfadiazine

23
Q

When do you leave open

A

Epidermal

24
Q

When do you use non-adherent gauze

A

Superficial partial thickness

25
Q

What should you do with ulcers

A

Leave

26
Q

When do you refer to 2 care

A

All deep dermal and full thickness
All circumferential
If superficial partial >3% or >2% in children
If involved face, hands, feet or genitalia
Any inhalation
Any chemical or eletrical
If suspect NAI

27
Q

When do you refer to Burn;s unit

A

Complex burns
Involves hand, perineum or face
>10% adults or >5% in children

28
Q

What surgery can be done

A

Excision of non-viable tissue
Closure of wound with autograft
Escharotomy
Dressing changes under GA

29
Q

What does Echarotomy do

A 
Incision through burnt tissue to 
Improves ventilation 
Relive compartment syndrome 
Improve circulation 
Beware of damaging nerve
30
Q

When do you do immediate surgery

A 
If eyelids
If circumferential 
If Escharotomy needed
If debridement needed
Closure of defects
Skin graft
31
Q

What is early surgery within 2-3 days for

A

Excision of non-viable tissue

Graft

32
Q

What is late surgery usually for

A

Release of contractures

Post burn reconstruction

33
Q

What type of excision

A

All necrotic

Tangential which shaves away non-viable tissue until viable is reached

34
Q

General principles

A

Maintain core temp to prevent hypothermia
Avoid hypo or hypervolaemia
Minimse blood loss

35
Q

What occurs post op

A

Splint to prevent contracture

Physio

36
Q

When requires frequent adjustment to fluid balance

A

First 24-48 hours

37
Q

What formula is used

A

Parkland

3-4ml x % BSA x weight (kg) = amount of fluid to be given in 24 hours

38
Q

How do you give the fluid

A

Give 1/2 in 1st 8 hours from time of burn

Then give over half over next 16 hours

39
Q

What is most commonly used fluid in burns

A

Hartmann’s
Human albumin
- Look at local trust

40
Q

When do you give resus fluids

A

If>10% burn children

>15% in adults

41
Q

What may be required if haemorrhaging

A

Transfusion

42
Q

What do you do for kids

A 
Modified Parkland
2ml instead of 4 
Use 4,2,1, surgical fluid
If <30kg will also need to add maintenance at constant rate (albumin / 5% glucose 0.45% saline) 
First 10kg = 100ml / kg
Next 10kg = 50ml/kg
Next 10kg = 20ml / kg
43
Q

What fluid

A

Normal saline +- 5% dextrose

44
Q

What should you monitor

A

Capillary glucose every 4-6 hours

45
Q

How do you monitor fluid

A 
Catheter for UO
Central venous line
BP
HR
ABG - if acidotic or high lactate suggests poor perfusion
46
Q

Aim of UO

A

0.5-1ml / kg/. h

47
Q

What is important to remember with Parkland

A

Only replaces the fluid lost by burns
Can still be dehydrated if no oral intake
Give fluid bolus
Review

48
Q

When is escharotomy indicated

A

Any circumferential burns

Deep burns causing resp or vascular compromise

49
Q

What bedside tests

A 
Obs
BP
Urinanalysis - no protein 
Blood glucose 
May want ECG if electrical
ABG if electrical
50
Q

What tests

A

FBC, U+E, LFT
G+S + clotting if theatre
Bone profile if electrolyte / worry arrhythmia
CK and cardiac enzyme if thinking compartment / rhabdo

51
Q

What is typically given for analgesia

A

Morphine

Anaesthetics, ED and Plastics (14 decks)

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