Module 10: Burns Flashcards
A burn injury has an effect on all of the five major functions of the skin which are?
- Thermoregulation
- Fluid and electrolyte imbalance
- Immune response
- Protection from bacterial invasion
- Neurosensory interface.
The Jackson’s burn wound model describes a number of pathophysiological zones associated with burns including?
• Zone of hyperaemia
- Least amount of damage - Red appearance due to increase blood flow - Intact circulation
• Zone of stasis
- Cell damage but not irreversibly - 24 hours post circulation may cease - Has the potential to transform into zone of coagulation
• Zone of coagulative necrosis
- Most severe tissue damage - Most intimate contact with heat source - Made up of dying or dead cells - Coagulation necrosis & absence of blood flow - Irreversible damage - Will appear charred or white
What is an epidermal burn?
Superficial burns result in minor tissue damage to outer epidermal layer only, but do cause an intense and painful inflammatory response. Most common injury of this type is “sunburn.”
What are the characteristics of superficial dermal burn?
- Pale pink colour
- Small amount of blistering
- Capillary refill present
- Painful
- Usually heals without significant medical treatment
What are the characteristics of mid-dermal burns?
- Mid-dermal will be dark pink in colour.
- Blisters will be present
- Capillary refill will be sluggish
- There may be altered or no sensation including pain
- Usually heal without scarring, because cells lining deeper portions of hair follicles and sweat glands will multiply and grow new skin for healing.
- Antibiotic creams or various specialized types of dressings are routinely used to treat these burns and, therefore, appropriate medical evaluation and care should be provided for patients with these injuries.
• Emergency care of mid-dermal burn involves
cooling burn and covering with a clean, dry
dressing.
What are the characteristic of full thickness burns?
- Full-thickness burns cause damage to all layers of epidermis and dermis. No more skin cell layers are left, so healing by regrowth of epidermal cells is impossible.
- All full-thickness burns leave scars that later may contract and limit motion of extremity (or restrict movement of chest wall).
- Deeper full-thickness burns usually result in skin protein becoming denatured and hard, forming a firm, leather like covering that is referred to as eschar.
What is the prehospital treatment plan for burns?
• Burn injury might be associated with other forms of trauma – it is important not to be distracted by the burn
Airway: consider early intubation in some circumstances.
• Assess the airway and consider inhalation injury.
• HISS: Hoarse voice, inspiratory stridor, singed facial hair, soot in saliva/sputum
• Suspect in all fires
Breathing: give high flow oxygen and consider the consequences of circumferential burns
• Consider toxin inhalation (particularly in house fires)
Cool the burn area for 20 mins
Circulation: commence IV therapy as soon as practical.
• Commence fluid resuscitation in line with the Modified Parkland formula to combat shock
• Give analgesia.
What fluids do you give for burns?
<15%: No fluids
15 - 25% + >30 mins from hospital: 1L/1Hr
>25%: 1L stat + 1L/1Hr
How do you manage an electrical burn?
- Turn off power source
- Ensure own safety
- Spine protections is mandatory
- Primary and secondary survey
- Cardiac monitoring
- Fluid resus
- Manage compartment syndrome
- 20 minute flush of wound
What is paradoxical breathing and what does it indicate?
An abnormal respiratory pattern causing the thoracic cavity to move outward during expiration and collapses inward on inspiration, resulting in inhibition of gas exchange.
It can indicate a flail chest injury. When broken ribs detach from the chest wall causing them to move in the opposite direction.
