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Anaesthetics, ED and Plastics > Plastics - Burns > Flashcards

Plastics - Burns Flashcards

1
Q

What types of burn can you get

A 
Thermal = most common 
- Scald = paeds
- Flame = adult 
- Contact 
Electrical
Chemical
Radiation
Friction
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2
Q

What causes a scald and when is it common

A

Wet heat

Commonly paediatric

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3
Q

What does it result in usually but what can it

A

Superficial skin loss

Boiling water or fat can cause full thickness in seconds

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4
Q

What causes thermal burn

A

Dry heat from direct contact with flames or hot appliances

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5
Q

What does it result in

A

Deep burn

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6
Q

What does depth of electrical burn depend on

A

Energy transfer

  • Voltage - high or low
  • Contact time
  • Factors that lower resistsce
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7
Q

What can electrical burn cause

A

Sparing of skin but damage to deep tissue

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8
Q

What does severity of chemical burns depend on

A

Type of chemical

Alkali = more dangerous

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9
Q

What model for changes that burns cause at local level and what are these
- EXAM

A

Jackson’s Burns Model
Zone of Coagulative Necrosis
Zone of Stasis
Zone of Hyperaemia

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10
Q

What is the Zone of Coagulative Necrosis

A

Region where direct transfer or heat
Unable to conduct heat away rapidly enough
Leads to immediate coagulation of cellular protein and death
Irrerversible
Loss of sensation

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11
Q

What is the Zone of Stasis

A

Area of tissue that surrounds necrosis
Damage to dermal microcirculation leads to ischaemia and compromised circulation
Potentially viable tissue

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12
Q

What can happen in Zone of stasis

A

Can recover under correct condition e.g fluid resus
May undergo necrosis over 3-5 days = known as progression over burn
Always get back to review
May compromise sensation dependent on depth

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13
Q

What is Zone of Hyperaemia

A

Release of inflammatory mediators from damaged tissue leads to widespread vasodilation and increase in blood flow
Red area

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14
Q

When would this zone involve entire body

A

If burn >25%

Dangerous as can affect all the body system

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15
Q

What is a significant burn and what requires resus fluids always

A

20-25% TBSA as will alter all organ system
>15% adults
>10% in children or very frail adults

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16
Q

What systems affected

A 
Vascular / CVS
Renal
Respiratory
GI 
Metabolic
Immune 
Long term
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17
Q

What happens to vascular system / CVS

A

Loss from weeping area / skin dysfunction due to zone of hyperaemia = obvious loss
Large volume 3rd space loss = oedema
Vasodilation + increased permeability due to inflammatory mediators
Causes hypo-perfusion and hypovolaemia
Cell death due to ischaemia

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18
Q

What can be life saving and easily correctable

A

Hypovolaemia with fluid resus

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19
Q

What is an Eschar

A

Rigid area which doesn’t allow expansion of swelling tissue
Occurs in deep burns down to fat
If circumferential will act as tourniquet

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20
Q

What is required

A

Escharotomy

Aids respiration and prevents ischaemia

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21
Q

How is renal affected

A

Hypovolaemia = vasoconstriction of renal artery
Myoglobin from rhabdomyolysis / damaged muscle
Hb from haemolytic further damage kidney
= AKI

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22
Q

How is resp system affected

A

Widespread bronchoconstriction = ARDS

Bilateral infiltrate on GXR

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23
Q

How is GI affected

A

Gastroparesis due to SIRS

Stress ulcers

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24
Q

What should you do

A

Give PPI

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25
Q

How is metabolism affected

A 
Stress hormones released 
- Cortisol
- Glucagon
- Catecholamines
Suppression of anabolic 
- Insulin
- GH
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26
Q

What does this lead too

A

Profound catabolic state

Muscle protein breakdown to provide AA to repair burnt tissue

27
Q

How is immune system affected

A 
Cortisol impacts on immune
Infection = biggest mortality in burns
Delayed healing
Cortisol also causes hyperglycaemia 
Loss of gut barrier function leads to whole body sepsis
28
Q

What are most problematic organisms

A

Psueodomona
MSRA
Fungal in later stage

29
Q

What is long term consequences

A 
Growth and development 
Nightmares
Social problem
Wound breakdown
Hypertrophic scars
30
Q

How do you prevent growth being affected

A

Correct positioning
Splinting
Early physio

31
Q

What is most important determinant in severity of burn

A

Depth of tissue affected

% Body surface area affected

32
Q

How do you measure BSA affected

A

Lung and Browder
Wallace Rule of 9’s
Patients palm surface

33
Q

What is most accurate

A

Lung and Browder

Used in hospital setting

34
Q

When is Rule of 9’s used

A 
Outside hospital
Divide body parts into multiples of 9
9% = UL and head
18% = LL and torso front and back 
Groin = 1%
35
Q

What is patients palm

A

Palm = 1% of patient’s body

36
Q

When is it not accurate

A

Burns >15%

37
Q

When is it most appropriate

A

Small burns
Children
Or large burns to measure area not affected

38
Q

What are types of burn depth

A 
Epidermal 
Superficial derma (1)
Mid-dermal (2) 
Deep-dermal
Full thickness (3)

1st, 2nd, 3rd not used

39
Q

What causes epidermal

A

Sunburn = most common

Hot liquid

40
Q

How do they appear

A

Red burn
Wet burns
No blisters
SEVERE pain

41
Q

CRT

A

Brisk due to vasodilation

42
Q

How do they heal / scar

A

Spontaneous with 2 intention
Usually 7-14 days
Minimal scar

43
Q

Where does superficial-mid dermal extend to

A

Papillary dermis (upper)

44
Q

What causes

A

Sunburn

Hot liquid

45
Q

How does it present

A 
Pink skin 
Darker if mid-dermal
Small blisters but large if mid-dermal 
Blanches 
Superficial = painful
Mid = reduced pain
46
Q

CRT

A

Slow

47
Q

How does it heal

A

Spontaneous
May take 2-4 weeks
Heals with minimal to moderate scar
Mid dermal can go either way

48
Q

Where deep dermal extend too

A

Involves entire epidermis and dermis

49
Q

What causes

A

Chemical

Flames

50
Q

How does it present

A

Dry or moist
Cherry red / blotchy
Blisters or may have none depending on how much dermis
White
Can be painful or painless due to nerve fibres dying
Painless
No sensation

51
Q

CRT

A

Absent - no blanching or sluggish

52
Q

How long to heal

A

3-8 weeks

53
Q

What is required to heal

A

Skin graft
Refer early to skin surgeon
Dress with Ax prior
Will scar

54
Q

Where does full thickness affect

A

Destroys epidermis and dermis

Invades into underlying structures

55
Q

What causes

A

Chemical
Flames
Explosion

56
Q

How does it present

A 
Dry
White eschar
Can see yellow fat 
Charred
No blisters 
NO PAIN
NO SENSATION
57
Q

CRT

A

ABSENT

58
Q

How does it heal

A

Requires skin graft

Severe scars

59
Q

What should you always look for with burn

A

Hidden injury that is masked by visible burn

60
Q

How does sunburn make you feel ill

A

Cytokine release

61
Q

Why does CRT slow

A

As blood supply is damaged

Do with something sterile

62
Q

What should you do if on genitalia

A

Get catheter in quick before swelling

63
Q

What do you always do

A

Reassess after 24-72 hours due to progression

Anaesthetics, ED and Plastics (14 decks)

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