Plastics burns Flashcards
most common cause of burns in adults and children
adults - flames
children - scaleds
Describe assessment of an epidermal burn
Red, no blisters, cap refill present, sensation present
What depth of burns are not expected to heal?
Deep dermal and full thickness
some mid-dermal may not heal
Describe assessment of a superficial dermal burn
Pale pink, small blisters, cap refill present, painful.
What features are checked to assess the depth of a burn?
Color
Blisters
Cap refill
sensation
Describe assessment of a mid dermal burn
Dark pink, large blisters, sluggish cap refill, painful ± sensation to light touch may be lost
Describe assessment of a deep dermal burn
blotchy red fixed stain gin, sometimes blistering, cap refill absent, no sensation
Describe assessment of a full thickness burn
White / leathery, no blisters, cap refill absent, sensation absent
Burn is pink, with blisters, patient is in pain when wound is examined, can’t feel pin prick sensation. How deep is the burn?
Mid dermal
estimated %TBSA of palm of hand
1%
Most accurate measurement for estimating TBSA of burns
Lund and Browder chart
% TBSA of perineum
1%
% TBSA of child’s head?
18%
% TBSA of adult back
18%
% TBSA of adult hamstring and calf
9%
% TBSA of adult forearm
4.5% including anterior and posterior
% TBSA of adult head
9%
% TBSA of back of child’s legs
7%
% TBSA of child’s arm
9%
% TBSA of child’s back
18%
What are the principles of burn management
- First Aid
- Primary Survey
- Secondary surgery
- Further management
What does primary survey involve?
Airway maintenance + C spine control Breathing and Ventilation Circulation w/ haemorrhage control Disability Exposure + environmental control Fluid resuscitation
What does secondary survey involve?
- Head to toe exam
- AMPLE
Allergies, meds, past illnesses, last meal, events/environment related to injury - Mechanism of injury
Parkland formula for fluid resuscitation
3-4ml Hartmann’s x Bodyweight (kg) x %TBSA
Given in the first 24hrs after the burn (not from time of presentation)
Half in the first 8 hours from the burn, the other half over the next 16.
What sort of fluid shift happens in burn victims?
( esp burns over 20-30% TBSA)
generalised process
intravascular hypovolaemia due to oedema and evaporative loss form the moist burn surface
Fluid resuscitation for children
Maintenance fluids 5% glucose in 0.45% NaCl + resuscitation fluids
- 100ml/kg up to 10kg
+ 50ml/kg from 10-20kg
+ 20ml/kg for every kg over 20kg
Distal ischaemia is a complication fo what type of burns.
Prevention
Full thickness and deep dermal
because of oedema, the skin can’t expand.
Manage by emergency escharotomy ( incision down to subcutaneous fat) to allow adequate ventilation and prevent ischaemia
What are the wrist flexors and extensors?
Flexors = flexor carpi radialis and ulnaris Extensors = extensor carpi radialis brevis, extensor carpi radialis longus and extensor carpi lunaris
Blood supply of the thumb and index finger
radial artery
Blood supply to deep palmar arch
radial artery
Blood to middle, ring and little fingers
Ulnar artery
