Principles of Burn Management Flashcards
What is a burn?
- Coagulative destruction of the surface layers of the body
- 50% of all burn admissions are children (1-5)
- Age of pt + % of burns, if value > 100 = death
How do you assess the extent of the burn with Wallace’s Rule of 9s?
-
Wallace’s Rule of Nines
- head & neck = 9%
- each arm = 9%
- each anterior part of leg = 9%
- each poserior part of the leg = 9%
- anterior chest = 9%
- posterior chest = 9%
- anterior abdomen = 9%
- posterior abdomen = 9%
What is the most accurate method of assessing the extent of burns?
- Lund and Browder chart
How can you classify the depth of burns?
What is the aetiology of burns?
-
Thermal (90%) → related to temp + duration
- wet heats (scalds) = partial thickness
- dry heat = tend to be deep
-
Chemical (5%)
- alkali - worse than acid, cause coagulative necrosis, short lived
- acid - liequfactive necrosis, deep + prolonged, needs dilution
- Electrical → low <1000 (domestic) or high voltage, be wary of compartment syndrome - do escharotomy
- Radiation
What is the pathophysiology of severe burns?
- Local response → progressive tissue loss + cytokine release
- Systemically → CVS effects, fluid loss + sequestration of fluid into third space
- Marked catabolic response
- Immunosupression common w/ large burns + bacterial translocation from gut lumen is recognised event
- Sepsis a common cause of death following major burns
What is the emergency/immediate first aid for burns?
- ABCDE
- Burns caused by heat → remove person from source
- Within 20 mins, irrigate burn with cool (not iced) water, for between 10-30mins
- Cover burn using cling film, layered rather than wrapped around limb
- Electrical burns → switch off power supply, remove person from source
- Chemical burns → brush any powder off then irrigate w/ water, attempts to neutralise chemical not recommended
What is the management in primary care for burns?
- Initial first aid as mentioned
- Review referral criteria
- Superficial epidermal → symptomatic relief, analgesia, emollients etc.
- Superficial dermal → cleanse wound, leave blister intact, non-adherent dressing, avoid topical creams, review in 24hrs
What are the criteria for referral to secondary care?
- All deep dermal + full-thickness burns
- Superficial dermal burns of >3% total body surface area (TBSA) in adults, or >2% TBSA in children
- Superficial dermal burns involving: face, hands, feet, perineum, genitalia, any flexure OR circumferential burns of limbs, torso or neck
- Any inhalation injury
- Any electrical or chemical burn injury
- Suspicion of non-accidental injury
What is the management of more severe burns?
- Initial aim → stop burning process + resuscitate patient
- Children: IV fluids if burns >10% TBSA
- Adults: IV fluids if burns >15% TBSA
- Parkland formula for fluids → fluid vol = TBSA % x wt (kg) x4
- Half of fluid administered in first 8 hrs
- Urinary catheter + analgesia
- Burns unit for complex burns → hand, perineum, face, burns >10% (adults) and >5% (children)
- Conservative management for superficial burns, heal in 2wks
- No evidence to support use of anti-microbial prophylaxis or topical antibiotics in burn pts
What is the surgical management for burns?
- Circumferential burns affecting limb or severe torso burns impeding respiration → escharotomy (to cut into the skin and the tissues underneath to allow them to spread open, relieving the pressure building in the affected area)
- Complex burns → excision + skin grafting
- Excision and primary closure not generally practised (high risk of infection)
Escharotomies are indicated for circumferential full thickness burns to torso/limbs and require careful divison of encasing band of burn tissue to improve ventilation (if burn involves torso), or relieve compartment syndrome and oedema (where limb is involved)
