The assessment & management Flashcards
What is the definitions of Burns ?
Injury to skin and other tissues caused by Heat
What are the types of Burns with Heat?
Flash burns
Flame burns
Scalds
Contact burns
Injury can also be caused by ?
Electricity
Chemicals
Radiation
What do you know about Skin ?
Largest organ of the body. It
* Protection
* Sensation
* Regulation
* Maintaining Fluids
* Metabolic /endocrine
* Excretion
What does the skin protect the human from ?
microorganisms, UV, chemicals
What does the skin prevent from sensation ?
pain, touch, temperature
What does the skin help to regulate ?
thermoregulation
How can you tell what type of burn the pt presenting with ?
By looking at the depth of the burn-
- Appearance
- Blanching ( to see how quickly it goes white, if it doesn’t then it’s non blanching - could be meningitis )
- Sensation
what are superficial burns? ?
- No blistering
- Blanching, CRT normal
- Only involves epidermis
- Very Painful
- When calculating areas of burn, simple burn aren’t included
- Sunburns
What are the depts of burns ?
- Superficial Burns
- Superficial Partial Thickness / Superficial Dermal Burns
- Deep Partial Thickness / Deep Dermal Burns
- Full Thickness Burns
- Deep Burns
What is Superficial Partial Thickness/Superficial Dermal Burns look like ?
- Blisters – thin-walled & clear
- Superficial (papillary) dermis
- Very painful
- Moist and red
- Sunburns, contact burn
- Scalds
Epidermis is involved
What is Deep Partial Thickness?
- Blisters – thick-walled & cloudy fluid
- Deep (reticular) dermis
- Painful and tight
- Reduced Sensation
- Moist
- Red or pale, moist usually
- Delayed CRT
- Chemical burns
- Scalds
- Electric (domestic)
- Contact burns
Epidermis and dermis are involved
How does full thickness burn look look ?
- Brown or pale
- Entire dermis
- Loss of sensation
- Painless
- No CRT
- Stiff skin
- Scalds, flame, electricity
- Chemical
- Scalds in Children
involve entire dermis
How does deep burns look like ?
Painless
Black
Dead skin
All skin layers are involved
How do you carry out the Assessment ?
% total body surface areas (TBSA)
Ignore superficial burns
Fluid resus
Prognosis
Severity
How are the assesment classified ?
Minor
Moderate
Major
How is the Minor classified as ?
<10% adult
<5% in children
+ <2% of full thickness burn
How is Moderate Classified as ?
- 10-20% adult
- 5-10% children
- 2-5% FTB
- High voltage injury
- Possible inhalation injury
- Circumferential burn
- other health problems
How is major classified as ?
- > 20% adult
- > 10% children
- 5> FTB
- High Voltage Burn
- Known inhalation injury
- significant burn to face, joints, hands or feet
- Associated injuries
What is the Wallace’s Rule of 9s
Used in burn pts to calculate the total body surface area ( TBSA) affected by 2nd and 3rd degree burns
Entire Head & Neck ?
9%
Entire Right Arm ?
9%
Entire Left Arm ?
9%
Entire Trunk ?
36%
Groin
1 %
Entire Right Leg
18 %
Entire Left Leg
18 %
What are considered as special areas for burns ?
Face / Airways
Hands
Feet
Genitalia
Perineum
What are the Pre hospital Management ?
Running cold water for 10 mins
Cling film
Burn dressing (burnshield)
Keep warm
Analgesia
What are the 3 P’s of Analgesia ?
Psycological
Physical
Pharmacological
Why is Cling Film good for ?
Sterile
Non-adherent
Transparent
Why is Cling film against for ?
Non absorbent
No thermal insulation
Tourniquet effect
What is the Resuscitation and initial management ?
Firstly, assessment
A- if compromised airway (stridor), sedate and intubate
B- inhalation, high flow O2 ( is the pt breathing? are they maintaing their oxygen level )/ have they inhaled any materials like hot particles / any risks of inhalation
C- shock, odeoma, hypovolemia, fluid (crystalloid- hartmann’s - parkland formular (TBSA x weight X4)half in the first 8h, half in the next 16h afterwards maintenance (4ml/kg for first 10kg, 2mls/kg for second 10kg, 1ml/kg afterwards X 24h ) ), catheter, NG tube, analgesia (opiate)
D- level of consciousness
E- hypothermia
What do you mostly worry about ?
Always make sure to check the airway during facial burn
* especially if the burn is in an enclosed space
* Are they coughing up? ( brown and black stuff?
* Do they have any signed nasal or facial hair ?
* Do they have any carbon deposits on mucosa
* Do they have any coarse or change in voice
What signs do you look for in people to give intubation ?
- Stridor, Dyspnoea, Tachypnoea
- Erythema
- Swelling
By intubating pts at early will lead to much safer management
What are the questions would you ask in history ?
- Age
- Energy Transfer
- Cause - How did it happen ?
- Contact time -
- % TBSA
- Are there any Inhalation injury
- What are the Signs of inhalation injuries(bronchospasm)
- Enclosed space
- Site
What would be the treatment in GP?
- Superficial - Non adherent absorbable dressing
- Deep dermal - grafting
- Full thick- refer
What would be the effect of Burn?
Increase risk of HR, reduce BP= shock
Oedema due to reduction of blood supply to the tissue
Necrosis
What is the Prognosis of Burns ?
To determine by the severity and the age of the patient; the older the patient, the high risk of death
What is the Maintanence Fluid Formulation for hourly rate ?
4ml/kg for first 10kg, plus
2ml/kg for second 10kg, plus
1ml/kg thereafter
Urine output 1 – 1.5ml/kg/hr
How do you calculate Total fluids over 24hrs ?
20 x 75 x 4 = 6,000 ml
( 40 + 20+ 55 ) x 24 = 2,760 ml
What are the compliactions of Resuscitation ?
- Under-resuscitation
- Over-resuscitation
Pulmonary Oedema
Abdominal Compartment Syndrome
Electrolyte abnormalities
**Early: K+ Na+
Late: Ca++ Mg++ P++ ** - Raised ocular pressure
- Compartment Syndrome
- Infection
What are the further management would you do ?
- Check for other injuries?
- Dressing – non-adherent material
- Prevent hypothermia
- Referral to Burns Centre
What is the Burn Management in Primary Care for superficial dermal burns ?
Superficial dermal burns
* Non-adherent absorbent dressing
* Review every 2 days
* Should heal in < 2 weeks
Antibiotics?
What is the Burn Management in Primary care for Deep dermal burns ?
Discuss for consideration for grafting
What is the Burn Management in Primary care for Full thickness ?
Refer for assessment & grafting
What is the time frame for management of Burns with primary care ?
- Review in 1 – 2 days
- Then every 3 – 5 days, unless:
Infected
Persistent pain
Copious discharge - Should re-epithelialize in < 3 weeks
- Review in 2 months
- Consider Physio / OT
What is the long term impact of sun burn ?
Scarring and Contractures
What would be the long term effect of someone with burn ?
Psycological effect comes as immediate stress, medium term and long term
What is immediate stress?
This is during Resuscitation phase
* Survival
* Drugs & treatment
* environment
What is medium term of stress ?
**Hospital Phase **
* Sleep disturbances
* Pain
* Grief
* depression
What is Long term of stress ?
This is discharge phase
* Reintegration
* physical limitation
* social and financial issues
* Addiction
* relationship or sexual issues
What is the 7 R’s of managing Burns ?
- Rescue – maintain safety
- Resuscitate – A, B, C, D, E
- Referral – National Guidelines
- Resurface – dressings & skin grafts
- Review – early & regularly
- Reconstruct– scars
- Rehabilitate– physically & mentally
What do you have to consider in Burn about breathing ?
Inhalation burns lead to respiratory injury caused by
Hot air, Hot steam in the Larynx which can cause Laryngeal obstruction and Bronchospasm.
Smoke, Hot particles, Aspiration and it lead to mucosal slough, infection, broncholar plugging, Atelectasis and Bronchospasm
Also casued by irritant gases which lead to Pnuemonia, Pulmonary oedema, alveolar capillary defect.
What would you consider in circulation in pts with burns ?
Are they in shock?
what is the cause, is it burn? or any other causes? or combination
What do you check in Disability ?
Check their consiousness? has it been decreased?
- Smoke inhalation
- Alcohol/ Ilicit drugs
- Any head injuries ?
- CVA ?
What would look for in exposure ?
Hypothermia
Compartment syndrome
Fasciotomy/ Escharotomy
