Thermal injuries Flashcards

1
Q

Principles of thermal injury management

A

High index of suspicion for airway compromise
Identify and manage associated mechanical injuries
Maintain haemodynamic normality with volume resuscitation
Prevent hypothermia
Remove pt from injurious environment
Energy transfer and oedema may not be evident immediately (think about IV lines, tube ties, ID bands)

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2
Q

Primary survey and resus in burns

A

Stop burning process
Ensure airway and ventilatory adequacy
Manage circulation

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3
Q

Stop the burning process in burns patients

A

Completely remove patient’s clothing
Prevent overexposure and hypothermia
Think about possible wound contamination
Brush any dry chemical powders from the wound and then rinse

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4
Q

Airway compromise in burns patients

A

Direct injury
Massive oedema

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5
Q

Factors increasing risk of upper airway obstruction

A

Increasing burn size and depth
Burns to head and face
Inhalation injury
Burns inside the mouth
Age: children with burn injuries are at higher risk for airway problems

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6
Q

Causes of hypoxia in burns patients

A

Inhalation injury
Circumferential chest burns
Thoracic trauma unrelated to thermal injury

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7
Q

In patients who were burned in enclosed areas, always assume

A

Carbon monoxide exposure

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8
Q

Manage inhalation (smoke) injury

A

CXR and ABG
Supportive treatment
Intubate if significant burns
Elevate head and chest 30 degrees to reduce oedema when appropriate

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9
Q

Fluid rate for 2nd and 3rd degree burns

A

2 ml lactated ringer’s x body weight x % surface area in burns

  • one half in first 8 hours
  • one half over next 16 hours

3ml for paediatrics
- in children <30kg add maintenance fluids of 5% dextrose in water

Adjust according to urine output

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10
Q

History in burns patient

A

Associated injuries whilst escaping fire
Explosions (internal injuries, fractures)
Time of burn injury
Enclosed space (inhalation risk)
LOC

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11
Q

Superficial burn description

A

Erythema
Pain
No blisters, no fluid replacement necessary

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12
Q

Superficial partial-thickness burn description

A

Moist
Painfully hypersensitive
Possible blisters
Pink
Blanches to touch

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13
Q

Deep partial thickness burn

A

Dry
Not painful
Possible blisters
Red/mottled
Does not blanch to touch

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14
Q

Full thickness burn description

A

Leathery appearance
Translucent/waxy skin
Painless
Dry

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15
Q

Escharotomy

A

Incision in burn eschar that release pressure in underlying soft tissue

If oedema
+ reduced elasticity of burned skin

that results in increased pressure in underlying soft tissue

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16
Q

Secondary survey in thermal injuries

A

Document
Baseline bloods including carboxyhaemoglobin
Maintain peripheral circulation in circumferential extremity burns
Gastric tube
Narcotic analgesia and sedatives
Wound care
Tetanus immunisation

17
Q

Bloods for thermal injury

A

FBC
Cross match
ABG with carboxyhaemoglobin
Glucose
U&Es
pregnancy test if appropriate
CXR in intubated pts or suspected inhalation injury

18
Q

Risk in circumferential extremity burns

A

Compartment syndrome
(dec skin elasticity and increased soft tissue oedema)

19
Q

Possible indications for fasciotomy (as opposed to escharotomy) in thermal injuries

A

Skeletal trauma
Crush injury
High voltage electrical injury

20
Q

Indications for gastric tube in thermal injuries

A

Nausea, vomiting or abdominal distension

Burns >20% body surface area

(Insert and attach suction prior to transfer)

21
Q

Before administering narcotic analgesics or sedatives in thermal injury patients, first manage

A

Hypoxemia and inadequate fluid resus

  • do small frequent IV doses only
  • cover wounds to help decrease pain
22
Q

Wound covering for partial thickness burn wounds

A

Cover with clean sheets

23
Q

You should break blisters in burns patients, true or false

24
Q

Before using antibacterial topical agents on burns wounds, you should

A

Remove any previously applied medication

25
How to clean dirty burns wounds
Sterile saline
26
Cold compresses or cold water should not be applied to patients with extensive burns, true or false
True (risk of hypothermia)
27
Should antibiotics be used early post burn period
no
28
Irrigation to wash off chemicals in a patient with chemical burn injury should not occur until
the airway has been assessed and secured
29
Interventions for treating rhabdomyolysis
Fluids to target urine output at 100mls/hr Mannitol - free radical scavenger and osmotic diuretic, to increase urine output and therefore wash out of myoglobin
30
Effect on muscles of electrical burns
Contracture
31
Management of electrical burns
Therapy for suspected myoglobinuria 4ml/kg/%TBSA to ensure urinary output of 100ml/hr
32
Suspicious burn injuries for abuse
Circular burns Clear edges and unique patterns Burns on soles of feet Burns to buttocks Old burns seen with new traumatic injury
33
Criteria for transfer to a burns centre
Partial thickness burns on greater than 10% total body surface area Burns involving face, hands, feet, genitalia, perineum and major joints Third degree burns Electrical burns Chemical burns Inhalation injury Pre-existing medical disorders Concomitant trauma Children, when capabilities for children are not present Special intervention required (social, emotional, rehab)
34
Passive rewarming
Environment that reduces heat loss - dry clothing, blankets etc
35
Active rewarming
Additional sources of heat energy - warmed IV solution - warmed packs to areas of high vascular flow eg groin/axilla
36
Signs of non freezing injury
Black appearance Alternating arterial vasospasm and vasodilation Affected tissue progresses from cold and numb to hyperemia with painful burning and dysesthesia oedema, blistering, redness, ecchymosis, ulceration
37
Manage frostbite and nonfreezing cold injury
Stop tissue freezing Replace constricting, damp clothing with warm blankets Hot fluids by mouth Place injured part in circulating water at constant 40 degrees Avoid excessive dry heat, do not rub area Analgesia monitor cardiac status and peripheral perfusion
38
Wound care for frostbite
Prevent infection Avoid opening uninfected vesicles Elevate injured area Leave wound open to air Keep wound clean Withhold vasoconstrictive agents
39
Severe hypothermia
Core temp below 32