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ATLS > Thermal injuries > Flashcards

Thermal injuries Flashcards

1
Q

When may energy transfer and oedema in thermal injuries present

A

Are not always immediately evident and may progress over time through progression of inflammatory response

Maintain suspicion regarding airway

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2
Q

Cause of hypovolaemia in burn injury

A

Inflammatory changes and capillary leak

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3
Q

Goal of resuscitation in thermal injuries

A

Stop burning process

Secure airway and ventilation

Maintain intravascular fluid in face of ongoing leak
(Rather than stopping the leak with haemorrhage)

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4
Q

Methods to stop burning process

A

Completely remove pt clothing

Prevent overexposure / hypothermia

Recognise wound contamination

Brush dry chemical powders from wound and then rinse

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5
Q

Indications for early intubation in thermal injuries

A

Signs of airway obstruction
Total body surface area burn >40-50%
Extensive / deep facial burns
Burns inside mouth
Significant or risk of oedema
Difficulty swallowing
Respiratory compromise
Reduced GCS
Full thickness circumferential neck burns

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6
Q

High risk factors for airway compromise in thermal injuries

A

Children
Inhalation injury

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7
Q

Causes of Breathing problems with thermal injuries

A

Hypoxia
Carbon monoxide poisoning
Smoke inhalation

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8
Q

Causes of hypoxia in thermal injuries

A

Inhalation injury
Circumferential chest burns
Thoracic trauma unrelated to thermal injury

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9
Q

Diagnosis of CO poisoning

A

History of burns in enclosed areas
Carboxyhaemoglobin measurement

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10
Q

Management of CO poisoning

A

100% oxygen via NRB mask

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11
Q

American Burn Association diagnosis of inhalation injury

A

Exposure to combustible agent
+
Signs of exposure in lower airway below vocal cords seen on bronchoscopy

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12
Q

Management of smoke inhalation injury

A

Supportive

Intubate
Elevate head + chest 30 degrees to reduce oedema when appropriate

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13
Q

When to provide burn resuscitation fluids

A

Deep partial or full thickness burns > 20% TBS area

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14
Q

How to calculate initial fluid rate for burn resuscitation fluids

A

Parkland formula

First half of the volume in first 8 hours
Second half of the volume over next 16 hours

Adjust fluids based on urine output

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15
Q

Fluid of choice for burn resuscitation fluids

A

Warmed Hartmann’s

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16
Q

Parkland formula for flame burns in Adults and children > 14 yrs

A

2 (ml) x patient body weight (kg) x TBS area (%)

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17
Q

Target UO for adults and children > 14 yrs with flame burns

A

0.5 ml/kg/hr

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18
Q

Parkland formula for flame burns in children < 14 yrs and > 30kg

A

3 (ml) x patient body weight (kg) x TBS area (%)

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19
Q

Target UO in children < 14 yrs and > 30kg with flame burns

A

1 ml/kg/hr

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20
Q

Parkland formula for flame burns in infants and young children < 30kg

A

3 (ml) x patient body weight (kg) x TBS area (%)

AND

Sugar containing solution (5% Dextrose) at maintenance rate

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21
Q

Target UO for infants and young children < 30kg with flame burns

A

1 ml/kg/hr

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22
Q

Parkland formula for electrical burns in all age groups

A

4 (ml) x patient body weight (kg) x TBS area (%)

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23
Q

Target UO in adults with electrical burns

A

100 ml/hr

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24
Q

Target UO in all age groups children < 30kg with electrical burns

A

1-1.5 ml/kg/hr

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25
Q

Why to avoid fluid boluses in thermal injuries (unless pt hypotensive)

A

Can increase oedema and additional complications

(inc airway compromise and compartment syndrome)

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26
Q

How to assess TBS area percentage

A

Patient’s palmar surface = 1%

Rule of 9s

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27
Q

Adult burns rule of 9s

A

Each of the following represent TBS area 9%:
- Head and neck
- Each upper limb
- Anterior chest
- Posterior chest
- Anterior abdomen / pelvis
- Posterior abdomen / pelvis
- Each anterior lower limb
- Each posterior lower limb

Genitalia = the last 1%

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28
Q

Paediatric burns rule of 9s

A

Differs from adults as head and neck is splint into 2x 9%, and each lower limb section reduced to 7%

Following areas represent TBS area 9%:
- Anterior head and neck
- Posterior head and neck
- Anterior chest
- Posterior chest
- Anterior abdomen / pelvis
- Posterior abdomen / pelvis
- Each upper limb

Each of following are 7%:
- Each anterior lower limb
- Each posterior lower limb

29
Q

Superficial burn
(Epidermal burn)

A

Pink
Painful
No blisters

30
Q

Superficial partial thickness burn
(Superficial dermal burn)

A

Moist
Pink
Painful
Blisters
Blanches to touch

31
Q

Deep partial thickness burn
(Deep dermal burn)

A

Dry
Non blanching
Not painful
Red / mottled
Possible blisters

32
Q

Full thickness burn
(Third degree burn)

A

Leathery
Translucent / waxy skin
Painless
Dry

33
Q

Adjuncts to burns management in secondary survey

A

Bloods
Assessment for compartment syndrome
NG tube
Tetanus immunisation

34
Q

Bloods for burns patients

A

FBC
G+S
ABG - carboxyhaemaglobin
Glucose
Electrolytes
Pregnancy test

35
Q

Indication for CXR in thermal injuries

A

Intubated patient
Suspected smoke inhalation injury

36
Q

Thermal injuries with risk of compartment syndrome

A

Circumferential burns of:
- Extremities
- Chest
- Abdomen

37
Q

Cause of compartment syndrome in thermal injuries

A

Reduced skin elasticity
Increased soft tissue oedema

38
Q

Management of compartment syndrome in thermal injuries

A

Escharotomy

Allows oedematous soft tissue to expand freely

39
Q

Escharotomy definition
(Es-car-otomy)

A

Emergency incision of burnt skin to release the eschar and its restrictive effects

40
Q

Escharotomy vs Fasciotomy

A

Escharotomy involves burnt tissue and does not extend to fascial layer

41
Q

Indication for gastric tube insertion

A

Vomiting / Abdo distention
Burns > 20% TBS area

42
Q

Managing agitation in burn patients

A

Treat hypoxia
Treat hypovolaemia
Analgesia and sedatives if above unsuccessful

43
Q

Pain management in burns patients

A

Cover wounds
Analgesia

44
Q

Wound care for burns

A

Gently cover with clean sheets
Clean with sterile saline

45
Q

Things to avoid with burns wound care

A

Do NOT break blisters
Do NOT apply cold compresses or cold water

46
Q

Use of prophylactic abx for burns

A

Avoid in early post burn period
Abx to treat infection only

47
Q

Management of chemical burns

A

Brush away any dry powder chemicals FIRST

Irrigate liquid chemicals with copious warm water

Immediate wound care

Attempt to identify the chemical

48
Q

Electrical burns mechanism of damage

A

Current travels inside blood vessels / nerves
Cause local thrombosis and nerve injury

Frequently more damaging than appear on body surface

49
Q

Areas at particular risk from electrical burns

A

Extremities / Digits

50
Q

Risk from electrical burns

A

Muscle injury causing myoglobinuria and renal failure

51
Q

Treatment of myoglobinuria

A

Fluid resus with UO target 100 ml/hr in adults
Can consider mannitol

52
Q

Role of mannitol in treatment of myoglobinuria

A

Free radical scavenger
Osmotic diuretic to flush out myoglobin along with IV fluids

53
Q

Test for myoglobinuria

A

Urine test for hemochromogen

54
Q

Management of electrical burns

A

Control airway
IV access
Continuous ECG monitoring
Treatment of rhabdomyolysis / myoglobinuria

55
Q

Management of tar / asphalt burns

A

Rapid cooling of tar
Mineral oil used to dissolve tar

56
Q

Signs of Non Accidental Injury burns

A

Circular burns
Burns with clear edges
Burn to soles of feet
Burn to buttocks
Old burns with new traumatic injury

57
Q

Indication for transfer to burns centre

A

Partial thickness burn > 10% TBSA
Burns involving certain areas
Third degree burn
Electrical burn
Chemical burn
Inhalation injury
Burn with concomitant trauma (eg. fracture

58
Q

Burns involving which certain areas are indication for transfer to Burns centre?

A

Face
Hands
Feet
Genitalia
Perineum
Major joints

59
Q

Types of cold injury

A

Frostbite
Non-freezing injury

60
Q

Causes of damage in frostbite

A

Freezing of tissue
Cell membrane injury secondary to ice crystals
Microvascular occlusion
Tissue anoxia
Reperfusion injury on rewarming

61
Q

Cause of non-freezing injury

A

Long term exposure to wet conditions and temperatures just above freezing

62
Q

Characteristics of non-freezing injury

A

Microvascular endothelial damage, stasis and vascular occlusion

63
Q

Signs of non-freezing injury

A

Black appearance
Alternating arterial vasospasm and vasodilation
Blisters
Oedema
Ecchymosis
Ulcers

64
Q

Affected tissue progression in non-freezing injury

A

1) Cold
2) Numb
3) Hyperaemia
4) Painful burning
5) Dysaesthesia

65
Q

Management of cold injuries

A

Stop freezing tissue

Remove constricting / damp clothing

Warm blankets

Oral warm fluids

Place injured area in circulating water at constant 40 degrees

Avoid excessive dry heat

Avoid vasoconstrictive agents

66
Q

Hypothermia definition

A

Core temperature < 36 degrees

67
Q

Severe hypothermia definition

A

Core temperature < 32 degrees

68
Q

Management of mild hypothermia

A

Passive warming
Eg blankets

69
Q

Management of severe hypothermia

A

Active warming
Eg warmed IV fluids

ATLS (14 decks)

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