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ATLS > Thermal trauma > Flashcards

Thermal trauma Flashcards

1
Q

How to stop the burning process with chemicals

A

Remove all clothing (except if adherent)

Brush dry chemical away

Rinse with copious amounts of warm (to avoid hypothermia) saline irrigation

Once the burning process has stopped, cover pt with warm, clean dry linens to prevent hypothermia

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2
Q

Child vs adult airway susceptibility post burns

A

Children more susceptible as their airway is smaller

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3
Q

Indications for early intubation for burns

A

Signs of airway obstruction or respiratory distress

TBSA >40%-50%

Oedema

Deep fascial burns or mouth burns

Difficulty swallowing

Reduced GCS

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4
Q

What carboxyhaemoglobin level indicates inhalation injury

A

more than 10%

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5
Q

Diagnosis of carbon monoxide poisoning

A

Hx of exposure (pt who were burned in enclosed areas)

Raised serum carboxyhaemoglobin

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6
Q

At what carboxyhaemoglobin level do patients express physical sx

A

> 20%

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7
Q

Various HbCO levels and their associated presentations

A

Headache + nausea (HbCO level of 20%-30%)

Confusion (HbCO level of 30%-40%)

Coma (HbCO level of 40-60%)

Death (HbCO level of >60%)

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8
Q

The affinity of Hb for O2 vs CO

A

CO has an affinity of 240 times more than O2

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9
Q

Oxygen therapy in possible CO exposure

A

Breathing 100% O2 reduces the HbCO from 4 hrs to 40 mins,

Apply 100% O2 for 4-6 hrs unless COPD

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10
Q

ET tube minimum size in children and adults

A
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11
Q

Pulse oximetry in CO poisoning

A

Not reliable, may be showing readings between 98 and 100%

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12
Q

PaO2 from ABG’s reliability in CO poisoning

A

Does not reliably predict CO poisoning

PaCO of 1mmHg results in HbCO of 40%

Need HbCO levels taken as well as ABG and pulse oximetry

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13
Q

Sign of cyanide inhalation

A

a product of combustion

could lead to unexplained persistent metabolic acidosis

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14
Q

Hyperbaric oxygen therapy for burns

A

No role in acute trauma

Consult burn centre for further guidance after pt resuscitated

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15
Q

Pathophysiology of smoke inhalation

A

Smoke particles settle into distal bronchioles, causing SIRS, leading to necrotic cells obstructing airways

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16
Q

Treatment of smoke inhalation

A

Supportive

(intubate if >20% of TBSA in adults or >10% in <10yo or >50yo)

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17
Q

Cannulation in burns

A

2 large bore cannulas (at least 18 gauge)

Try avoiding burned skin if possible

Upper limb preferred to lower limb as increased risk of septic phlebitis in lower limb

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18
Q

Fluid resuscitation calculation in adult scalding burns patients

A

24hour fluid volume requirement: 2ml * TBSA * Wt

The first half should be given over 8 hours

The second half is given over 16hrs

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19
Q

Urine output aim for adult scalding burns patients

A

0.5 ml/kg/hr

between 30-50mls per hr

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20
Q

Fluid resuscitation calculation in child burns patients

A

3ml/kg/%TBSA (as children have a larger surface area:body mass)

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21
Q

Urine output aim for child burns patients

A

1ml/kg/hr

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22
Q

Fluid resuscitation calculation in infant and young child (<30kg) burns patients

A

3ml/kg/TBSA

Plus 5% dextrose in addition

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23
Q

Electrical burn fluid resuscitation calculation

A

4ml/kg/%TBSA

24
Q

Urine output aim for electrical injury

A

1-1.5ml/kg/hr until urine clears

25
Q

Paediatric rule of 9s

26
Q

Adult rule of 9s

27
Q

Palmar sizing of burns

A

Palmar surface of PATIENT’S hand including fingers is approximately 1% TBSA

28
Q

Which skin layer does each type of burn affect

A

Superficial: dermis

Superficial partial-thickness: Papillary

Deep partial-thickness: reticular

Full-thickness: Subcutaneous tissue

29
Q

Superficial burn sx

A

Erythema and pain

eg sunburn

30
Q

Superficial partial-thickness burn features

A

Moist

Painful

Blister

Blanch to touch

31
Q

Deep partial-thickness burn features

A

Drier

Less painful

Possible blisters

Red mottled in appearance

Non blanching to touch

32
Q

Full-thickness burn features

A

Skin is waxy white or translucent

Painless to touch or pinprick

Dry

33
Q

What compartment pressure could lead to muscle necrosis

A

>30mmHg (although a pressure above systolic is required to stop blood flowing, pressures above 30 are enough to cause necrosis)

34
Q

Presentation of compartment syndrome

A

Pain > expected

Pain on passive stretch

Tense swelling

Paraesthesia or altered sensation

35
Q

Treatment of circumferential chest and abdominal burns

A

Escharotomies along the mid-axillary line with a cross-incision along the clavicular line and junction of thorax and abdomen

36
Q

How soon after injury may escharotomy be required

A

not for the first 6 hours

37
Q

NG tube indication in burns

A

N+V

Abdo distention

TBSA >20%

38
Q

Use of antibiotics in burns

A

No indication for prophylaxis

39
Q

Blister management

A

Do not break

Do not apply antiseptic agent

40
Q

Why are alkali burns more serious than acid burns

A

Acid burns cause coagulation necrosis, which prevents penetration of acid into deeper tissue

Alkali burns cause liquefication necrosis, penetrating more deeply

41
Q

Management of chemical burns

A

Remove the substance

Irrigate with saline (neutralising agents may be harmful)

42
Q

Irrigation time for chemical burns

A

20-30mins for acidic burns

Longer for alkali

8 hours for the eye (through a cannula in palpebral fossa)

43
Q

Treatment of tar burn

A

Cool down tar by irrigation

Apply a large amount of oil to dissolve it

44
Q

Types of cold injury

A

frostbite or nonfreezing injury

45
Q

1st-degree frostbite features

A

hyperaemia and oedema without skin necrosis

46
Q

Second-degree frostbite features

A

Large clear vesicle formation accompanies Hyperaemia and oedema with partial-thickness skin necrosis

47
Q

Third-degree frostbite features

A

Full-thickness and/sc tissue necrosis occurs

Haemorrhagic vesicle formation

48
Q

Fourth-degree frostbite features

A

Full thickness skin necrosis, including muscle and bone with lateral necrosis

49
Q

Nonfreezing injury cause

A

Prolonged exposure to wet conditions and temperatures just above freezing 1.6 to 10 degrees

Typically in homeless, sailors, soldiers, fishermen

AKA trench foot

50
Q

Nonfreezing injury phases

A

Alternating vasospasm and vasodilation

51
Q

Management of frostbites or nonfreezing cold injuries

A

Replace restricting damp clothes with dry towels

Hot fluids by mouth

Place foot in circulating warm water (40 degrees) until pink and perfusion return (20 -30 mins)

Avoid dry heat as could cause burn

Analgesia as rewarming is very painful

52
Q

Passive vs active rewarming

A

Passive:

  • to avoid loss of heat by placing in a warm environment and hoping patient will regain heat
  • mild hypothermia

Active:

  • to heat with warmed iv fluids or bypass
  • moderate/severe hypothermia
53
Q

Ongoing care for frostbites

A

Uninfected non haemorrhagic blisters intact for 7-10 days to provide sterile biological dressing

Minimise wt bearing

Avoid tobacco, nicotine and other vasoconstriction

Thrombolytic agents may be helpful if given in the first 23hrs

54
Q

Definition of hypothermia

A

Core temp less than 36 degrees

55
Q

Definition of severe hypothermia

A

Core temp less than 32 degrees

ATLS (14 decks)

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