Week 11: Burns Flashcards
Define superficial burns
Erythema of the skin, with no blistering (most sunburns and some water scalds fall into this group) rarely requiring treatment
Define the term burn
A thermal insult which damages the skin and/or underlying structures
Define partial thickness burns
Results from deeper damage but variable number of the skins structures of the dermis, (capillaries, nerve endings, sweat glands, hair follicles) are still present
What is the appearance of partial thickness burn?
Blistering of the epidermis, and presence of pain, they look red and have a blotchy red and white appearance
Define the term, full thickness burn
Results from death of all layers of the skin and sometimes underlaying structures
What is the appearance of a full thickness burn?
Not painful (dead nerve endings), doesn’t blanch on pressure, appears white or even charred or leathery
What are different mechanisms of injury?
- flame/hot gas
- fluids
- contact with a solid object
- chemical burns
- electrical burns
- radiations burns
Define flame/hot gas burns
- associated with FTB
- airway burns
- blunt trauma (explosions, jumping from buildings, carbon monoxide poisoning)
Define contact with solid object burn
- usually FTB and shows the pattern of the object with which the skin has come into contact with
Define a fluid burn
- often called scalds when hot water involved
- burns from water are usually PTB and fat FTB
Define chemical burns
- identification of exact chemical
- transport of labels/containers to A&E to assist with management
Define electrical burns
- associated with cardiac arrhythmia
- factures (tectanic contraction of muscles)
Define radiation burns
- sunburn rarely requires treatment
- actor skin burns from radioactive material indicate overwhelming radiation exposure
- rescuer safety and decontamination is essential
What is a friction ‘burn’ classed as?
More of an abrasion than a burn
What is the zone of coagulation?
Centre area of wound, where all tissues are damages
What is the zone of stasis?
Surrounds the coagulation area, some tissues are damages
What is the zone of hyperaemia?
Unburned area surrounds the stasis but it is red due to inflammation
What happens to the body in presence of a burn?
- capillary permeability increases
- leads to loss of intravascular proteins and fluid into interstitial space
peripheral and splanchnic vasoconstriction occur and myocardial contractibility decreases - combined with fluid loss from the burn may result in hypotension and end-organ hyoperfusion
What are some complications of burns?
- airway/inhalation
- fluid loss/ hypovolaemic shock
- pain
- Caron monoxide/ cyanide poisoning
- hidden injury
- hypothermia
- circumferential
How is airway/inhalation a complication of burns?
Almost always occur in the supraglottic region of the larynx, interventions such as tracheal tubes or cricothryiodotomy may be required
How is fluid loss/hypovolaemic shock a complication of a burn?
Significant fluid loss (IV fluids requires), if they burn is >25% on an adult and 12.5% surface area
How is pain a complication of a burn?
Burns are painful (unless FTB), entonox is an affective analgesic, however adapt a stepwise approach and IV drugs such as paracetamol/morphine can be considered
How is carbon monoxide/cyanide poisoning a complication of burns?
If the patient has been in a fire, initial presentation may be confusion or a reduced GCS, SPO2 reading will be normal. High flow 02 to be considered, cyanide is a result from burning plastics- variable respiratory distress, rapidly loses consciousness and often leads to cardiac arrest
How can a hidden injury be a complication of burns?
- blunt trauma (spinal, abdominal)
- happens during falls, explosions, falls and occasionally electrics
How is hypothermia a complication of a burn?
- burns predispose heat loss
- over enthusiastic irrigation and water soaked dressings can increase rate of cooling, especially in children
How is circumferential a complication of a burn?
- burnt skin swells and loses elasticity
- if burn encircled limb or chest, can cause constriction
- can cause ischaemia and chest respiratory failure
What history should you ask for a burn?
What was the mechanism of injury:
- fluid - what temp/ what fluid
- flame/hot gas- indoor/outdoor, explosion, smoke, fall, LOC
- chemical- what chemical/ any info on the chemical
- electrical- domestic/high voltages/ lightening / falls/ LOC
- contact- what with/how long for
What is the order of examination for burns?
- airways (soot/singed nasal hair/stridor/tissue destruction)
- cervical spine (every time expect blunt trauma)
- breathing (circumferential or widespread burns to thorax)
- circulation (unusual for patient to have hypovolemic shock, even from an extensive burn within 2-3hrs, if patient in shock, expect other cause e.g. bleeding/abdominal)
What should be considered if a burn patient is in shock?
Consider bleding/abdominal trauma, if within first 2-3hr window
What burns are included when assessing body surface area of a burn?
PTB and FTB, and any Redding go the total burn area
What can you use to calculate body surface area burns?
- rule of nines
- mersey burns chart app
What % of Body surface area burns should be treated as time critical?
- 12.5% paediatric
- 25% adults
think major trauma bypass, if not consider pre alert
What is the order of burn management?
- rescuer safety
- stop further burns
- cover with cling film
- thermal burns need to be cooled
- do not use ice
- do not leave dressing for extended period of time
- chemical burns
What is meant by rescuer safety?
Ensure all electrical supplies are turned off, take advice from eternal agencies and specialist teams
How do you stop further burns?
Remove clothing and jewellery (unless adhered to skin), can cover the burn with water soaked dressing loosely placed over injury ASAP
What burns can you not cover with clingfilm?
Circumferential
What should you do with thermal burns?
Should be be cooled for 20 minutes, preferably with running water between (8-15 degrees)
Why should you not use ice on a burn?
Will not cause harm but can increase risk of hypothermia
Why should you not leave dressings in for extended periods of time?
Can induce hypothermia
What should you do in the presence of a chemical burn?
- remove clothing
- irrigate for 30 minutes
- brush off chemical powder before irrigating
What are drugs that can be used for burns?
- IV sodium chloride (max dose 1L)
- oxygen 15L/100%
- entonox
- morphine
- oramorph paracetamol
What must you be careful of when administering IV sodium chloride?
People who are elderly or in heart failure, ensure patient are not over infused
Why should you try to warm fluids if in hospital?
To avoid increased risk of hypothermia
What is the main way to identity a 1st degree burn (superficial burn)?
Red, non-blistered skin
What is the main way to identify a 2nd degree burn (PTB)
Blisters and some thickening of the skin
What is the main way to identify 3rd degree burns (FTB)?
Widespread thickness with a white leathery appearance
