Burn Flashcards
surgery (27 cards)
Definition of Burn
Area of coagulation necrosis due to thermal injury.
Classification by Aetiology
Heat (Dry: flames, Moist: steam), Cold (frostbite), Physical (electric), Chemical (acid/alkali), Mechanical
(friction).
1st Degree Burn
superficial partial
not deeper than papillary dermis
red
dry or small-moderate size blister
painful
sunburn
2nd Degree burn
Deep partial/Deep dermal
deeper parts of reticular dermis
pink or mottle red
bullae or moist weeping surface
painful
Deep 2nd degree burn - anaesthetic to pinprick
pressure sensation - intact
limited exposure to flame
3rd Degree Burn
Full thickness - totally destroyed skin
pearly white, Charred or Parchment like
Dry surface
Insensate
Prolonged exposure to flames
4th Degree Burn
subcutaneous tissue, muscle, fascial bone
Major Burn
Adult >30% BSA, Child >15% BSA
Skin burn + inhalational injury
burn of hands, face or genitalia
Moderate Burn
Adult 15-30% BSA, Child 10-15% BSA.
Minor Burn
Adult <15% BSA, Child <10% BSA
Pre-hospital Burn Care
Ensure rescuer safety, ATLS, stop burning, cool wound, sit up if airway burn suspected
Burn Admission Indications
Adult >15% BSA, Child >10%,
inhalational injury, burns on face/hands/perineum,
social/psychiatric issues,
not accidental injury
extreme ages
potential serious sequelae - electric burn, strong acid burn
Signs of Airway Burn
obligatory inhalation of hot gases e.g car fire
Deep burn around mouth and neck
Burn on palate, nasal mucosa, loss of nasal hairs
Parkland Formula
1 Unit= 4cc/kg/% burn
½ Unit in 1st 8 hr
½ Unit in 2nd 16 hr
Muir-Barclay Formula
1 Unit= %TBSA x weight(kg) /2
1st 12 hr = 3 unit
2nd 12 hr = 2 unit
3rd 12 hr = 1 unit
Rule of 9s (Adults)
Entire head and neck - 9 %
Entire arm left - 9 %
Entire arm right - 9 %
Anterior surface upper trunk - 9 %
Anterior surface lower trunk - 9 %
Posterior surface upper trunk - 9 %
Posterior surface lower trunk - 9 %
Anterior surface of right leg - 9 %
Posterior surface of right leg - 9 %
Anterior surface of left leg - 9 %
Posterior surface of left leg - 9 %
Genitals - 1 %
Rule of Palm
Patient’s palm including fingers = 1% of BSA.
Age-based TBSA estimation chart, more accurate for children.
Lund & Browder Chart
Fluid Types
1st 24 hrs: Crystalloid (NS, RL),
After 24 hrs: Colloid.
>20% TBSA may need blood transfusion.
Monitoring During Resuscitation
Vital signs, ABG, PCV, CVP, urine output
Treatment - 1st Degree
ABX dressing
1% silver sulphadiazine cream
types of dressing - open, semi open, closed
Treatment - 2nd Degree
Similar to 1st degree. Early tangential excision for deep burns
Treatment - 3rd Degree
Early excision and SSG,
or wait for sloughing and grafting at 3 weeks.
Escharotomy Indication
For circumferential full-thickness burns to prevent compartment syndrome
Immediate Complications
Shock, Curling’s ulcer (stress ulcer).
