Burns

Question 1

What are some of the causes of burns ?

Answer 1

Heat eg. Liquid/steam\
Radiation eg. Sun, radiotherapy
Electricity - electric current
Chemicals - alkaline vs acidic
Cold eg.frostbite
Friction eg road rash during car accident

Question 2

What is TBSA

Answer 2

Total body surface area

Question 3

What are the types of burns

Answer 3

Superficial
Partial thickness
Deep partial thickness
Full thickness

Question 4

What layers of the skin did superficial burns affect ?

Answer 4

Epidermis

Question 5

What layers of the skin do partial thickness burns affect ?

Answer 5

Epidermis and dermis

Question 6

What layers of the skin do deep partial thickness burns affect?

Answer 6

Epidermis, dermis, hair follicles, sub cut glands, sweat glands

Question 7

What layers do full thickness burns affect?

Answer 7

All layers of the skin including tissue, muscle and bone

Question 8

What does burn severity depend on?

Answer 8

Depth of burn
% of TBSA burned
Age
Med hx - diabetes, HF
Location - face, neck, head etc
Inhalation injury

Question 9

What layers of the skin are burnt in a 1st degree burn?

Answer 9

Epidermis (superficial)

Question 10

What are the characteristics of a 1st degree burn ?

Answer 10

• v red/pink
• warm 2 touch
• no blisters/scars
• v quick cap refill

Question 11

What layers of the skin are burned in a 2nd degree burn ?

Answer 11

Epidermis and dermis (partial thickness)

Question 12

What are the characteristics of a 2nd degree burn?

Answer 12

• v painful
  -shiny & moist
• red/pink
• will blister/scar
  -+/- skin graft
  -blanches

Question 13

What layers of the skin are burned in a 3rd degree burn ?

Answer 13

Epidermis, dermis, hypodermis
( hair follicles, sweat glands and nerves destroyed)

Question 14

What are the characteristics of a 3rd degree burn?

Answer 14

• no pain
  -skin will not heal - skin graft
• black, yellow, red
  -hard areas - Eschar

Question 15

What is Eschar?

Answer 15

Burned dead tissue

Question 16

What must be done in a 3rd degree burn to promote healing?

Answer 16

Eschar must be removed

Question 17

What layers of the skin are burned in a 4th degree burn?

Answer 17

Epidermis, dermis, hypodermis, bones, muscle, ligaments etc
V deep

Question 18

What are the characteristics of a 4th degree burn ?

Answer 18

• all layers destroyed
• black w Eschar
• all sensation gone
• ++ skin grafting

Question 19

What is inhalation injury ?

Answer 19

Damage to respiratory system due to breathing in smoke - carbon monoxide, chemicals, thermal etc

Question 20

What are the S+S of someone who has suffered inhalation injury ?

Answer 20

• burns on nose/mouth
• carbonaceous sputum (black)
• sooty nose/mouth
• hairs singeing
• ++ red lips
• probs w talking
• confusion/anxiety

Question 21

What are the phases of burn Mgt

Answer 21

Emergent
Acute
Rehabilitative

Question 22

When does the emergent phase begin and end ?

Answer 22

Starts @ onset of burn injury
Ends @ restoration of cap permeability
First 24-48 hrs

Question 23

What is the ot at risk of during the emergent phase ?

Answer 23

Hypovolemic shock
Resp distress
Compartment syndrome

Question 24

When have we entered the acute phase ?

Answer 24

Cap permeability stabilised until wound closure
( 48-72 hrs until wound heals )

Question 25

What are our main focuses during the acute phase ?

Answer 25

- continue fluid replacement & monitor response - U/O, I&O, vitals, bloods -wound care - resp function - pain assessment + mgt - physio & OT- maintain ROM - nutritional care (dietician) - psych care

Question 26

When does the rehabilitation phase begin?

Answer 26

From when burn is healed until pt is able 2 function again

Question 27

What is our main focus during the rehabilitation phase?

Answer 27

- psychological support - ADLs - physio - OT - cosmetic correction if needed

Question 28

What are the priorities of burns treatment ?

Answer 28

- prevention of infection - prevention of hypovolemia - maintain norm body temp

Question 29

What is the emergency mgt pathway for burn wounds ?

Answer 29

- stop burning process - remove jewellery or hot clothing -cool burn- place under cool tap 4 20 mins/ apply hydro gel - pain relief (analgesia) - check for trauma + life threatening injuries - check tetanus status and provide immunisation if needed - assess burn size -assess burn depth - assess if pt required admission to burns unit

Question 30

What are the tools used to determine TBSA?

Answer 30

- Lund & Browler chart - 2x collegues - Rule of 9 Chart

Question 31

What does TBSA of <30% result in

Answer 31

Local response

Question 32

What does a TBSA of >30% result in ?

Answer 32

Local &. Systemtic response

Question 33

How are minor burns treated (1st nd 2nd degree)

Answer 33

- no hospitalisation -treated out-patient with wound care and dressing changes

Question 34

What are the 3 C’s for prehospital care for minor burns

Answer 34

-cool water : briefly soak area + no ice, creams or antibiotic ointment to open ski - cover the area : w a clean dry cloth - clothing removal : remove clothing and jewellery that is not adhered to the burned skin

Question 35

What is the no.1 intervention for major burns

Answer 35

- IV normal saline (0.9% NaCl) - IV Compound Sodium Lactate (Hartman’s)

Question 36

What are the S&S of major burns in the 1st 24hrs

Answer 36

- hyperkalemia : Tall, peaked T Waves on ECG (1st priority to correct) - low sodium (hyponatremia) <135 ( electrolyte imbalances) - ^ haemoglobin & haematocrit (H&H)

Question 37

What is the treatment for major burns in the 1st 24hrs ?

Answer 37

- fluid resuscitation : IV norm saline + IV lactated Ringer’s - nutrition but only after fluid resus- admin feeding once bowel sounds return - infection prevention esp w open burns

Question 38

How do you know if fluid resuscitation is working ?

Answer 38

-U/O > 30mls/hr - BP >/= 90 systolic - HR <120bpm

Question 39

What is the patient education given for the rehabilitation phase ?

Answer 39

- water based lotions (minimises itching + scaring ) - wear pressure garments (minimise scarring + keeps skin nd tissues tight whilst promoting circulation) - exercise daily (ROM) - sunscreen = protective clothing when going out in open sun

Question 40

What is the wound care mgt for burns ?

Answer 40

- keep wound clean &moist - clean + remove foreign bodies (prevention of infection) - Irrigate wound - norm saline, tap H2O, - debridement if Eschar - analgesia b4 dressing change - take photos of wound - remove loose skin + keep small blisters - covered with non-adhesive dressing - if infection- daily dressing nd antibiotics

Question 41

What are the diff type of dressings for wounds?

Answer 41

Hydrogels, honey dressings, foams, anti-microbials

Question 42

What’s is the NI for burn care ?

Answer 42

- Fluid resus (based on TBSA) - monitor IV - record + docu I&O - high carbo diet (avoid fats) - antimicrobial dressings (reduce infection) - admin meds- antibiotics, analgesics, sedatives - comp burns- rev by plastics - psych support - rehab programme