- For Circumferential full thickness burns where there is restricted ventilation or vascular compromise.

Burns Flashcards by Tom Bicknell

Factors which influence the severity of a burn

• Cause of burn
• Duration of exposure
• Anatomical site
• Size of involved area
• Use of early first aid cooling

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Types of burn

Thermal
Chemical
Electrical
Friction
Radiation

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High voltage electrical shock can lead to:

Extensive deep tissue damage
Compartment syndrome
Myonecrosis
Rhabdomyolosis
Renal failure

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High voltage vs low voltage

Low = <1000volts (usually domestic)
High = >1000volts (usually industrial)
Lightning = up to 300 million volts

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Which electrical current is more likely to cause cardiac arrhythmias, Alternating or direct?

Alternating

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Do acids or alkalines cause deep tissue burns?

Alkalines

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In relation to electrical burns and electric shock, what is arcing?

Arcing occurs when electrical current jumps between two objects without a direct connection. This can result in a flash injury without electrical current passing through the individual.

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What are the classifications of burn depth?

1) Superficial
2) Partial thickness/Dermal - Partial dermal
- Deep dermal
3) Full thickness

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Characteristics of a superficial burn

Erythema/Redness
Painful

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Characteristics of a superficial dermal burn

Blisters
Painful
Pink
Blanching

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Characteristics of a deep dermal burn

Blisters
Sensation reduced
Prolonged CRT
Blotchy pink/red

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Characteristics of a full thickness burn

Charred black or leathery white
‘Woody’ feel
Insensitive to light touch
Non-blanching

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Water temperature for cooling a burn

Ideally between 8 - 15 degrees Celsius.

(Cool to dissipate the heat but not ice cold which could vasoconstriction and deepen the burn)

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Signs of inhalation burn injury

Burns to face/neck
Swelling to mouth/oropharynx
Soot in nose or mouth
Singed nasal hair
Cough with black sputum
Hoarse voice or stridor
Wheeze on auscultation
Dyspnoea and hypoxia

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Parkland formula

3ml x Patient weight (kg) x TBSA (%)
- This gives the total amount to be given in a 24 hour period
- First half of this to be given in the first 8 hours
- Second half to be given in the following 16 hours.

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Carbon Monoxide (CO) has an affinity how many times more than oxygen to haemoglobin

240 times

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Antidote for Cyanide poisoning

Hydroxycobalamin (Cyanokit)

Dicobalt editate

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Half-life of CO

Breathing Air - 320 minutes

This can be reduced to 80 minutes breathing 100% oxygen

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Escharotomy

For Circumferential full thickness burns where there is restricted ventilation or vascular compromise.

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Burns referrals - Burns unit criteria for Adults

≥10%<40%
or
≥10%<25% with inhalation injury

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Burns referrals - Burns unit criteria for paediatrics

≥5% <30%
≥5% <15% if under 1 year old

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Burns referrals - Burns centre criteria for adults

> 40% TBSA
or
25% TBSA with inhalation injury

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Burns referrals - Burns centre criteria for paediatrics

> 30%TBSA
15% TBSA in under 1
20% TBSA if full thickness

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Burns centre vs Burns unit

Burn Centres – This level of in-patient burn care is for the highest level of injury complexity and offers a separately staffed, geographically discrete ward. The service is skilled to the highest level of critical care and has immediate operating theatre access.

Burn Units – This level of in-patient care is for the moderate level of injury complexity and offers a separately staffed, discrete ward.

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Where would an adult with 35% TBSA burns go?

Burns Unit Burns unit criteria for adults: ≥10%<40% or ≥10%<25% with inhalation injury

Where would an adult with 30% TBSA burns and inhalation injury go?

Burns Centre Burns Centre criteria for adults: >40% TBSA or >25% TBSA with inhalation injury

Where would a 2 year old with 10% TBSA burns go?

Burns unit (Burns unit criteria for peads: ≥5% <30% ≥5% <15% if under 1 year old)

Where would a 4 year old with 18% TBSA burns go?

Burns unit (Burns unit criteria for peads: ≥5% <30% ≥5% <15% if under 1 year old)

Where would a 5 year old with 25% full thickness TBSA burns go?

Burns Centre Burns centre criteria for paeds: > 30%TBSA > 15% TBSA in under 1 > 20% TBSA if full thickness

Treatment of chemical burn

Irrigate copiously amphoteric irrigating agent if possible such as Diphoterine Do not wrap in cling film

Definition of major burns in Adults

>20% TBSA

Clinical features correlating with the need for early intubation in burns

Full thickness facial burns Stridor Respiratory distress Swelling on laryngoscopy Smoke inhalation Singed nasal hairs

Carbon monoxide severe poisoning

>30%

Optimal duration of burn cooling

20 mins

Optimal water temp for burn cooling

12oC

Optimal Flow rate of water for burn cooling

1-1.5 l/min

Burn cooling effective up to _____ hours after injury

Which burn type should we not apply cling film?

Chemical

Which type of burns should irrigation be continued for as long as practicably possible?

Chemical

In burns greater than ___% fluid resuscitation should be started pre-hospitally for both adults and children

20%

Which drugs should not be administered for analgesia in burns patients requiring fluid administration?

NSAIDS

Indications for hydroxycobalamin

Smoke inhalation with altered mental status or cardiovascular instability

Intubation of a burns patient

Uncut tube Largest tube possible Avoid tie around the neck/face

Normal CO levels in non-smokers, smokers and heavy smokers

Non-smokers = <3% Smokers = <5% Heavy smokers = <9%

All burns patients should received high flow O2 during transport to ED because?

It reduces the half life of COHb to 40min

Antidotes for cyanide poising include

Hydroxycobalamin and Dicobalt Edetate

Burn depths include

Superficial Superficial dermal Deep dermal Full thickness

Cyanide poising should be suspected in?

Any obtunded patient with evidence of smoke inhalation

Indications for IV fluid in burns

When TBSA >15% in adults TBSA >10^ in children

NSAIDS should be avoided during burns because?

This can impact on the inflammatory response, kidneys and wound healing

The aim of fluid resuscitation in burns is?

To prevent burn shock and account for third space losses secondary to inflammation

Water temperature for burn cooling should be

Between 8 and 15 degrees

What formula is used to calculate crystalloid requirements in burn patients

Parkland

What is best for the pre-hospital treatment of chemical burns?

Neutralising agents such as Diphoterine or Hexafluorine if available, if not avaliable, irrigate with water

ADULT burns CENTRE referral (2 situations)

40% or more burns 25% or more with inhalation burns

ADULT burns unit referral threshold (5 situations)?

10-39% TBSA (10 - 25% if inhalation injury) 5-39% TBSA if full thickness/non blanching Significant burn to hands, feet, face, perinuem or genitalia (and circumferential burn) Any predicated or actual need for HDU/ITU Any NAI should be referred within 24hrs of injury

Additional notes regarding adult burns referral?

Burns between 3-9% TBSA (including inhalation injury) Any full thickness burn regardless of size (if under 10%) Any burn not healed in 2 weeks

Faculty statement fluid grid - describe:

50kg 20-50% TBSA = 500ml/hr >50% TBSA = 750ml/hr >75kg between 20-50% TBSA = 750ml/hr >50% TBSA = 1000ml/hr

Fluid should be administered to what urine output endpoint?

1ml/kg/hr

Half life of carboxyhaemoglobin is how many minutes?

320 mins (5hrs+)

How cold should water be when used to cool a burn?

Water should be more than 8°c

How long should chemical burns be irrigated for

More than the standard 20mins (ideally as long as possible)

How many deaths are due to burns on the UK each year?

Around 200 deaths per year

If you have a CO monitor, what level of CO indicates a severe poisoning?

More than 30%

Paediatric burns CENTRE referral (4 situations)?

15% or more TBSA if under 1yr old 30% or more TBSA if over 1yr old 20% or more if full thickness Pts requiring or predicted to require ventilation for more than 24hrs Any child who is physiologically unstable (eg requiring inotropic support, renal support, base deficit >5 or increased O2 requirement FiO2 of 50% and increasing with abnormal CO2 and RR)

Paediatric burns FACILITY referral thresholds: (3 situations)

2-5% TBSA All full thickness Burns not healed in 2 weeks

Paediatric burns UNIT referral (5 situations)?

5-15% TBSA (under 1yr old) 5-30% TBSA (over 1yr old) 1% full thickness (under 6 months) 2% full thickness (under 10) Any predicted or actual need for HDU/PICU Any significant deterioration in the pt Any burn secondary to NAI (within 24hrs of injury)

Problem with Pulse oximetry use in carbon monoxide poisoning?

Standard pulse oximeters will not differentiate between O2 and CO until COHb levels reach >40%

Three types of burns referral unit

Facility - standard plastic surgery ward for non complex burns Unit - moderate level complexity in a seperate ward Centre - highest level of complexity, critical care and immediate access to operating theatre

Who should make the decision regarding end of life care post burn injury?

At least 2 consultants, 1 of whom should be a specialist burn care surgeon

Faculty statement - In children, when should fluid resuscitation be initiated?

When the child is burned >20% TBSA

Burns Flashcards

(71 cards)