Flashcards in Burns Deck (43)
6 functions of the skin
Barrier to fluid loss
6 causes of burns
mechanical (eg friction)
Who is more at risk of burns?
Mad (psychological/pyschiatric problems, drugs)
Sad (self harm, substance misuse)
Why are the extremes of age more at risk of burns?
Poorer reflexes and spatial awareness
Inability to fend for themselves
Thinner and more frail skin
5 types of shock
How do burns cause hypovolaemic shock?
Increased vascular resistance
Name the 3 zones of a burn
Centre: Zone of coagulation/necrosis
Zone of stasis
Outer: Zone of hyperaemia
Role of histamine in the inflammatory response
Released by mast cells
Creates large endothelial gaps
Role of prostaglandins in inflammatory response
Released from damaged tissue
Attract neutrophils and macrophages
Release thromboxane and interleukins
Local vasodilation and capillary leakage
Role of thromboxane in inflammatory response
Produced by platelets in the zone of injury
Vasoconstriction in undamaged tissue adjacent to the burn
Results in damage extension
What inflammatory mediator is released by platelets
What inflammatory mediator causes thromboxane and interleukins to be released?
Role of catecholamines in the inflammatory response?
Reduces capillary pressure in unburnt tissue
Causes burn extension
Role of oxygen free radicals in the inflammatory response?
Produced by neutrophils and macrophages
Damage endothelial cell membranes
Increase capillary leakage
What is found in the urine after a burn?
Red cells lost
Intensifies the effect of plasma loss
50% burn, 10% loss of red blood cells
What is the rule of nines?
Body surface area can be estimated using 9%
Each leg 18%
Each arm 9%
How do you classify depth of burns?
How do you recognise a partial thickness burn?
Tissue paper appearnace
How do you recognise a full thickness burn?
Thick and leathery
Swelling in limbs
When do you need to IV fluid resuscitate someone after a burn?
If adult>15% BSA affected
What is the aim for adequate fluid balance?
Urine output of 0.5-1 ml/kg/hour
What type of fluid should be used in IV fluid resus after burns? And rate?
Crystalloid (Ringer's lactate)
4ml/kg/%burn for 1st 24hrs
When would more fluid need to be replaced?
In myoglobinuria, electrical injury or associated skeletal injury
How much fluid needed for a 70kg man with 45% BSA burns?
4 x 70 x 45 = 12600ml in 24hours
6300ml in first 8 hours
6300ml in next 16 hours
When would you intubate early in emergency burns management?
Singeing of facial/nasal hair
Inflammation of oropharynx
What would you do to manage circumferential full thickness burns?
Slice through lengthways to allow breathing
What blood test is needed after being in a fire?
How do you estimate BSA in children with burns?
Each arm 9%
Each leg 14% at aged 0
For each year between 0 and 10 take 1% off head and add 0.5% to each leg
How do you stop the burning process immediately after a burn?
25ºC water for 10 mins
Beware of hypothermia