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Flashcards in Burns Deck (21)
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What is a thermal burn, what determines severity

Burn due to direct contact with hot object or hot vapour
temperature, duration of exposure and thickness of the skin


What does severity of an electrical burn depend on
what are the associated injuries

voltage, duration of contact
deep tissue damage eg. blood vessel thrombosis, muscle damage


What substance causes worse chemical burns, and why are chemical burns difficult to manage

Alkali substances, because they are difficult to remove to cause ongoing damage


What are the main types and subtypes of depths of burns

partial thickness: superficial erythema, superficial partial thickness, deep partial thickeness


What defines a superficial erythema burn

Blanching erythema with/without blistering, germinal layer in tact
healing is days


What defines a superficial partial thickness burn

involves germinal layer, intense blisterinf and sloughing of the skin
healing is 10 days


What defines a deep partial thickness burn

extends to germinal layer, destroys dermis and appendages, slow healing associated with scarring


What defines a full thickness burn

non-blanching, do not bleed on needle testing and absent sensation
complete destruction of skin and germinal layer, inital blistering and then slough which takes 3-4 weeks to go leaving underlying granulation tissue. Causes dense scarring


What is the rule of 9s

used to estimate the surface area of the burn
9% for head, neck and each arm
18% for each leg, front of trunk and back of trunk
1% for the perineum
(palm and finders also 1%)


What parts of the history are suggestive of airway burn

fire in an enclosed space, signs of stridor, tachypnoea, or dyspnoea, singed nasal hair, facial burns, harsh cough or carbonaceous sputum (black)


How is the amount of fluid lost estimated

using surface burnt not depth, leads to intravascular depletion and shock


What percentage burns require admission for iv fluids

>15% (eg a whole leg or an arm and some of the head)


What are the steps in initial systemic management

Pain requires iv opiates
Fluid replacement with hartmanns
4ml x total burns surface x kg- half given in first 8 hours and other half given in the next 8-24 hours from the time of the burn
consider antibiotics and parenteral nutrition if indicated


What is the local treatment of a partial thickness burn

non-adherent dressing with/without topical antibiotics
Hands may be covered in sulfadiazine (Abx) cream and covered with a plastic bag


What is the local treatment of a full thickness burn

total excision of the burn wound, may require grafting for large areas


What is the danger with full thickness circumfrential burns

can constrict the blood flow to limbs or breathing in chest so must be excised


What is the complication of full thickness burns to the hands

risk of contractures and severe disability so should be splinted in a position


what are some early and late complications of burns

early- wound sepsis (strep pyogenes, or pseudmonas), wound contractures
late- sepsis, acute peptic ulceration, AKI (hypovolaemia), psychological disturbance


When should grafting take place

5 days after burn if the wound is free of infection


What is the maximum burns that can be managed as an outpatient

adults- partial thickness <10%
children- partial thickness <5%
full thickness <1%


What are some indications for referral to specialist burns centre management

burns >30% of total body area (both legs)
partial thickness >10%
full thickness >1%
circumfrential injury
inhalation injury
chemical or electrical injury
extremes of age