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Burns Flashcards

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1
Q

What is the pathology of a burn?

A

Proteins in the cells becoming denatured

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2
Q

What zone is the damage the worst in?

A

Zone of coagulation

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3
Q

What happens to the proteins in the zone of coagulation?

A

They are irreversibly damaged

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4
Q

Pathology of the zone of stasis

A

If there if infection or oedema etc and so won’t heal as well

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5
Q

Recovery of the zone of hyperemia

A

Do tend to recover
Apart from in
- sepsis
- hypoxia etc

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6
Q

Effects of burns

A 
Fluid loss
Bronchoconstriction (smoke inhalation)
Increased K+
Decreased Ca+
Na can increase or decrease
Increased cortisol 
Prone to infection 
Increased CO so have to work harder to get O2 to the Hb
ARDS -> fluid build up from the lungs
Circumferential burns 
- e.g. around chest - chest cannot expand as much
- compartment syndrome
Increased myoglobin leading to AKI
Increased capillary permeability
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7
Q

Why is there increased cortisol from a burn?

A

Due to the stress

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8
Q

Why is there fluid loss from a burn?

A

Increased basal metabolic rate

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9
Q

Why is there an increased BMR in burns?

A

Increased catabolism of fats and sugars to provide energy to heal the burns

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10
Q

Types of burns

A

Chemical
Thermal
Electrical
Radiation

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11
Q

What do chemical burns look like?

A

Shiney

Lose top layer so red appearance

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12
Q

What do electrical burns look like?

A

Can have a round entrance
Can have an exit wound
Deeper
Can be black on the outside

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13
Q

What level do electrical burns go to?

A

At least subdermal

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14
Q

Who are thermal burns common in?

A

People who drink a lot

Epilepsy

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15
Q

Where are radiation burns commonly seen?

A

Iatrogenic e.g. after mastectomy

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16
Q

3 causes of damage of electrical injury

A

Conversion to thermal energy
Blunt trauma from muscle contraction
Direct effect

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17
Q

Classification of the extent of burns

A 
Superficial 
Superficial dermal 
Deep dermal 
Full thickness
4th degree
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18
Q

What does a superficial burn effect?

A

The epidermis

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19
Q

Presentation of a superficial burn

A

Sore
Red but still blanches (still got cap refill)
No blistering

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20
Q

How long would a superficial burn take to heal?

A

A week

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21
Q

What is another name for a superficial dermal burn?

A

Partial thickness

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22
Q

What layers of the skin does a superficial dermal burn effect?

A

Epidermis

Upper dermis

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23
Q

Presentation of superficial dermal burns

A

Blisters
Still blanches (still got cap refill)
Will leave a scar
Painful

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24
Q

How long will superficial dermal burns take to heal?

A

Up to 2 weeks

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25
What layers of the skin are affected in deep dermal burns?
Reticular dermis
26
Presentation of deep dermal burns
No pain Red and white Non blanching (no cap refill)
27
How long do deep dermal burns take to heal?
2 weeks
28
What layers of the skin are effected in full thickness burns?
Fat layers | Can go further
29
Presentation of full thickness burns
White or charred appearance Non blanching Not painful
30
Healing of full thickness burns
Will not heal on own - grafts or surgery needed
31
Why in some thickness of burns would you get no pain?
As pain receptors are burnt off
32
What does a 4th degree burn affect?
Muscle Fat Bone
33
What tells us how much fluid is lost from a burn?
The surface area of the burn
34
What is the rule of 9s? (fluid loss)
Different scores for different parts of the body | Everything adds up to 9 apart from the groin (1)
35
What is used to measure fluid loss from smaller burns?
Hand method
36
In the hand method, how much does a palm equate to?
1%
37
What is used to measure the surface area of burns in children? Why?
Lunder and Browder charts | Kids with disproportionate bodies
38
Treatment for superficial burns
``` Remove clothing from area Cold water for 20 mins OTC pain relief Do not burst blisters Cover with cling film / bandage ```
39
What must be considered when dealing with the airway of ABCDE of a burn?
Singed eyebrows / nose hairs Hoarseness Carbon deposits in nasopharynx / sputum If have been in big fire think about intubating quite early as can become oedematous and also tongue swelling
40
What must be considered when dealing with the breathing of ABCDE of a burn?
Respiratory compromise / effort Expansion CO poisoning
41
What must be considered when dealing with the circulation of ABCDE of a burn?
Hypovolaemic shock from fluid loss HR, BP, Cap refills Bilateral large bore access or central access as can be hard to get IV access with burns
42
What is the thresholds for bilateral large bore access or central access due to burns in adults and children?
Adults > 15% | Children > 10%
43
What does parklands formula tell you about? What does it not?
Tells you about need for replacement fluid | Not maintenance
44
What is parklands formula?
4ml x body weight (kg) x surface area of the burns (%)
45
When is replacement fluid given?
50% in 1st 8 hours | 50% over the next 16 hours
46
What are the fluids of choice for replacement fluids?
Saline | Hartmans
47
What does hartmans contain?
Electrolytes
48
What would you consider doing in dirty injuries / burns?
A tetanus booster
49
What symptom can circumferential burns cause?
Tightness
50
Treatment of circumferential burns?
Escharotomy
51
What presentation can circumferential burns have?
Scarring Sooty appearance No pink
52
What must be considered with the D and E of ABCDE when dealing with burns?
Glucose Temperature Expose to reveal other injuries
53
What happens to the glucose levels with burns?
Increased BMR can lead to hypoglycaemia
54
What happens to the temperature in burns?
Not the same barrier function so can become hypothermic
55
2 main things to be worried about in burns
Infection | Shock
56
What threshold of adults and children are used when transferring to burn care services?
> 10% adults | > 5 % children
57
Criteria to transfer to burn care services
``` > 10% adults > 5% children Not healed within 2 weeks Suspicion of NAI All full thickness and circumferential burns ```
58
Long term consequences of burns
Scarring Psychological - depression / PTSD Contractures
59
What are contractures as a consequence of burns?
Limb cant work as well due to scarring
60
Complications of electrical burns
Rhabdomyolysis Peripheral nerve injuries Osteonecrosis (long bones) Compartment syndrome
61
What is important to do when treating chemical burns?
Important to irrigate to get it out - > usually using plenty of water (some exceptions)
62
What is paramount when dealing with chemical burns?
Personal safety
63
What do chemical burns caused by alkali metals need to be irrigated with?
Oil
64
Which of alkalis or acids tend to penetrate deeper?
Alkalis

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