Burns

Question 1

Define

Answer 1

Injury to the skin and superficial tissue as a result of heat

Question 2

How do you determine the severity of a burn?

Answer 2

1. Size (% of total body area)
2. Depth (1^st - 4^th degree burn)

… which depend on temperature of the burn, duration of exposure and structural integrity of the skin

Question 3

What determines local vs systemic response?

Answer 3

• Local response**-* coagulation of injured tissue
• Systemic response**-* if burns >20% of the total body surface area, there is a systemic response causing release of vasoactive mediators. Capillaries start leaking, tissue oedema and organ dysfunction.

Question 4

What is a first degree burn?

Answer 4

Superficial, erythema involving epidermis only

E.g. simple sunburn; dry and painful

Question 5

What are the 2 types of 2nd degree burns?

Answer 5

2nd degree (partial thickness)= Involve the epidermis and the superficial dermis- Appear red and blistered (painful and wet)

2nd degree (deep partial thickness)- involves the epidermis and the deep dermis- Appear red/ white no blisters (painful and wet)

Question 6

What is a third degree burn?

Answer 6

Full thickness burns from epidermis and destroy whole dermis.

Charred grey leather like appearance (dry)

Question 7

What is a fourth degree burn?

Answer 7

Destroy entire skin including hypodermis. Fascia, muscle or bone are often destroyed too

Nerve endings destroyed and will feel painless

Question 8

What are the common signs and symptoms?

Answer 8

• Erythema
• Painful (depending on burns degree)
• Wet/dry
• Visible tendons/ bones
• Cellulitis- infection of wound

Question 9

What are some investigations for burns?

Answer 9

1. Bloods

• FBC- may show low Hct, hypovolaemia, neutropenia, thrombocytopenia
• Metabolic panel- raised urea, creatinine, low Na, low K
• ABG- metabolic acidosis if inhalation injury

1. Wound biopsy- to exclude infection
2. CT head/ spine- to check for other injuries

Question 10

What is management (at the scene)?

Answer 10

• Remove all extra clothing/ jewellery
• Cool the burn with room temperature water (not ice as this can exacerbate the shock)
• Wrap burn in clingfilm to protect the burn from infection

Question 11

Management in hospital?

Answer 11

A= consider laryngoscope (get anaesthetics) and consider early intubation as obstruction can develop over 24hrs. Decision to intubate is based on presence of oropharyngeal swelling, stridor, resp distress (hypoxia)

B= Exclude life threatning injuries- tension pneumothorax ACTION- give 100% oxygen. Always suspect CO poisoning

C= IV fluid resuscitation. 2 large-bore IV lines in non-injured skin. Look below to calculate fluid required.

Give IV Hartmann’s solution- appropriate volume as under resus= AKI, over resus= compartment syndrome

Give analgesis, LMWH, tetanus, Abx if infection

Dressing

Question 12

what are the complications from burns?

Answer 12

1. Compartment syndrome- common in 3^rd degree burns where the eschar (thick necrosed black skin) pressures neck, chest or extremities impairing infusion.
2. AKI
3. Infectionà sepsis
4. DVT