Burns Management Flashcards
(72 cards)
1
Q
What is the definition of a burn?
A
A thermal injury to skin
N/A
2
Q
What is the incidence of fire-related deaths due to burns?
A
1-2/100,000pa
N/A
3
Q
What are the classifications of burns based on depth?
A
Partial thickness and full thickness
N/A
4
Q
What characterizes first degree burns?
A
Erythema, pain, no blisters, heal in 5-10 days
Example: sunburn
5
Q
What are the signs of second degree (partial thickness) burns?
A
Red/mottled, swelling & blisters, hypersensitive, may weep
N/A
6
Q
What are superficial second degree burns like?
A
Moist, red, painful, sensate
N/A
7
Q
What do deep second degree burns look like?
A
White, feel thickened, still sensate
N/A
8
Q
How long does healing take for second degree burns without grafting?
A
2-6 weeks
N/A
9
Q
What are the characteristics of third degree (full thickness) burns?
A
Translucent/mottled/waxy white, leathery, generally dry, insensate
N/A
10
Q
What are the aetiologies of burns?
A
- Contact
- Flame
- Heat
- Scalding
- Electricity
- Chemical
N/A
11
Q
What are the clinical signs of partial thickness injuries?
A
Painful
N/A
12
Q
What are the clinical signs of full thickness burns?
A
Usually painless
N/A
13
Q
What indicates a suspicion of inhalation injury?
A
- Facial burns
- Singeing of eyebrows/nasal vibrissae
- Carbon deposits/inflammation in oropharynx
- Carbonaceous sputum
- History of impaired mentation
- Explosion with burns to head and torso
- CarboxyHB level >10%
- Any burn in an enclosed space
N/A
14
Q
What symptom indicates the need for immediate intubation?
A
Stridor
N/A
15
Q
What percentage of TBSA burn causes hypovolaemic shock?
A
More than 15-20%
N/A
16
Q
What are the pathological changes in burns?
A
- Hyperaemia and vasodilation (partial)
- Deep coagulation and necrosis
- Zones of coagulation/necrosis, injury/stasis, hyperaemia
- Injury with oxygen radicals and cytokines
- Cytokine mediated change in vessel permeability
- Hypermetabolic state
- Increased secretion of catecholamines, cortisol, glucagon, renin-Ag, ADH, aldosterone
- Inhalational injuries
- Electrical burns
N/A
17
Q
What functions of the skin are disrupted by a burn?
A
- Thermal regulation
- Prevention of fluid loss
- Barrier against infection
- Sensation
N/A
18
Q
What are the three zones in burn wounds?
A
- Zone of coagulation/necrosis
- Zone of injury or stasis
- Zone of hyperaemia
N/A
19
Q
What is the fluid loss pattern after a burn injury?
A
Greatest in the first 6-8 hours; normalizing capillary integrity by 36-48 hours
N/A
20
Q
What is the effect of burns on metabolism?
A
Causes a hypermetabolic state
N/A
21
Q
What are the concerns with inhalational burns?
A
- Supraglottic injury
- Subglottic injury
- Systemic toxic injuries
N/A
22
Q
What is a risk associated with electrical burns?
A
Myoglobinaemia leading to myoglobinuria and renal failure
N/A
23
Q
What is the ‘rule of 9s’ used for?
A
Assessment of the extent of burn
N/A
24
Q
What percentage of TBSA does the head represent in the ‘rule of 9s’?
A
9%
N/A
25
What percentage of TBSA does the torso (front and back) represent in the 'rule of 9s'?
18% each
## Footnote
N/A
26
What percentage of TBSA do the lower limbs represent in the 'rule of 9s'?
18% each
## Footnote
N/A
27
What percentage of TBSA do the arms represent in the 'rule of 9s'?
9% each (including 1% for the hand)
## Footnote
N/A
28
What percentage of TBSA does the genitalia represent in the 'rule of 9s'?
1%
## Footnote
N/A
29
30
What does the acronym ABCDE stand for in burn management?
Airway, Breathing, Circulation, Disability, Exposure
## Footnote
ABCDE is a systematic approach to assess and manage a patient in emergencies.
31
When should early intubation be considered in burn management?
+/- early intubation if signs of inhalation injury
## Footnote
Signs of inhalation injury may include difficulty breathing or hoarseness.
32
What type of oxygen should be administered if there is any smoke inhalation?
Humidified 100% O2
## Footnote
This helps in oxygenation and reduces the risk of airway injury.
33
True or False: Airway injuries from burns rarely extend below the vocal cords.
True
## Footnote
This is due to the cooling effect of the upper airways.
34
What should be avoided when performing tracheotomies in burn patients?
Performing through burned tissue
## Footnote
This is due to a very high complication rate.
35
How long should cooling occur after a burn?
Cool for 20 mins, using cold (8-25°C) water, if <3hrs since burn
## Footnote
Cooling helps to reduce the depth of the burn.
36
What is the recommended method for wound care after a burn?
Wash wound with saline and cover burn with cling film
## Footnote
Cling film should not be wrapped circumferentially.
37
What laboratory tests should be checked in burn patients?
CarboxyHb and electrolytes (Q6H)
## Footnote
Monitoring these levels helps in assessing the patient's condition.
38
What is the fluid resuscitation threshold for children and adults based on TBSA affected?
Children: >10% TBSA; Adults: >15% TBSA
## Footnote
TBSA stands for Total Body Surface Area.
39
What is the Parkland formula for fluid resuscitation?
4ml/kg x % (2nd + 3rd deg burns) in 24 hours
## Footnote
Half of this amount should be given in the first 8 hours.
40
What fluids can be used for resuscitation in burn patients?
Ringer’s lactate, Hartmann's, or a combination of colloid (e.g., Gelo) with N saline
## Footnote
The choice of fluid depends on the patient's needs.
41
What is the best indicator for adequacy of fluid management in burn patients?
Urine output (UO)
## Footnote
Aim for 1mL/kg as a target for urine output.
42
What should be done for fluid resuscitation on the 2nd and 3rd days after a burn?
2nd day: use approx half of the calculated amount; 3rd day: expect diuresis and fluid requirement to drop off
## Footnote
This reflects changes in the body's fluid needs post-burn.
43
When should tetanus toxoid be administered to burn patients?
Always give tetanus toxoid
## Footnote
This is essential for preventing tetanus infection.
44
What is the main principle of burn management?
Remove dead tissue and cover the wound with skin/substitute ASAP
## Footnote
This should be done within a few days from the time of burn.
45
What should be done for circumferential extremity burns?
Remove all jewellery and assess distal circulation
## Footnote
Circulatory embarrassment is best relieved by escharotomy.
46
What are the indications for referral to a burns unit?
* >10% (2nd & 3rd degree burns) BSA in patients <10 or >50yrs
* >20% (2nd & 3rd degree burns) BSA any age
* >5% BSA 3rd degree burns in any age group
* Burns of face, eyes, ears, hands, feet, genitalia
* Circumferential burns of limbs or chest
* Significant chemical or electrical burns
* Inhalation injury
* Patients with multiple injuries or at extremes of age
## Footnote
BSA stands for Body Surface Area.
47
What should be done for partial thickness burns under 20% TBSA?
Surrounding skin shaved of hair & Biobrane applied
## Footnote
Biobrane is a temporary wound dressing that promotes healing.
48
What are the signs and symptoms of carbon monoxide poisoning?
* CO level <20%: usually no physical symptoms or mild headache/confusion
* CO level >20%: headache, nausea, confusion, irritability
* CO level 40-60%: hallucinations, confusion, ataxia, collapse, coma
* CO level >60%: death
## Footnote
It's essential to assess CO levels in suspected poisoning cases.
49
What type of burns are usually more serious: alkali or acid burns?
Alkali burns
## Footnote
Alkali burns tend to penetrate deeper than acid burns.
50
What is the recommended management for chemical burns?
Brush away any dry powder first, then flush with water for 20-30 mins
## Footnote
Continuous irrigation is critical, especially for alkali burns to the eye.
51
What complications can electrical burns cause?
* Rhabdomyolysis
* Myoglobinuria
* Acute Renal Failure (ARF)
## Footnote
These complications require close monitoring and management.
52
How long does it typically take for 1st degree burns to heal?
Healing usually occurs within 10 days without scarring
## Footnote
Pain typically resolves in 48-72 hours.
53
What is the prognosis for deep dermal burns?
Heal over 25-35 days
## Footnote
Successful resuscitation typically leads to sealing off systemic capillary leak after 24 hours.
54
55
What is the mildest form of cold injury?
Frostnip
## Footnote
Frostnip presents with initial pain, pallor, and numbness of the affected body part.
56
What is the primary characteristic of frostnip?
Reversible with re-warming
## Footnote
Frostnip is the mildest form of cold injury.
57
What occurs during frostbite?
Freezing of tissue, intracellular ice crystal formations, and microvascular occlusions
## Footnote
These factors may cause tissue anoxia.
58
What are the symptoms of first degree frostbite?
Hyperemia and oedema without skin necrosis
## Footnote
It is the least severe form of frostbite.
59
What characterizes second degree frostbite?
Large clear vesicle formation with hyperemia and oedema, plus partial-thickness skin necrosis
## Footnote
It is more severe than first degree frostbite.
60
What occurs in third degree frostbite?
Full thickness and subcutaneous tissue necrosis, commonly with haemorrhage vesicle formation
## Footnote
It is more severe than second degree frostbite.
61
What is the most severe form of frostbite?
Fourth degree frostbite
## Footnote
It involves full thickness skin necrosis, including muscle and bone gangrene.
62
What is the initial treatment for frostbite?
Hot fluids by mouth, place the injured part in circulating water at 40°C
## Footnote
Until pink returns, typically in 20-30 minutes.
63
What should be monitored during re-warming of frostbite?
Cardiac monitoring
## Footnote
Re-warming can be painful; therefore, analgesia should be provided.
64
What causes nonfreezing injury?
Microvascular endothelial damage, stasis, and vascular occlusion
## Footnote
Treatment is the same as for frostbite.
65
What is trench foot?
A condition where the entire foot may appear black but deep tissue destruction may not be present
## Footnote
It arises from alternating arterial vaso-spasm and dilation.
66
What are the symptoms of trench foot?
Pain, oedema, hyperemia, and possible blistering, ecchymosis, and ulcerations
## Footnote
These symptoms can occur in 24-48 hours.
67
What are chilblains?
Pruritic, red-purple skin lesions
## Footnote
They are a manifestation of chronic repetitive cold exposure.
68
What may chilblains progress to?
Ulcerative or hemorrhagic lesions with scarring, fibrosis, or atrophy
## Footnote
They can become severe if untreated.
69
How is hypothermia classified based on core body temperature?
Core body temp <35 = mild, <32 = moderate, <30 = severe
## Footnote
This classification helps in assessing the severity of hypothermia.
70
What is the treatment for hypothermia?
Warm blankets, cardiac monitoring, and possibly active rewarming
## Footnote
Immersion in warm (40-42 degrees) water bath may be used.
71
What is the survival rate for hypothermic patients whose core temperature drops below 32 degrees?
Approximately 50%
## Footnote
This emphasizes the seriousness of severe hypothermia.
72
True or False: A hypothermic person can be pronounced dead until re-warmed above 32 degrees.
True
## Footnote
This is important for proper assessment in hypothermic cases.
