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Flashcards in FN: Burns Deck (23):
1

RF

Age: children and elderly
Co-mobidities: epilepsy, CVA, dementia, mental illness
Occupation

2

Classification

Superficial
Partial thickness
Full thickness

3

Superficial

Erythema
Painful
e.g. sunburn

4

Partial thickness

- heal w/i 2-3 weeks if not complcaited

5

Superficial partial thickness

No loss of dermis
Painful
Blisters

6

Deep partial thickness

Loss of dermis but adnexae remain
Healing from adnexae e.g. follicles
V. painful

7

Full thickness

- complete loss of dermis
- charred, waxy, white, skin
- Anaesthetic
- Heal from the edges - scar

8

Complications early

- Infection: loss of barrier function, necrotic tissue, SIRS, hospital
- hypovolaemia: loss of fluid in skin + raised cap permeability
Metabolic syndrome: hyperkalaemia, hypermyoglobin, raised Hb - AKI
- Compartment syndrome: circumferential burns
- Peptic ulcers: Curlings ulcers
- Pulmonary: CO, poisoning, ARDS

9

Intermediate complications

VTE
PRessure sores

10

Late complications

Scarring
Contractures
Psychological problems

11

Assessment

Wallace rule of 9s: % BSA burnt
- head and neck:9%
- Arms: 9% each
- Torso: 18% front and back
- Leg: 18% each
- Perineum: 1%
- (Palm:1%)

N.B. may also use Lund and Browder charts

12

Management

- Based on ATLS principles
- Specific concerns with burns

13

Specific concerns with burns

- Secure airway
- Manage fluid loss
- Prevent infection

14

Airway management

Examine for respiratory burns
- soot in oral or nasal cavity
- burnt nasal hairs
- hoarse voice, stridor

Flexible laryngoscopy can be helpful
Consider early intubation + dexamethasone (reduced inflammation)

15

Breathing management

- 100% oxygen
- Exclude constricting hours
- Signs of CO poisoning
-ABG

16

Signs of CO poisoning

Headache
n.v
confusion
Cheery red appearance

17

ABG results

CoHb level
SpO2 unreliable of CO poisoning

18

Circulation

- Fluid losses may be huge
- 2x large-bore cannulae in each ACF
- Bloods: FBC, U+E, G+S/XM
- Start 2L warmed - Hartmann's immediately

19

Parkland Formula to guide replacement in 1st 24 hrs

- 4 xwt. (kg) x % burn = mL of Hartmann's in 24h
- replace fluid from time of burn
- Give half in 1st 8h
- Best guide is UO:30-50mL/h

20

Muir and Barclay Formula to guide fluid replacement

- (wt, x % burn)/2 = mL of Colloid per unit time
- Time units: 4,4,4,6,6,12 = 36 hours
- may need to use blood

21

Partial thickness burns

1. Analgesia: morphine
2. Dress partial thickness burns
- Biological e.g. cadaveric skin
- Synthetic
- Cream e.g. Flamazine (silver sulfadiazine) + sterile film

22

Full thickness burn Rx

- Tangenital excision debridement
- Split-thickness skin grafts
- Anti-tetanus toxoid (0.5ml ATT)
- Consider prophylactic Abx: esp. anti-pseudommonal

23

Circumferential burns

May require excharotomy to prevent compartment syndrome

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