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Anaesthetics, ED and Plastics > Management of Burns > Flashcards

Management of Burns Flashcards

(51 cards)

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1
Q

What is important in the Hx of burns

A 
Time injury occurred
Circumstances e.g. open or closed fire, RTA, explosion
Co-existing injury - e.g. if jumped to escape 
Any first aid received
How long in water 
Date of last tetanus 
PMH e.g. DM 
DH e.g. steroid / anti-coagulant 
Allergies
Any analgesia given
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2
Q

What do you do as first aid

A

Stop burning process
Cool the burn
Cover the burn

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3
Q

How do you stop burning

A

Extinguish flame
Switch of power
Remove clothing
Diluate acid or alkali

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4
Q

How do you cool the burn

A

Cold running water for 20 minutes

Not ice cold as will cause vasoconstriction worsening

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5
Q

How do you cover burn

A

Wrap in cling film or place limb in plastic bag

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6
Q

How do you assess

A

Primary survey

ABCDE

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7
Q

A

A

Airway and C-spine

Low threshold for intubation esp if suspect inhalation as swelling will obstruct quickly

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8
Q

B -

A

Breathing
High flow O2 applied
Look for evidence of CO poisoning - cherry pink skin
Assess chest for circumferential burns

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9
Q

C

A 
Direct pressure if bleeding 
Ensure limb perfusion / any eschar
Pulse 
IV access
2 large bore cannula through unburned skin
Start fluid resus - bolus immediate 
Catheter to monitor 
FBC, U+E, clotting, G+S, X-match, glucose 
Carboxy-Hb if suspect CO 
bHCG in female to ensure not pregnant 
Haematocrit - if high suggests more fluid needed 
ABG
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10
Q

D

A 
AVPU
GCS
PEARL
Consider head injury if any abnormal
Beware of hypoxaemia / shock - causing restlessness and reduced GCS
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11
Q

E

A

Remove clothing and fully expose
Remove jewellery / piercing
Maintain temp as skin not working
Log roll

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12
Q

What is a big risk in burns

A

Hypothermia

Heat is lost as blister evaporates and normal capillary control is lost

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13
Q

F

A

FLUIDS

- Parkland formula

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14
Q

What are extra’s

A 
X-ray for injury / bilateral infiltrate in ARDS
May get trauma CT if blast injury 
Tetanus immunisation 
PPI for stress ulcers 
Mannitol / diuretic - excrete myoglobin
NG
Catheter to monitor UO 
Ax
Arterial line for invasive BP monitoring
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15
Q

What is given as tetanus immunisation

A

Full 3 doses

Human IM Ig if never had before

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16
Q

Why is PPI given

A

Reduce risk of stress ulcer

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17
Q

What is mannitol / diuretic given for

A

Increase myoglobin excretion and prevent renal damage

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18
Q

When do you give Ax

A

If look infected

NOT in acute phase

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19
Q

What is NG for

A

If gastroporesis

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20
Q

What happens in secondary survey

A 
AMPLE 
- Allergies
- Medication
- Past illness
- Last meal
- Events leading up to
Examine for evidence of smoke inhalation 
Full body exam
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21
Q

What do you do think of after resus

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A

Managemen to Burns

22
Q

What are options for burns not going to 2nd care

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A

Analgesia
Leave open + cover with emollient
Dress with non-adherent gauze and review in 24 hours
Cover with silver sulfadiazine

23
Q

When do you leave open

24
Q

When do you use non-adherent gauze

Study These Flashcards
A

Superficial partial thickness

25
What should you do with ulcers
Leave
26
When do you refer to 2 care
All deep dermal and full thickness All circumferential If superficial partial >3% or >2% in children If involved face, hands, feet or genitalia Any inhalation Any chemical or eletrical If suspect NAI
27
When do you refer to Burn;s unit
Complex burns Involves hand, perineum or face >10% adults or >5% in children
28
What surgery can be done
Excision of non-viable tissue Closure of wound with autograft Escharotomy Dressing changes under GA
29
What does Echarotomy do
``` Incision through burnt tissue to Improves ventilation Relive compartment syndrome Improve circulation Beware of damaging nerve ```
30
When do you do immediate surgery
``` If eyelids If circumferential If Escharotomy needed If debridement needed Closure of defects Skin graft ```
31
What is early surgery within 2-3 days for
Excision of non-viable tissue | Graft
32
What is late surgery usually for
Release of contractures | Post burn reconstruction
33
What type of excision
All necrotic | Tangential which shaves away non-viable tissue until viable is reached
34
General principles
Maintain core temp to prevent hypothermia Avoid hypo or hypervolaemia Minimse blood loss
35
What occurs post op
Splint to prevent contracture | Physio
36
When requires frequent adjustment to fluid balance
First 24-48 hours
37
What formula is used
Parkland | 3-4ml x % BSA x weight (kg) = amount of fluid to be given in 24 hours
38
How do you give the fluid
Give 1/2 in 1st 8 hours from time of burn | Then give over half over next 16 hours
39
What is most commonly used fluid in burns
Hartmann's Human albumin - Look at local trust
40
When do you give resus fluids
If>10% burn children | >15% in adults
41
What may be required if haemorrhaging
Transfusion
42
What do you do for kids
``` Modified Parkland 2ml instead of 4 Use 4,2,1, surgical fluid If <30kg will also need to add maintenance at constant rate (albumin / 5% glucose 0.45% saline) First 10kg = 100ml / kg Next 10kg = 50ml/kg Next 10kg = 20ml / kg ```
43
What fluid
Normal saline +- 5% dextrose
44
What should you monitor
Capillary glucose every 4-6 hours
45
How do you monitor fluid
``` Catheter for UO Central venous line BP HR ABG - if acidotic or high lactate suggests poor perfusion ```
46
Aim of UO
0.5-1ml / kg/. h
47
What is important to remember with Parkland
Only replaces the fluid lost by burns Can still be dehydrated if no oral intake Give fluid bolus Review
48
When is escharotomy indicated
Any circumferential burns | Deep burns causing resp or vascular compromise
49
What bedside tests
``` Obs BP Urinanalysis - no protein Blood glucose May want ECG if electrical ABG if electrical ```
50
What tests
FBC, U+E, LFT G+S + clotting if theatre Bone profile if electrolyte / worry arrhythmia CK and cardiac enzyme if thinking compartment / rhabdo
51
What is typically given for analgesia
Morphine

Anaesthetics, ED and Plastics (14 decks)

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