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Flashcards in Management of Burns Deck (51)
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1

What is important in the Hx of burns

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

2

What do you do as first aid

Stop burning process
Cool the burn
Cover the burn

3

How do you stop burning

Extinguish flame
Switch of power
Remove clothing
Diluate acid or alkali

4

How do you cool the burn

Cold running water for 20 minutes
Not ice cold as will cause vasoconstriction worsening

5

How do you cover burn

Wrap in cling film or place limb in plastic bag

6

How do you assess

Primary survey
ABCDE

7

A

Airway and C-spine
Low threshold for intubation esp if suspect inhalation as swelling will obstruct quickly

8

B -

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

9

C

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

10

D

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

11

E

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

12

What is a big risk in burns

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

13

F

FLUIDS
- Parkland formula

14

What are extra's

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

15

What is given as tetanus immunisation

Full 3 doses
Human IM Ig if never had before

16

Why is PPI given

Reduce risk of stress ulcer

17

What is mannitol / diuretic given for

Increase myoglobin excretion and prevent renal damage

18

When do you give Ax

If look infected
NOT in acute phase

19

What is NG for

If gastroporesis

20

What happens in secondary survey

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

21

What do you do think of after resus

Managemen to Burns

22

What are options for burns not going to 2nd care

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

23

When do you leave open

Epidermal

24

When do you use non-adherent gauze

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