Plastics - Burns Flashcards by Eilidh Seaton

What types of burn can you get

Thermal = most common 
- Scald = paeds
- Flame = adult 
- Contact 
Electrical
Chemical
Radiation
Friction

How well did you know this?

Not at all

Perfectly

What causes a scald and when is it common

Wet heat

Commonly paediatric

How well did you know this?

Not at all

Perfectly

What does it result in usually but what can it

Superficial skin loss

Boiling water or fat can cause full thickness in seconds

How well did you know this?

Not at all

Perfectly

What causes thermal burn

Dry heat from direct contact with flames or hot appliances

How well did you know this?

Not at all

Perfectly

What does it result in

Deep burn

How well did you know this?

Not at all

Perfectly

What does depth of electrical burn depend on

Energy transfer

Voltage - high or low
Contact time
Factors that lower resistsce

How well did you know this?

Not at all

Perfectly

What can electrical burn cause

Sparing of skin but damage to deep tissue

How well did you know this?

Not at all

Perfectly

What does severity of chemical burns depend on

Type of chemical

Alkali = more dangerous

How well did you know this?

Not at all

Perfectly

What model for changes that burns cause at local level and what are these
- EXAM

Jackson’s Burns Model
Zone of Coagulative Necrosis
Zone of Stasis
Zone of Hyperaemia

How well did you know this?

Not at all

Perfectly

What is the Zone of Coagulative Necrosis

Region where direct transfer or heat
Unable to conduct heat away rapidly enough
Leads to immediate coagulation of cellular protein and death
Irrerversible
Loss of sensation

How well did you know this?

Not at all

Perfectly

What is the Zone of Stasis

Area of tissue that surrounds necrosis
Damage to dermal microcirculation leads to ischaemia and compromised circulation
Potentially viable tissue

How well did you know this?

Not at all

Perfectly

What can happen in Zone of stasis

Can recover under correct condition e.g fluid resus
May undergo necrosis over 3-5 days = known as progression over burn
Always get back to review
May compromise sensation dependent on depth

How well did you know this?

Not at all

Perfectly

What is Zone of Hyperaemia

Release of inflammatory mediators from damaged tissue leads to widespread vasodilation and increase in blood flow
Red area

How well did you know this?

Not at all

Perfectly

When would this zone involve entire body

If burn >25%

Dangerous as can affect all the body system

How well did you know this?

Not at all

Perfectly

What is a significant burn and what requires resus fluids always

20-25% TBSA as will alter all organ system
>15% adults
>10% in children or very frail adults

How well did you know this?

Not at all

Perfectly

What systems affected

Vascular / CVS
Renal
Respiratory
GI 
Metabolic
Immune 
Long term

How well did you know this?

Not at all

Perfectly

What happens to vascular system / CVS

Loss from weeping area / skin dysfunction due to zone of hyperaemia = obvious loss
Large volume 3rd space loss = oedema
Vasodilation + increased permeability due to inflammatory mediators
Causes hypo-perfusion and hypovolaemia
Cell death due to ischaemia

How well did you know this?

Not at all

Perfectly

What can be life saving and easily correctable

Hypovolaemia with fluid resus

How well did you know this?

Not at all

Perfectly

What is an Eschar

Rigid area which doesn’t allow expansion of swelling tissue
Occurs in deep burns down to fat
If circumferential will act as tourniquet

How well did you know this?

Not at all

Perfectly

What is required

Escharotomy

Aids respiration and prevents ischaemia

How well did you know this?

Not at all

Perfectly

How is renal affected

Hypovolaemia = vasoconstriction of renal artery
Myoglobin from rhabdomyolysis / damaged muscle
Hb from haemolytic further damage kidney
= AKI

How well did you know this?

Not at all

Perfectly

How is resp system affected

Widespread bronchoconstriction = ARDS

Bilateral infiltrate on GXR

How well did you know this?

Not at all

Perfectly

How is GI affected

Gastroparesis due to SIRS

Stress ulcers

How well did you know this?

Not at all

Perfectly

What should you do

Give PPI

How well did you know this?

Not at all

Perfectly

How is metabolism affected

``` Stress hormones released - Cortisol - Glucagon - Catecholamines Suppression of anabolic - Insulin - GH ```

What does this lead too

Profound catabolic state | Muscle protein breakdown to provide AA to repair burnt tissue

How is immune system affected

``` Cortisol impacts on immune Infection = biggest mortality in burns Delayed healing Cortisol also causes hyperglycaemia Loss of gut barrier function leads to whole body sepsis ```

What are most problematic organisms

Psueodomona MSRA Fungal in later stage

What is long term consequences

``` Growth and development Nightmares Social problem Wound breakdown Hypertrophic scars ```

How do you prevent growth being affected

Correct positioning Splinting Early physio

What is most important determinant in severity of burn

Depth of tissue affected | % Body surface area affected

How do you measure BSA affected

Lung and Browder Wallace Rule of 9's Patients palm surface

What is most accurate

Lung and Browder | Used in hospital setting

When is Rule of 9's used

``` Outside hospital Divide body parts into multiples of 9 9% = UL and head 18% = LL and torso front and back Groin = 1% ```

What is patients palm

Palm = 1% of patient's body

When is it not accurate

Burns >15%

When is it most appropriate

Small burns Children Or large burns to measure area not affected

What are types of burn depth

``` Epidermal Superficial derma (1) Mid-dermal (2) Deep-dermal Full thickness (3) ``` 1st, 2nd, 3rd not used

What causes epidermal

Sunburn = most common | Hot liquid

How do they appear

Red burn Wet burns No blisters SEVERE pain

CRT

Brisk due to vasodilation

How do they heal / scar

Spontaneous with 2 intention Usually 7-14 days Minimal scar

Where does superficial-mid dermal extend to

Papillary dermis (upper)

What causes

Sunburn | Hot liquid

How does it present

``` Pink skin Darker if mid-dermal Small blisters but large if mid-dermal Blanches Superficial = painful Mid = reduced pain ```

CRT

Slow

How does it heal

Spontaneous May take 2-4 weeks Heals with minimal to moderate scar Mid dermal can go either way

Where deep dermal extend too

Involves entire epidermis and dermis

What causes

Chemical | Flames

How does it present

Dry or moist Cherry red / blotchy Blisters or may have none depending on how much dermis White Can be painful or painless due to nerve fibres dying Painless No sensation

CRT

Absent - no blanching or sluggish

How long to heal

3-8 weeks

What is required to heal

Skin graft Refer early to skin surgeon Dress with Ax prior Will scar

Where does full thickness affect

Destroys epidermis and dermis | Invades into underlying structures

What causes

Chemical Flames Explosion

How does it present

``` Dry White eschar Can see yellow fat Charred No blisters NO PAIN NO SENSATION ```

CRT

ABSENT

How does it heal

Requires skin graft | Severe scars

What should you always look for with burn

Hidden injury that is masked by visible burn

How does sunburn make you feel ill

Cytokine release

Why does CRT slow

As blood supply is damaged | Do with something sterile

What should you do if on genitalia

Get catheter in quick before swelling

What do you always do

Reassess after 24-72 hours due to progression

Plastics - Burns Flashcards

(63 cards)