Plastics - Burns Flashcards Preview

Anaesthetics, ED and Plastics > Plastics - Burns > Flashcards

Flashcards in Plastics - Burns Deck (63)
Loading flashcards...
1

What types of burn can you get

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

2

What causes a scald and when is it common

Wet heat
Commonly paediatric

3

What does it result in usually but what can it

Superficial skin loss
Boiling water or fat can cause full thickness in seconds

4

What causes thermal burn

Dry heat from direct contact with flames or hot appliances

5

What does it result in

Deep burn

6

What does depth of electrical burn depend on

Energy transfer
- Voltage - high or low
- Contact time
- Factors that lower resistsce

7

What can electrical burn cause

Sparing of skin but damage to deep tissue

8

What does severity of chemical burns depend on

Type of chemical
Alkali = more dangerous

9

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

10

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

11

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

12

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

13

What is Zone of Hyperaemia

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

14

When would this zone involve entire body

If burn >25%
Dangerous as can affect all the body system

15

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

16

What systems affected

Vascular / CVS
Renal
Respiratory
GI
Metabolic
Immune
Long term

17

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

18

What can be life saving and easily correctable

Hypovolaemia with fluid resus

19

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

20

What is required

Escharotomy
Aids respiration and prevents ischaemia

21

How is renal affected

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

22

How is resp system affected

Widespread bronchoconstriction = ARDS
Bilateral infiltrate on GXR

23

How is GI affected

Gastroparesis due to SIRS
Stress ulcers

24

What should you do

Give PPI

25

How is metabolism affected

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

26

What does this lead too

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

27

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

28

What are most problematic organisms

Psueodomona
MSRA
Fungal in later stage

29

What is long term consequences

Growth and development
Nightmares
Social problem
Wound breakdown
Hypertrophic scars

30

How do you prevent growth being affected

Correct positioning
Splinting
Early physio