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The assessment & management Flashcards

(59 cards)

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1
Q

What is the definitions of Burns ?

A

Injury to skin and other tissues caused by Heat

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2
Q

What are the types of Burns with Heat?

A

Flash burns
Flame burns
Scalds
Contact burns

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3
Q

Injury can also be caused by ?

A

Electricity
Chemicals
Radiation

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4
Q

What do you know about Skin ?

A

Largest organ of the body. It
* Protection
* Sensation
* Regulation
* Maintaining Fluids
* Metabolic /endocrine
* Excretion

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5
Q

What does the skin protect the human from ?

A

microorganisms, UV, chemicals

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6
Q

What does the skin prevent from sensation ?

A

pain, touch, temperature

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7
Q

What does the skin help to regulate ?

A

thermoregulation

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8
Q

How can you tell what type of burn the pt presenting with ?

A

By looking at the depth of the burn-

  • Appearance
  • Blanching ( to see how quickly it goes white, if it doesn’t then it’s non blanching - could be meningitis )
  • Sensation
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9
Q

what are superficial burns? ?

A
  • No blistering
  • Blanching, CRT normal
  • Only involves epidermis
  • Very Painful
  • When calculating areas of burn, simple burn aren’t included
  • Sunburns
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10
Q

What are the depts of burns ?

A
  • Superficial Burns
  • Superficial Partial Thickness / Superficial Dermal Burns
  • Deep Partial Thickness / Deep Dermal Burns
  • Full Thickness Burns
  • Deep Burns
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11
Q

What is Superficial Partial Thickness/Superficial Dermal Burns look like ?

A
  • Blisters – thin-walled & clear
  • Superficial (papillary) dermis
  • Very painful
  • Moist and red
  • Sunburns, contact burn
  • Scalds

Epidermis is involved

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12
Q

What is Deep Partial Thickness?

A
  • Blisters – thick-walled & cloudy fluid
  • Deep (reticular) dermis
  • Painful and tight
  • Reduced Sensation
  • Moist
  • Red or pale, moist usually
  • Delayed CRT
  • Chemical burns
  • Scalds
  • Electric (domestic)
  • Contact burns

Epidermis and dermis are involved

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13
Q

How does full thickness burn look look ?

A
  • Brown or pale
  • Entire dermis
  • Loss of sensation
  • Painless
  • No CRT
  • Stiff skin
  • Scalds, flame, electricity
  • Chemical
  • Scalds in Children

involve entire dermis

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14
Q

How does deep burns look like ?

A

Painless
Black
Dead skin

All skin layers are involved

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15
Q

How do you carry out the Assessment ?

A

% total body surface areas (TBSA)

Ignore superficial burns

Fluid resus

Prognosis

Severity

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16
Q

How are the assesment classified ?

A

Minor
Moderate
Major

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17
Q

How is the Minor classified as ?

A

<10% adult

<5% in children

+ <2% of full thickness burn

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18
Q

How is Moderate Classified as ?

A
  • 10-20% adult
  • 5-10% children
  • 2-5% FTB
  • High voltage injury
  • Possible inhalation injury
  • Circumferential burn
  • other health problems
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19
Q

How is major classified as ?

A
  • > 20% adult
  • > 10% children
  • 5> FTB
  • High Voltage Burn
  • Known inhalation injury
  • significant burn to face, joints, hands or feet
  • Associated injuries
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20
Q

What is the Wallace’s Rule of 9s

A

Used in burn pts to calculate the total body surface area ( TBSA) affected by 2nd and 3rd degree burns

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21
Q

Entire Head & Neck ?

A

9%

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22
Q

Entire Right Arm ?

A

9%

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23
Q

Entire Left Arm ?

A

9%

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24
Q

Entire Trunk ?

25
Groin
1 %
26
Entire Right Leg
18 %
27
Entire Left Leg
18 %
28
What are considered as special areas for burns ?
Face / Airways Hands Feet Genitalia Perineum
29
What are the Pre hospital Management ?
Running cold water for 10 mins Cling film Burn dressing (burnshield) Keep warm Analgesia
30
What are the 3 P's of Analgesia ?
Psycological Physical Pharmacological
31
Why is Cling Film good for ?
Sterile Non-adherent Transparent
32
Why is Cling film against for ?
Non absorbent No thermal insulation Tourniquet effect
33
What is the Resuscitation and initial management ?
Firstly, assessment A- if compromised airway (stridor), sedate and intubate B- inhalation, high flow O2 ( is the pt breathing? are they maintaing their oxygen level )/ have they inhaled any materials like hot particles / any risks of inhalation C- shock, odeoma, hypovolemia, fluid (crystalloid- hartmann's - parkland formular (TBSA x weight X4)half in the first 8h, half in the next 16h afterwards maintenance (4ml/kg for first 10kg, 2mls/kg for second 10kg, 1ml/kg afterwards X 24h ) ), catheter, NG tube, analgesia (opiate) D- level of consciousness E- hypothermia
34
What do you mostly worry about ?
Always make sure to check the **airway** during facial burn * especially if the burn is in an enclosed space * Are they coughing up? ( brown and black stuff? * Do they have any signed nasal or facial hair ? * Do they have any carbon deposits on mucosa * Do they have any coarse or change in voice
35
What signs do you look for in people to give intubation ?
* Stridor, Dyspnoea, Tachypnoea * Erythema * Swelling By intubating pts at early will lead to much safer management
36
What are the questions would you ask in history ?
* Age * Energy Transfer - Cause - How did it happen ? - Contact time - - % TBSA * Are there any Inhalation injury - What are the Signs of inhalation injuries(bronchospasm) - Enclosed space * Site
37
What would be the treatment in GP?
* Superficial - Non adherent absorbable dressing * Deep dermal - grafting * Full thick- refer
38
What would be the effect of Burn?
Increase risk of HR, reduce BP= shock Oedema due to reduction of blood supply to the tissue Necrosis
39
What is the Prognosis of Burns ?
To determine by the severity and the age of the patient; the older the patient, the high risk of death
40
What is the Maintanence Fluid Formulation for hourly rate ?
4ml/kg for first 10kg, plus 2ml/kg for second 10kg, plus 1ml/kg thereafter Urine output 1 – 1.5ml/kg/hr
41
How do you calculate Total fluids over 24hrs ?
20 x 75 x 4 = 6,000 ml ( 40 + 20+ 55 ) x 24 = 2,760 ml
42
What are the compliactions of Resuscitation ?
* Under-resuscitation * Over-resuscitation Pulmonary Oedema Abdominal Compartment Syndrome Electrolyte abnormalities **Early: K+ Na+ Late: Ca++ Mg++ P++ ** * Raised ocular pressure * Compartment Syndrome * Infection
43
What are the further management would you do ?
* Check for other injuries? * Dressing – non-adherent material * Prevent hypothermia * Referral to Burns Centre
44
What is the Burn Management in Primary Care for superficial dermal burns ?
Superficial dermal burns * Non-adherent absorbent dressing * Review every 2 days * Should heal in < 2 weeks Antibiotics?
45
What is the Burn Management in Primary care for Deep dermal burns ?
Discuss for consideration for grafting
46
What is the Burn Management in Primary care for Full thickness ?
Refer for assessment & grafting
47
What is the time frame for management of Burns with primary care ?
* Review in 1 – 2 days * Then every 3 – 5 days, unless: Infected Persistent pain Copious discharge * Should re-epithelialize in < 3 weeks * Review in 2 months * Consider Physio / OT
48
What is the long term impact of sun burn ?
Scarring and Contractures
49
What would be the long term effect of someone with burn ?
Psycological effect comes as immediate stress, medium term and long term
50
What is immediate stress?
This is during **Resuscitation phase** * Survival * Drugs & treatment * environment
51
What is medium term of stress ?
**Hospital Phase ** * Sleep disturbances * Pain * Grief * depression
52
What is Long term of stress ?
This is **discharge phase** * Reintegration * physical limitation * social and financial issues * Addiction * relationship or sexual issues
53
What is the 7 R's of managing Burns ?
* Rescue – maintain safety * Resuscitate – A, B, C, D, E * Referral – National Guidelines * Resurface – dressings & skin grafts * Review – early & regularly * Reconstruct – scars * Rehabilitate– physically & mentally
54
55
What do you have to consider in Burn about breathing ?
**Inhalation burns lead to respiratory injury** caused by Hot air, Hot steam in the Larynx which can cause Laryngeal obstruction and Bronchospasm. Smoke, Hot particles, Aspiration and it lead to mucosal slough, infection, broncholar plugging, Atelectasis and Bronchospasm Also casued by irritant gases which lead to Pnuemonia, Pulmonary oedema, alveolar capillary defect.
56
What would you consider in circulation in pts with burns ?
Are they in shock? what is the cause, is it burn? or any other causes? or combination
57
What do you check in Disability ?
Check their consiousness? has it been decreased? * Smoke inhalation * Alcohol/ Ilicit drugs * Any head injuries ? * CVA ?
58
What would look for in exposure ?
Hypothermia Compartment syndrome Fasciotomy/ Escharotomy
59

Burns (1 decks)

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