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Thermal injuries Flashcards

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1
Q

When may energy transfer and oedema in thermal injuries present

A

Are not always immediately evident and may progress over time through progression of inflammatory response

Maintain suspicion regarding airway

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2
Q

Cause of hypovolaemia in burn injury

A

Inflammatory changes and capillary leak

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3
Q

Goal of resuscitation in thermal injuries

A

Stop burning process

Secure airway and ventilation

Maintain intravascular fluid in face of ongoing leak
(Rather than stopping the leak with haemorrhage)

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4
Q

Methods to stop burning process

A

Completely remove pt clothing

Prevent overexposure / hypothermia

Recognise wound contamination

Brush dry chemical powders from wound and then rinse

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5
Q

Indications for early intubation in thermal injuries

A

Signs of airway obstruction
Total body surface area burn >40-50%
Extensive / deep facial burns
Burns inside mouth
Significant or risk of oedema
Difficulty swallowing
Respiratory compromise
Reduced GCS
Full thickness circumferential neck burns

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6
Q

High risk factors for airway compromise in thermal injuries

A

Children
Inhalation injury

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7
Q

Causes of Breathing problems with thermal injuries

A

Hypoxia
Carbon monoxide poisoning
Smoke inhalation

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8
Q

Causes of hypoxia in thermal injuries

A

Inhalation injury
Circumferential chest burns
Thoracic trauma unrelated to thermal injury

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9
Q

Diagnosis of CO poisoning

A

History of burns in enclosed areas
Carboxyhaemoglobin measurement

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10
Q

Management of CO poisoning

A

100% oxygen via NRB mask

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11
Q

American Burn Association diagnosis of inhalation injury

A

Exposure to combustible agent
+
Signs of exposure in lower airway below vocal cords seen on bronchoscopy

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12
Q

Management of smoke inhalation injury

A

Supportive

Intubate
Elevate head + chest 30 degrees to reduce oedema when appropriate

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13
Q

When to provide burn resuscitation fluids

A

Deep partial or full thickness burns > 20% TBS area

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14
Q

How to calculate initial fluid rate for burn resuscitation fluids

A

Parkland formula

First half of the volume in first 8 hours
Second half of the volume over next 16 hours

Adjust fluids based on urine output

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15
Q

Fluid of choice for burn resuscitation fluids

A

Warmed Hartmann’s

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16
Q

Parkland formula for flame burns in Adults and children > 14 yrs

A

2 (ml) x patient body weight (kg) x TBS area (%)

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17
Q

Target UO for adults and children > 14 yrs with flame burns

A

0.5 ml/kg/hr

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18
Q

Parkland formula for flame burns in children < 14 yrs and > 30kg

A

3 (ml) x patient body weight (kg) x TBS area (%)

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19
Q

Target UO in children < 14 yrs and > 30kg with flame burns

A

1 ml/kg/hr

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20
Q

Parkland formula for flame burns in infants and young children < 30kg

A

3 (ml) x patient body weight (kg) x TBS area (%)

AND

Sugar containing solution (5% Dextrose) at maintenance rate

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21
Q

Target UO for infants and young children < 30kg with flame burns

A

1 ml/kg/hr

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22
Q

Parkland formula for electrical burns in all age groups

A

4 (ml) x patient body weight (kg) x TBS area (%)

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23
Q

Target UO in adults with electrical burns

A

100 ml/hr

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24
Q

Target UO in all age groups children < 30kg with electrical burns

A

1-1.5 ml/kg/hr

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25
Why to avoid fluid boluses in thermal injuries (unless pt hypotensive)
Can increase oedema and additional complications (inc airway compromise and compartment syndrome)
26
How to assess TBS area percentage
Patient's palmar surface = 1% Rule of 9s
27
Adult burns rule of 9s
Each of the following represent TBS area 9%: - Head and neck - Each upper limb - Anterior chest - Posterior chest - Anterior abdomen / pelvis - Posterior abdomen / pelvis - Each anterior lower limb - Each posterior lower limb Genitalia = the last 1%
28
Paediatric burns rule of 9s
Differs from adults as head and neck is splint into 2x 9%, and each lower limb section reduced to 7% Following areas represent TBS area 9%: - Anterior head and neck - Posterior head and neck - Anterior chest - Posterior chest - Anterior abdomen / pelvis - Posterior abdomen / pelvis - Each upper limb Each of following are 7%: - Each anterior lower limb - Each posterior lower limb
29
Superficial burn (Epidermal burn)
Pink Painful No blisters
30
Superficial partial thickness burn (Superficial dermal burn)
Moist Pink Painful Blisters Blanches to touch
31
Deep partial thickness burn (Deep dermal burn)
Dry Non blanching Not painful Red / mottled Possible blisters
32
Full thickness burn (Third degree burn)
Leathery Translucent / waxy skin Painless Dry
33
Adjuncts to burns management in secondary survey
Bloods Assessment for compartment syndrome NG tube Tetanus immunisation
34
Bloods for burns patients
FBC G+S ABG - carboxyhaemaglobin Glucose Electrolytes Pregnancy test
35
Indication for CXR in thermal injuries
Intubated patient Suspected smoke inhalation injury
36
Thermal injuries with risk of compartment syndrome
Circumferential burns of: - Extremities - Chest - Abdomen
37
Cause of compartment syndrome in thermal injuries
Reduced skin elasticity Increased soft tissue oedema
38
Management of compartment syndrome in thermal injuries
Escharotomy Allows oedematous soft tissue to expand freely
39
Escharotomy definition (Es-car-otomy)
Emergency incision of burnt skin to release the eschar and its restrictive effects
40
Escharotomy vs Fasciotomy
Escharotomy involves burnt tissue and does not extend to fascial layer
41
Indication for gastric tube insertion
Vomiting / Abdo distention Burns > 20% TBS area
42
Managing agitation in burn patients
Treat hypoxia Treat hypovolaemia Analgesia and sedatives if above unsuccessful
43
Pain management in burns patients
Cover wounds Analgesia
44
Wound care for burns
Gently cover with clean sheets Clean with sterile saline
45
Things to avoid with burns wound care
Do NOT break blisters Do NOT apply cold compresses or cold water
46
Use of prophylactic abx for burns
Avoid in early post burn period Abx to treat infection only
47
Management of chemical burns
Brush away any dry powder chemicals FIRST Irrigate liquid chemicals with copious warm water Immediate wound care Attempt to identify the chemical
48
Electrical burns mechanism of damage
Current travels inside blood vessels / nerves Cause local thrombosis and nerve injury Frequently more damaging than appear on body surface
49
Areas at particular risk from electrical burns
Extremities / Digits
50
Risk from electrical burns
Muscle injury causing myoglobinuria and renal failure
51
Treatment of myoglobinuria
Fluid resus with UO target 100 ml/hr in adults Can consider mannitol
52
Role of mannitol in treatment of myoglobinuria
Free radical scavenger Osmotic diuretic to flush out myoglobin along with IV fluids
53
Test for myoglobinuria
Urine test for hemochromogen
54
Management of electrical burns
Control airway IV access Continuous ECG monitoring Treatment of rhabdomyolysis / myoglobinuria
55
Management of tar / asphalt burns
Rapid cooling of tar Mineral oil used to dissolve tar
56
Signs of Non Accidental Injury burns
Circular burns Burns with clear edges Burn to soles of feet Burn to buttocks Old burns with new traumatic injury
57
Indication for transfer to burns centre
Partial thickness burn > 10% TBSA Burns involving certain areas Third degree burn Electrical burn Chemical burn Inhalation injury Burn with concomitant trauma (eg. fracture
58
Burns involving which certain areas are indication for transfer to Burns centre?
Face Hands Feet Genitalia Perineum Major joints
59
Types of cold injury
Frostbite Non-freezing injury
60
Causes of damage in frostbite
Freezing of tissue Cell membrane injury secondary to ice crystals Microvascular occlusion Tissue anoxia Reperfusion injury on rewarming
61
Cause of non-freezing injury
Long term exposure to wet conditions and temperatures just above freezing
62
Characteristics of non-freezing injury
Microvascular endothelial damage, stasis and vascular occlusion
63
Signs of non-freezing injury
Black appearance Alternating arterial vasospasm and vasodilation Blisters Oedema Ecchymosis Ulcers
64
Affected tissue progression in non-freezing injury
1) Cold 2) Numb 3) Hyperaemia 4) Painful burning 5) Dysaesthesia
65
Management of cold injuries
Stop freezing tissue Remove constricting / damp clothing Warm blankets Oral warm fluids Place injured area in circulating water at constant 40 degrees Avoid excessive dry heat Avoid vasoconstrictive agents
66
Hypothermia definition
Core temperature < 36 degrees
67
Severe hypothermia definition
Core temperature < 32 degrees
68
Management of mild hypothermia
Passive warming Eg blankets
69
Management of severe hypothermia
Active warming Eg warmed IV fluids

ATLS (14 decks)

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