Thermal trauma Flashcards by K D

How to stop the burning process with chemicals

Remove all clothing (except if adherent)

Brush dry chemical away

Rinse with copious amounts of warm (to avoid hypothermia) saline irrigation

Once the burning process has stopped, cover pt with warm, clean dry linens to prevent hypothermia

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Child vs adult airway susceptibility post burns

Children more susceptible as their airway is smaller

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Indications for early intubation for burns

Signs of airway obstruction or respiratory distress

TBSA >40%-50%

Oedema

Deep fascial burns or mouth burns

Difficulty swallowing

Reduced GCS

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What carboxyhaemoglobin level indicates inhalation injury

more than 10%

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Diagnosis of carbon monoxide poisoning

Hx of exposure (pt who were burned in enclosed areas)

Raised serum carboxyhaemoglobin

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At what carboxyhaemoglobin level do patients express physical sx

> 20%

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Various HbCO levels and their associated presentations

Headache + nausea (HbCO level of 20%-30%)

Confusion (HbCO level of 30%-40%)

Coma (HbCO level of 40-60%)

Death (HbCO level of >60%)

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The affinity of Hb for O2 vs CO

CO has an affinity of 240 times more than O2

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Oxygen therapy in possible CO exposure

Breathing 100% O2 reduces the HbCO from 4 hrs to 40 mins,

Apply 100% O2 for 4-6 hrs unless COPD

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ET tube minimum size in children and adults

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Pulse oximetry in CO poisoning

Not reliable, may be showing readings between 98 and 100%

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PaO2 from ABG’s reliability in CO poisoning

Does not reliably predict CO poisoning

PaCO of 1mmHg results in HbCO of 40%

Need HbCO levels taken as well as ABG and pulse oximetry

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Sign of cyanide inhalation

a product of combustion

could lead to unexplained persistent metabolic acidosis

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Hyperbaric oxygen therapy for burns

No role in acute trauma

Consult burn centre for further guidance after pt resuscitated

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Pathophysiology of smoke inhalation

Smoke particles settle into distal bronchioles, causing SIRS, leading to necrotic cells obstructing airways

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Treatment of smoke inhalation

Supportive

(intubate if >20% of TBSA in adults or >10% in <10yo or >50yo)

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Cannulation in burns

2 large bore cannulas (at least 18 gauge)

Try avoiding burned skin if possible

Upper limb preferred to lower limb as increased risk of septic phlebitis in lower limb

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Fluid resuscitation calculation in adult scalding burns patients

24hour fluid volume requirement: 2ml * TBSA * Wt

The first half should be given over 8 hours

The second half is given over 16hrs

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Urine output aim for adult scalding burns patients

0.5 ml/kg/hr

between 30-50mls per hr

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Fluid resuscitation calculation in child burns patients

3ml/kg/%TBSA (as children have a larger surface area:body mass)

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Urine output aim for child burns patients

1ml/kg/hr

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Fluid resuscitation calculation in infant and young child (<30kg) burns patients

3ml/kg/TBSA

Plus 5% dextrose in addition

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Electrical burn fluid resuscitation calculation

4ml/kg/%TBSA

Urine output aim for electrical injury

1-1.5ml/kg/hr until urine clears

Paediatric rule of 9s

Adult rule of 9s

Palmar sizing of burns

Palmar surface of PATIENT'S hand including fingers is approximately 1% TBSA

Which skin layer does each type of burn affect

Superficial: dermis Superficial partial-thickness: Papillary Deep partial-thickness: reticular Full-thickness: Subcutaneous tissue

Superficial burn sx

Erythema and pain eg sunburn

Superficial partial-thickness burn features

Moist Painful Blister Blanch to touch

Deep partial-thickness burn features

Drier Less painful Possible blisters Red mottled in appearance Non blanching to touch

Full-thickness burn features

Skin is waxy white or translucent Painless to touch or pinprick Dry

What compartment pressure could lead to muscle necrosis

\>30mmHg (although a pressure above systolic is required to stop blood flowing, pressures above 30 are enough to cause necrosis)

Presentation of compartment syndrome

Pain \> expected Pain on passive stretch Tense swelling Paraesthesia or altered sensation

Treatment of circumferential chest and abdominal burns

Escharotomies along the mid-axillary line with a cross-incision along the clavicular line and junction of thorax and abdomen

How soon after injury may escharotomy be required

not for the first 6 hours

NG tube indication in burns

N+V Abdo distention TBSA \>20%

Use of antibiotics in burns

No indication for prophylaxis

Blister management

Do not break Do not apply antiseptic agent

Why are alkali burns more serious than acid burns

Acid burns cause coagulation necrosis, which prevents penetration of acid into deeper tissue Alkali burns cause liquefication necrosis, penetrating more deeply

Management of chemical burns

Remove the substance Irrigate with saline (neutralising agents may be harmful)

Irrigation time for chemical burns

20-30mins for acidic burns Longer for alkali 8 hours for the eye (through a cannula in palpebral fossa)

Treatment of tar burn

Cool down tar by irrigation Apply a large amount of oil to dissolve it

Types of cold injury

frostbite or nonfreezing injury

1st-degree frostbite features

hyperaemia and oedema without skin necrosis

Second-degree frostbite features

Large clear vesicle formation accompanies Hyperaemia and oedema with partial-thickness skin necrosis

Third-degree frostbite features

Full-thickness and/sc tissue necrosis occurs Haemorrhagic vesicle formation

Fourth-degree frostbite features

Full thickness skin necrosis, including muscle and bone with lateral necrosis

Nonfreezing injury cause

Prolonged exposure to wet conditions and temperatures just above freezing 1.6 to 10 degrees Typically in homeless, sailors, soldiers, fishermen AKA trench foot

Nonfreezing injury phases

Alternating vasospasm and vasodilation

Management of frostbites or nonfreezing cold injuries

Replace restricting damp clothes with dry towels Hot fluids by mouth Place foot in circulating warm water (40 degrees) until pink and perfusion return (20 -30 mins) Avoid dry heat as could cause burn Analgesia as rewarming is very painful

Passive vs active rewarming

Passive: - to avoid loss of heat by placing in a warm environment and hoping patient will regain heat - mild hypothermia Active: - to heat with warmed iv fluids or bypass - moderate/severe hypothermia

Ongoing care for frostbites

Uninfected non haemorrhagic blisters intact for 7-10 days to provide sterile biological dressing Minimise wt bearing Avoid tobacco, nicotine and other vasoconstriction Thrombolytic agents may be helpful if given in the first 23hrs

Definition of hypothermia

Core temp less than 36 degrees

Definition of severe hypothermia

Core temp less than 32 degrees