Flashcards
Plastics: Principles of Burn Management
Cards in this deck (11)
- 13614 List causes of burns.* Wet heat/scalds - most common
* Dry heat
* Chemical
* Electrical
* Radiation
* Cold
See lecture: https://www.dropbox.com/home/P-Year%20Surgical%20Lectures?preview=Burns+-+Miss+J.+Odili.pptx - 23615 What three zones are seen within a burn injury?
- 33615 Outline the local response to a burn.* Inflammatory mediators cause increased micovascular permeability, oedema formation, microvascular stasis, thrombosis
* These responses can lead to progressive injury & cell death leading to deeepening of the wound
See lecture: https://www.dropbox.com/home/P-Year%20Surgical%20Lectures?preview=Burns+-+Miss+J.+Odili.pptx - 43617 Explain how burns can affect tissues & organs other than the skin.Systemic response to burns:
* In larger burns (>25-30% TBSA) mediators are released into the circulation (PG's, LT's, free radicals, histamine)- these effect all organs
* Burn oedema - oedema of burned & non-burned tissues. Pro
* Impaired microvascular integrity leads to burn oedema (oedema of burned & non-burned tissue). Protein loss peaks at 8-12 hrs.
* Hypovolaemia
* Myocardial depression
* RBC destruction - up to 40% of circulating volume
* Glucose intolerance
See lecture: https://www.dropbox.com/home/P-Year%20Surgical%20Lectures?preview=Burns+-+Miss+J.+Odili.pptx - 53616 Describe the classification of burns by thickness of burn.* Erythema:
> Epidermal damage
> No skin loss
> Heals within days without scarring
Superficial partial thickness (eg's flash burns, sunburn, some hot water scalds):
> Pink, moist, blistered
> Blanch on pressure
> Very painful
> Predominantly epidermal loss (germinal layer intact)
> Heals within 3 weeks
> Minimal scarring
* Deep partial thickness (eg's some hot water scalds, hot fat, contact burns):
> White / red with fixed staining
> No blanching on pressure
> Loss of germinal layer epidermis
> Prolonged healing by migration of epidermal cells from appendages & edges
> Scarring
> Sometimes/often needs skin grafting
* Full thickness (eg's flame burns, prolonged contact burns, corrosive chemicals):
> Leathery & insensate
> Loss of entire dermis
> Will not heal unless very small
> Scarring & contractures
> Needs skin grafting
See lecture: https://www.dropbox.com/home/P-Year%20Surgical%20Lectures?preview=Burns+-+Miss+J.+Odili.pptx - 63618 Describe the use of the rule of nines in the assessment of a pt with burns.
- 73620 Discuss factors which influence prognosis following a burn.Factors in burn severity:
* Burn location - hands, feet, genitalia
* Age
* Pre-existing medical conditions
* Medications
* Presence of multi-systems trauma
* Inhalation injury
See lecture: https://www.dropbox.com/home/P-Year%20Surgical%20Lectures?preview=Burns+-+Miss+J.+Odili.pptx - 83621 Describe the immediate first aid steps in the management of a pt with burns.STOP THE BURNING WOUND!
* Extinguish flames - pt horizontal
* Remove affected clothing (unless melted to skin)
* Cold water or wet towels (beware hypothermia)
* Clingfilm
* Continuous irrigation of chemical burns
* No other topical agents (toothpaste, butter, eggs)
See lecture: https://www.dropbox.com/home/P-Year%20Surgical%20Lectures?preview=Burns+-+Miss+J.+Odili.pptx - 93622 Explain which pt's with burns need in-pt Mx.Criteria for referral to burns unit:
* >10% TBSA in children
* >15% TBSA in adults
* Face, hands, feet, genitalia, perineum, major joints
* Circumferential burns
* Electrical burns
* Inhalation injury
* Significant pre-existing medical conditions, co-existing trauma
* NAI
See lecture: https://www.dropbox.com/home/P-Year%20Surgical%20Lectures?preview=Burns+-+Miss+J.+Odili.pptx - 103623 Describe the emergency Mx of pt's with severe burns.* Airway & C-spine:
> Deal with any obstruction
> Collar if suspicion of spinal injury
> If any evidence of impending obstruction (stridor, oropharyngeal swelling) get senior help/anaesthetist
* Breathing:
> High flow O2
> Check COHb & ABG
> If circumferentional burns of chest consider escharotomy
> CXR
* Analgesia:
> IV access - large bore x 2
> BD's - x-matching, FBC, COHb, U & E, glucose, coagulation
> IV morphine titrated to response + antiemetic (eg 50mg cyclizine IV)
* Fluid resuscitation:
> Start with isotonic crystalloid (eg 0.9% saline) at 2-4mL/kg per % TBSA burned over 24 hrs (half of the volume in 1st 8 hrs)
> Catheterise & test urine (myoglobinuria = ^risk of renal failure)
> R/V fluids frequently - aim for urine output >50mL/hour in adults
> Monitor BP & RR
> Burns >10% TBSA may require RBC transfusion
Oxford Handbook of Emergency Medicine. - 113624 List the acute complications of burns & describe measures to prevent them.Early complications:
* Impaired renal function
* Haemoglobinuria
* Overtransfusion
* Infxn & impaired immune function
* Pulmonary damage
* Burn encephalopathy
* Toxic shock syndrome
* Malnuitrition (may occur later)
See lecture: https://www.dropbox.com/home/P-Year%20Surgical%20Lectures?preview=Burns+-+Miss+J.+Odili.pptx
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- SGUL LOB's for Plastics: Principles of Burn Management.
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- Andrew Street
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