5007PM - BURNS & SCALDS

what is a burn

Injury caused by thermal, chemical, electrical and radiation energy

what is a scald

• A scald is a burn caused by contact with hot liquid or steam

• Damage to skin caused by heat

how is the severity of a burn characterised

• Extent of skin affected

• Anatomical site

• Depth of injury

• Age of patient

• Presence of coexisting disorders

what are the three zone of a burn injury

1. zone of coagulation

2. zone of statsis

3. zone of hyperaemia

what is a 1st degree burn

burn to the superficial thickness

e.g sunburn

what is the presentation of a first degree burn

• warm

• red

• painful

what is a second degree burn

burn to partial thickness

further classified- superficial or deep

superficial - epidermis only

deep - epidermis & dermis

whats the presentation of 2nd degree burns

• Blistering

• Painful

• Glistening wound bed

how long does it take to recover from 2nd degree burns

2-3 weeks of wound care

what is a third degree burn

• full thickness

• deep into dermis

what is the presentation of third degree burns

• leathery

• white to charred

• dead tissue

• appearance- thick dry white

• have pain from areas adjacent to burn site

what is the treatment for 3rd degree burns

Surgical intervention and intense period of rehabilitation.

what is a 4t degree burn

Not only to skin but also subcutaneous fat, muscle and bone

what are the types of burn

• thermal

• scald

• radiation

• electrical

• chemical

• non-accidental

what is a thermal burn

• Caused by fire and heat

• Direct injury to skin and tissue

what is a scald

• Caused by hot liquid

• Thicker the liquid and the longer the contact of skin = the greater the scald

what is radiation burn?

• Exposure to radiation

• Cell structure can be altered as the body responds to the radiation - causing cell mutations and cancer some times

what is an eletrical burn

• Caused by currents of electricity

• Usually deep

• May cause severe damage to the skin and underlying tissue

• Patients often have entry and exit wounds

how can electrical burns cause an arrest

Cardiac arrest due to the current passing through the myocardium.

Hand to hand worse than hand to feet.

how can electrical burns induce arrythmias

• Mass destruction of muscles which then release potassium and myoglobin.

• Potassium increases serum levels which can induce cardiac arrhythmias.

how can electrical burns damage kidney

When myoglobin is released into the bloodstream kidney damage may ensue

in this case urine may be coca cola or tea coloured.

what is a chemical burn?

• Occurs when your skin or eyes come into contact with an irritant

• Such as acid or a base

• Be aware of cross contamination

what is a non accidental burn

• Forced submersion in a fixed position

  • Zebra striped

  • Doughnut hole sparing

what should you ask yourself if you expect a non accidental burn?

• is the story consistent with injury?

• Are there varying accounts of what happened?

• does injury have a clean line of demarcation? signs of inflicted burn?

• any other injuries?

• why delay in medical attention?

• aggressive bystander?

what are the assessment tools used for burn severity?

• wallace rule of nine

• lund and browder chart

• patients palmer surface

• mersey burns

what is the tool- wallace rule of nine?

9% - head and neck

9% - arm (each)

18% - trunk - each for anterior and posterior

1% for genitalia and perinueum

18% - leg (each)

what is the tool- patients palmer surface

The surface area of a patient's palm (including fingers) is roughly 0.8% of total body surface area.

what is the tool- Lund and Browder chart?

• This is a good, quick way of estimating medium to large burns in adults.

• The body is divided into areas of 9%

• The total burn area can be calculated.

•  It is not accurate in children.

what is the presentation of TIME CRITICAL patients?

• Major CAcBCD problems

• Significant facial burns

• Airway burns (soot or oedema around mouth and nose)

• Hx of hot air and gas inhalation (appear well initially)

• Resp distress

• Circumferential burns of the chest, neck and limbs

• Child >10% TBSA

• Adult >15 TBSA

• Presence of other major injuries

• Preceding medical conditions

what % of burn is time critical in children

10%

what % of burn is time critical in adults

15%

what are the S&S of airway burns

• Facial or neck burns

• Soot in nasal or oral cavities

• Productive cough - black sputum

• Hoarseness

• Dyspnoea - difficulty in talking

• Dysphagia - difficulty in swallowing

• Blistering round mouth and tounge

• Scored hair, eyebrows and facial hair

• Stridor/wheezing

• Loss of consciousness

what is the management of burns?

• large burns require fluids

• elevate extremities

• apply wet non adherent dressing

• apply cling film (not on chemical)

• cool/irrigant burn

how long should you cool burn for

20 mins

how long should you cool a chemical burn

up to an hour

what are the complications of having a burn injury

• Inhalation injury

• UTI

• Clots in leg due to long lie

• Infection

• Hypovolemia and hypothermic shock - body regulates fluid and heat loss

• Wound progression- swelling decreased blood flow lead to full thickness

• Tetanus

what is a surgical circothyroidtomy

incision made through the skin and cricothyroid membrane to establish a patent airway during certain life-threatening situation