thermal trauma not finished

what is a burn?

• injury caused by exposure to heat/electricity/chemicals/radiation

• most commonly affects skin, may also affect airways, lungs, muscle, bone and internal organs

what burns are complex?

• all electrical and chemical burns

• thermal burns covering critical area

• more than 15% TBSA of adult

• more than 10% TBSA of child

• more than 5% TBSA of child under 1

what are the critical areas?

• face

• hands

• feet

• perineum

• genitals

• major joints

what are the three layers of skin?

• epidermis (outermost layer)

• demis (nerve endings, blood vessels)

• subcutaneous (fat and muscle)

what are the types of burns?

• superficial epidermal burns

• superficial dermal burns

• deep dermal thickness burns

• full thickness burns

what are superficial epidermal burns?

• involves epidermis only

• red + painful

• no blistering, no scarring

• heals within 7 days

what are superficial dermal burns?

• involves epidermis and upper dermis

• pale pink, fine blisters, blanches to pressure

• extremely painful

• heals within 14 days

what are deep dermal thickness burns?

• involves epidermis and significant part of dermis

• blotchy red, may blister

• no cap refil

• decreased sensation

• white/pale/pink/blotchy red

• 21 days to heal

• 81% chance of scarring

what are full thickness burns?

• epidermis, dermis and cell structure destroyed

• white waxy charred

• no blisters

• will scar

• does not heal on its own

rule of 9s adults

• head - 9%

• trunk (front + back) - 18%

• arms (each) - 9%

• legs (each) - 18%

• genitals - 1%

what are some signs of inhalation injury?

• singed facial hair

• facial burns

• difficulty speaking/hoarseness

• stridor

• soot in oropharynx

• oropharyngeal oedema

• crackles on auscultation

• respiratory failure

how should inhalation injury be treated?

• easy intubation

• high flow oxygen

• rapid transport to major trauma centre

• sit upright

• early and aggressive airway management

why do circumferential burns pose a risk to breathing?

• burns to chest or abdomen create rigid tight shell that prevents expansion of chest and leads to apnea

• escharotomy needed

how to manage burns?

• irrigate with copious amounts of tepid water/saline for max 20 mins (beneficial up to 3 hours after burn) or 1 hour for chemical burns

• cut off burning clothes/remove jewlerry

• cover in clingfilm do not wrap

• keep pt warm

• pain relief