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Burns Notes

Medicine Notes > Medical Finals & OSCEs Notes

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Burns 6% of burn victims have an inhalational injury. There is twice the chance of death if there is inhalational injury. 80% have flame burns (? v deep and serious) or scalds (?usually children)

Causes Flare, scald, contact, frostbite, chemical (acid or alkali), electrical (high/low voltage). Alkali burns more deeply than acid: acid coagulates proteins so stops itself, alkali liquefies tissues so keeps going. Electricity?muscles contract, flexors stronger than extensors, so flex extremely strongly. Electricity?all conducting tissue, nerves so completely die ? anaesthesia; heart so arrhythmias; muscles so they swell. Feed patients with big burns early as microbial translocation in the gut occurs due to the large-scale intestinal barrier loss of the gut, and they are also in a very catabolic state, for months afterwards too.

Dx Hx- enclosed space? ?breathing smoke, CO etc. Found unconscious? ?length of time trapped O/E - face burns, oral/nasal burns, carbonaceous sputum, hoarse, stridor. Ix -


CO poisoning, do not use sats probe (which detects carboxyhaemoglobin so gives a false reading). Look for 'cherry red' tongue and bounding pulse


PaO2 is usually normal as the same amount of oxygen is dissolved in the blood.


But SaO2 decreases as CO is bound.


PaCO2 is normal (or down to an increased RR)


Decreased pH


Increased lactate (anaerobic respiration)


Thus a metabolic acidosis

Resuscitation (get to ITU and get senior help and call Regional Burns Unit early) A:


Thermal burn to upper airway, direct damage?oedema closes off. Therefore prophylactically intubate them before the airway closes off in a few hours


Intubate early and ventilate and give 100% O2.

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