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Burns Notes

Medicine Notes > Medical Finals & OSCEs Notes

This is an extract of our Burns document, which we sell as part of our Medical Finals & OSCEs Notes collection written by the top tier of Oxford University students.

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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 -

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

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

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But SaO2 decreases as CO is bound.

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PaCO2 is normal (or down to an increased RR)

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Decreased pH

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Increased lactate (anaerobic respiration)

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Thus a metabolic acidosis

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

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

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Intubate early and ventilate and give 100% O2.

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