20. Burns

Question 1

Management of dermal burns before referral

Answer 1

• 20 mins cold running water (only effective within first 3 hrs)
• clingfilm (not on face/head)- reduces air contact so decreases pain
• dressing: face = paraffin, neck/trunk acticoat
• check tetanus status

Question 2

Primary survey of significant burns patient?

Answer 2

Airway - could be threatened/burnt/inflamed - need intubation, cervical spine control if trauma
B= inhalation of smoke> lung injuries - use high flow O2; check for circumferential chest burn (eschar- coagulated mass of skin over burn - can constrict breathing, may need escharotomy)
Circulation - IV access - will need fluid, check for major haemorrhage from other injuries, circumferential limb burns restricting perfusion (elevate limbs/escharotomy)
Disability - mental state- Alert, Voice, Pain, Unresponsive; check pupils for size/symmetry
Exposure
Environment - warm room, blankets
Other injuries *from explosion etc

Question 3

Secondary survey

Answer 3

Burn assesment - depth

Adjuncts - fluids, analgesia

Question 4

depths of burns classes

Answer 4

superficial: epidermal, superficial dermal, mid dermal
deep: deep dermal (loss of sensation, absent cap refill, will need graft), full thickness (into underlying tissue/sub cut fat)

Question 5

surface area- how to calculate using rule of 9s?

Answer 5

in adult - front = 18%, each leg 18%, arm 9%, head 9%- bit different in kids.
1% = patient’s hand (palmar method)
most accuarte = lund and bowder chart

Question 6

What is used to guide resus fluid?

Answer 6

% total body surface area burnt

will also need dextroseo

Question 7

What is modified parkland formula?

Answer 7

3ml x weight (kg) x TBSA (%)

volume for 24 hrs, from then on volume is calculated using urinary output and heart rate.