36. Burns

Question 1

Approach to severe burns

Answer 1

ABCDE approach

Airway
- smoke inhalation can result in airway oedema
- early intubation should be considered if deep burns to the face or neck, blisters or oedema of the oropharynx, stridor etc

Circualtion
- IV fluids - The fluids are calculated using the Parkland formula which is; volume of fluid= total body surface area of the burn % x weight (Kg) x4. Half of the fluid is administered in the first 8 hours.
- urinary catheter

Question 2

what formula is used to calculate fluids in severe burns initial fluids

Answer 2

Parkland formula

Total fluid requirement in 24 hours =
4 ml x (total burn surface area (%)) x (body weight (kg))
50% given in first 8 hours
50% given in next 16 hours

Question 3

management of a burn caused by heat

Answer 3

remove the person from the source. Within 20 minutes of the injury irrigate the burn with cool (not iced) water for between 10 and 30 minutes. Cover the burn using cling film, layered, rather than wrapped around a limb

Question 4

management of electrical burn

Answer 4

switch off power supply, remove the person from the source

Question 5

management of a chemical burn

Answer 5

brush any powder off then irrigate with water. Attempts to neutralise the chemical are not recommended

Question 6

what is a escharotomy? when might it be required

Answer 6

Careful division of the encasing band of burn tissue will potentially improve ventilation (if the burn involves the torso), or relieve compartment syndrome and oedema (where a limb is involved)

Circumferential burns affecting a limb or severe torso burns impeding respiration may require escharotomy to divide the burnt tissue.

Question 7

what are the methods of assessing the extent of a burn

Answer 7

Wallace’s Rule of Nines

Lund and Browder chart: the most accurate method

Question 8

what is wallaces rule of nines

Answer 8

head + neck = 9%, each arm = 9%, each anterior part of leg = 9%, each posterior part of leg = 9%, anterior chest = 9%, posterior chest = 9%, anterior abdomen = 9%, posterior abdomen = 9%

Question 9

what are the 4 classifications of depth of burn

Answer 9

Superficial epidermal
Partial thickness (superficial dermal)
Partial thickness (deep dermal)
Full thickness

Question 10

presentation superficial burn

Answer 10

Red and painful, dry, no blisters

Question 11

presentation partial thickness burn (superficial dermal)

Answer 11

Pale pink, painful, blistered. Slow capillary refill

Question 12

presentation partial thickness burn (deep dermal)

Answer 12

Typically white but may have patches of non-blanching erythema. Reduced sensation, painful to deep pressure

Question 13

presentation full thickness burn

Answer 13

White (‘waxy’)/brown (‘leathery’)/black in colour, no blisters, no pain

Question 14

when to refer burns from primary care

Answer 14

All parital thickness deep dermal and full-thickness burns.

Partial thickness superficial dermal burns with…:
More than 3% TBSA in adults, or more than 2% TBSA in children
Involving the face, hands, feet, perineum, genitalia, or any flexure, or circumferential burns of the limbs, torso, or neck

Any inhalation injury
Any electrical or chemical burn injury
Auspicion of non-accidental injury

Question 15

management of burns in priamry care

Answer 15

initial first aid as above
review referral criteria to ensure can be managed in primary care
superficial epidermal: symptomatic relief - analgesia, emollients etc
superficial dermal: cleanse wound, leave blister intact, non-adherent dressing, avoid topical creams, review in 24 hours

Question 16

haematemesis after an extensive burn

Answer 16

Curling’s ulcer is an acute gastric erosion resulting as a complication from severe burns when reduced plasma volume leads to ischemia and cell necrosis (sloughing) of the gastric mucosa.

Question 17

complications burns

Answer 17

curlings ulcer
compartment syndrome
rhabdo especially after electrical burn
aki