acute burns management

Question 1

burn wound first aid - how to stop the burn process (5)

Answer 1

• remove patient from source of injury
• STOP, DROP, COVER face, ROLL if on fire
• remove hot, scalding or charred clothing
• remove any jewellery or constricting clothing ASAP
• don’t catch fire yourself

Question 2

burn wound first aid - how to cool a wound

• treatment options and indications (4)
• contraindicated treatment options

Answer 2

running water available
- cool the burn wound with running tap water
no running water available
- wet towels
- pads
- BurnAid hydrogel tea-tree dressing

don’t
- use ice

Question 3

first aid for burn wound within 3 hrs - contraindicated treatment

Answer 3

ice

Question 4

first aid for burn wounds - running tap water cooling

• method
• when can it be initiated

Answer 4

• cool with tap water for 20 minutes (non-chemical) or 1-2 hours (chemical)
• ideal temperature 15C, range 8-25C
• avoid hypothermia by keeping other body parts warm
• stop treatment if body temp < 35C

can be initiated within 3 hours of original burn

Question 5

first aid for burn wounds - pads, wet towels, and gel pads

- method

Answer 5

use two moistened pads, and alternate them in 15 second intervals

Question 6

burn wounds - indications for outpatient medical review

Answer 6

• anything bigger than a 20c piece with blistering

Question 7

management of a wound that is awaiting transfer

Answer 7

cool wound if < 3h

cover in plastic cling wrap

Question 8

what does cling wrap dressing protect against in a burn wound (3)

Answer 8

protects against

• colonisation
• excess fluid loss
• excess heat loss

Question 9

first aid management for a burn wound in community (broadly)

Answer 9

• stop the burn process
• cool the burn wound
• decide if medical advice is needed

Question 10

burn wound first aid on arrival in hospital (7)

Answer 10

• continuous irrigation of small burns
• continuous irrigation of eye burns w/. n saline until pH neutral
• place person on a clean dry sheet, keep warm
• cover burn with plastic cling wrap and clean sheet when not being assessed
• elevate burnt limbs or head and neck
• identify burn source and chemical if involved
• update tetanus immunisation status

Question 11

assessment of burn injury area - what s the rule of 9s for over 9yo

Answer 11

• palm surface, fingers, perineum = 1%
• whole arm, whole head = 9%
• front torso, back torso, each leg 18%

Question 12

assessment of burn injury area

- what is the rule of 9s for children up to 9

Answer 12

• palms and fingers = 1%
• perineum 1% if >9yo
• each arm 9%
• each leg 14% + age/2
• head 18% - age
• front torso, back torso 18%

Question 13

burn assessment - blistering suggests what burn depth

Answer 13

between superficial dermal - deep dermal

Question 14

burn assessment - capillary refill >2s suggests what burn depth

Answer 14

mid-dermal or deeper

Question 15

burn assessment - different burn wound depths

Answer 15

epidermal
superficial dermal
mid dermal
deep dermal
full thickness

Question 16

full thickness burns affect what layers

Answer 16

epidermis, dermis, subcutis and muscle

Question 17

difference between minor and severe burns

Answer 17

• minor burns can be managed as outpatient

- severe burns are anything that need retrieval or referral to a burns unit

Question 18

criteria for burn requiring retrieval (11)

Answer 18

airway, breathing, circulation

• intubated patient
• inhalation injury
• burn to chest that compromises circulation or respiration

burn pattern

• head or neck burns
• surface area > 10% TBSA in child, >20% in adult
• circumferential burn to limbs

associated injury

• burns with significant comorbidities
• trauma

burn source

• electrical, lightning
• chemicals like hydrofluoric acid

patient factor
- pre-existing medical disorder

Question 19

features of burn wound that will mean a graft is likely required (2)

Answer 19

• blistering AND

- cap refill > 2s

Question 20

criteria for burn requiring referral to burns unit (8)

Answer 20

burn pattern

• > 5% in children or >10% adult
• burns to hand / feet / genitalia / perineum / major joints

burn source

• chemical burn
• electrical burn
• suspected non-accidental injury

patient factor

• extremes of age
• patient has pre-existing medical condition
• pregnancy with cutaneous burns