Assessment & Stabilisation the Child with Severe Burns

Question 1

How do you approach burns?

Answer 1

A
B
C
D
E

Question 2

How do you test capillary return?

Answer 2

Lift limb above the level of the heart, press for 5s, should be less than 2s

Question 3

What determines the depth of a burn?

Answer 3

Intensity of the insult

Time that it’s applied

Question 4

How are burns characterised?

Answer 4

Superficial

• Epidermal
• Superficial dermal
• Mid dermal

Deep

• Deep dermal
• Full thickness

Question 5

Burns first aid?

Answer 5

> 20 minutes of cold running water

Not ice, fresh allovera

Question 6

When do you do an escharotomy? How?

Answer 6

When circumferential burn is present

Cut in anatomical position

Question 7

How do you estimate total body surface area?

Answer 7

Take the victim’s palm (it’s 1-1.5%) to estimate
Rule of 9’s
More accurate: Lund & Browder

Discount epidermal burn

Question 8

What are the percentages for each body part in Wallace’s rule of nines?

Answer 8

Adult

• Upper limb - 9% each
• Lower limb - 18% each
• Front and back - 18% each
• Head - 9%
• Genital - 1%

Question 9

How is fluid resuscitation estimated?

Answer 9

Using the %TBSA

Kids need dextrose containing maintenance - children are more prone

Question 10

What are the trauma x-ray views?

Answer 10

Lateral c-spine
CXR
Pelvic

Question 11

What Ix should you order?

Answer 11

Trauma bloods
Trauma XRs
Temperature, ECG, bHCG, eye-staining

Question 12

What is in the secondary survey?

Answer 12

AMPLE history

• Allergies
• Medications
• Past medical hx
• Last ate
• Event happened

Head to toe examination
Tetanus status
Wound care
Reassess primary survey

Question 13

What is an effective wound care material in first aid?

Answer 13

Cling film - reduces contact to the injury to reduce irritation
- One layer only

Question 14

When do you refer?

Answer 14

ANZBA referral criteria

• > 10% TBSA
• > 5% TBSA in children
• Full thickness burns >5%
• Burns with inhalation
• Chemical/Electrical burns
• Burns with major trauma
• Burns on existing injury
• Burns in special regions - face, genitals, hands, buttock
• Pregnant women
• Extremes of age
• Non-accidental

Question 15

What are the characteristics of the types of burns?

Answer 15

○ Superficial
- Red, painful, blistering, brisk cap refill

○ Superficial partial thickness (superficial dermal)
- Moist, reddened with broken blisters, brisk capillary return

○ Deep partial (deep dermal)
- Mottled, red, painless, moist white slough, sluggish cap refill

○ Full thickness
- White, charred, painless

Question 16

What are the six reasons why a child’s airway is more prone to being lost cf to an adults?

Answer 16

• It’s smaller
• The tongue is relatively larger in a relatively small oral cavity
• Large occiput
• Nose breathers
• Cartilaginous and soft trachea
• Larynx is higher and more anterior