Burn

Question 1

degree of burn not included in computation

Answer 1

1st degree

Question 2

used for estimation burn size in children <10 yo

Answer 2

Lund browder chart

Question 3

indication for transfer to burn center

Answer 3

patients with partial or full-thickness burns that involve the hands, feet, genitalia, face, eyes, ears,
and/or major joints or perineum
* partial thickness burns ≥20% TBSA in patients 10-50 yr
* partial thickness burns ≥10% TBSA in children ≤10 or adults ≥50 yr
* full thickness burns ≥5% TBSA in patients of all ages
* electrical burns including lightning (internal injury underestimated by TBSA), and chemical burns
* inhalation injury (high risk of mortality and may lead to respiratory distress)
* burn injuries in patients with medical comorbidities which could complicate management and
recovery
* any patients with simultaneous trauma and burns should be stabilized for trauma frst, then triaged
appropriately to burn centre
* any patients with burn injury who will require special emotional, social, and rehabilitation
intervention
* children with burns in a hospital not equipped with paediatric care specialists

Question 4

target urine output

Answer 4

maintain at >0.5 cc/kg/h (adults)
1.0 cc/kg/h in children <12 yr

Question 5

Degree of burn:
Insensate, difficult to distinguish from full thickness,
does not blanch, some hair follicles still attached, softer
than full thickness burn

Answer 5

second degree burn
deep partial thickness

Question 6

Degree of burn:
Painful, sensation intact, erythema, blanchable

Answer 6

erythema/superficial
1st degree burn

Question 7

Degree of burn:
Painful, sensation intact, erythema, blisters with clear
fuid, blanchable, hair follicles present

Answer 7

superficial partial thickness burn
2nd degree burn

Question 8

Injury to underlying tissue structures (e.g. muscle, bone)
Insensate (nerve endings destroyed), hard leathery
eschar that is black, grey, white, or cherry red in colour;
hairs do not stay attached, may see thrombosed veins

Answer 8

3rd/4th degree burn
full thickness burn

Question 9

target HR and MAP during resuscitation

Answer 9

HR <120/min, MAP >70 mmHg

Question 10

when to give tetanus toxoid prophylaxis

Answer 10

all patients with burns >10% TBSA, or deeper than superfcial-partial thickness, need 0.5 cc
tetanus toxoid

Question 11

when to give tetanus IG

Answer 11

also give 250 U of tetanus Ig if prior immunization is absent/unclear, or the last booster >10 yr
ago

Question 12

Parkland Formula

Answer 12

4 cc x mass in kg x % TBSA with 1/2 of total in frst 8 h from time of injury and 1/2 of total in next 16 h from
time of injury

Question 13

identify degree of burn.

Spontaneously re-epithelialize in 7-14 d from retained epidermal structures
± Residual skin discolouration

Answer 13

2nd degree

Question 14

identify degree of burn.
no scarring

Answer 14

1st degree

Question 15

indentify degree of burn
Re-epithelialize in 14-35 d from retained epidermal structures
Hypertrophic scarring frequent
Grafting recommended to expedite healing

Answer 15

deep second degree

Question 16

most common organism infected burn day 1-3

Answer 16

S. aureus, P. aeruginosa, and C. albicans

Question 17

most common organism infected burn day 3-5

Answer 17

(Proteus, Klebsiella)

Question 18

dressing for burn
May cause methemoglobinemia, stains (black),

Answer 18

Silver Nitrate (0.5% solution)

Question 19

dressing for burn

May stain, producing a pseudoeschar or facial
discolouration (bluish-gray discolouration; raised
liver enzymes

Answer 19

Nanocrystalline Silver-Coated
Dressing (Acticoat®

Question 20

dressing for burn

Slowed healing, leukopenia

Answer 20

Silver Sulfadiazine (cream)
(Flamazine®, Silvadene®

Question 21

dressing for burn

Mild inhibition of epithelialization, may cause
metabolic acidosis

Answer 21

Sulfamylon®

Question 22

treatment
Acid burn

Answer 22

water irrigation

Question 23

treatment
hydrofluoric acid

Answer 23

water irrigation
clip finger nails topical calcium gel, IV calcium gluconate

Question 24

treatment sulfuric acid

Answer 24

soap/lime prior to irrigation

Question 25

Tar

Answer 25

removal with repeated application of petroleum based antibiotic ointment

Question 26

Frost bite management

Answer 26

• immerse in 40-42°C agitated water for 10-30 min (very painful; administer adequate analgesia)
• clean injured area and leave it open to air
  tetanus prophylaxis
• consider penicillin G as frostbite injury has high-risk of infection

Question 27

Investigation for burn

Answer 27

investigations: CBC, electrolytes, U/A, CXR, ECG, ABG, carboxyhemoglobin

Question 28

Criteria for admission burn

Answer 28

■ 2nd degree burns >10% BSA, or any signifcant 3rd degree burns
■ 2nd degree burns on face, hands, feet, perineum, or across major joints
■ electrical, chemical burns, and inhalation injury
■ burn victims with chronic medical conditions or immunosuppressed patients