Burns

Question 1

What are the different types of burn?

Answer 1

Inhalation- due to fire smoke
Thermal
-due to direct contact with a hot object
- severity depends on heat level and length of exposure

Chemical
-can penetrate deep into skin and cause continuous damage

Electrical

• damage depends on voltage and length of exposure
• often deep tissue damage

Radiation

• due to things such as sunburn
• can cause cancer due to DNA damage

Question 2

What are the different classifications of burn?

Answer 2

Superficial erythema
Superficial partial thickness
Deep partial thickness
Full thickness

Question 3

What is a superficical erythema burn?

Answer 3

Affects epidermis only
Sensation in tact
Blanches
Has appearance of sunburn
Heals within a few days

Question 4

What is a superficial partial thickness burn?

Answer 4

Affects the epidermis and upper dermis
Sensation in tact
Blanches
Will form intense blisters and skin will peel 
Takes 10 days to heal

Question 5

What is a deep partial thickness burn?

Answer 5

Affects own to germal layer of dermis
Does not blanch
Sensation affected- blunt
Appears very red 
Heals leaving scars

Question 6

What is a full thickness burn?

Answer 6

Affects germal layer of dermis
Will be white
No sensation
Heals with intense scarring and contractures if not grafted

Question 7

How can TBSA be estimated?

Answer 7

Rule of 9s
Face= 9%
Back of Head= 9%
Upper chest= 9%
Upper back= 9%
Abdo=9%
Lower back= 9%
Arm= 9% per arm (4.5% front and 4/5% back)
Leg= 18% per leg
Perineum and genitals= 1%

Question 8

What is the fluid resus for patients with burns?

Answer 8

If TBSA >15% (10% paeds)
For 1st 24 hours

4 x % TBSA x weight

Give half fluid over 8 hours and other half over 16

Abx if signs of infection
Catheterise

Question 9

What is the management?

Answer 9

Superficial burns

• non adherent dressings with topical abx if indicated
• if on hands then sulfadiazine cream and place into sealed bags

Deep burns

• clear burn wound and remove tissue
• if small can suture together but if large will require grafting

Question 10

What are complications of burns?

Answer 10

Early

• wound infection
• wound contracture

Late

• AKI due to hypovolaemia
• wound infection
• acute peptic ulceration
• psychological disturbances

Question 11

When should a patient be referred to the burns unit?

Answer 11

• When TBSA >30%
• Superficial burns >15%
• Deep burns >1%
• Circumferential burn
• Chemical or electrical
• Associated inhalation injury
• Extremes of age
• Burn not healed within 3 wks