Burns

Question 1

Factors which influence the severity of a burn

Answer 1

• Cause of burn
• Duration of exposure
• Anatomical site
• Size of involved area
• Use of early first aid cooling

Question 2

Types of burn

Answer 2

Thermal
Chemical
Electrical
Friction
Radiation

Question 3

High voltage electrical shock can lead to:

Answer 3

• Extensive deep tissue damage
• Compartment syndrome
• Myonecrosis
• Rhabdomyolosis
• Renal failure

Question 4

High voltage vs low voltage

Answer 4

Low = <1000volts (usually domestic)
High = >1000volts (usually industrial)
Lightning = up to 300 million volts

Question 5

Which electrical current is more likely to cause cardiac arrhythmias, Alternating or direct?

Answer 5

Alternating

Question 6

Do acids or alkalines cause deep tissue burns?

Answer 6

Alkalines

Question 7

In relation to electrical burns and electric shock, what is arcing?

Answer 7

Arcing occurs when electrical current jumps between two objects without a direct connection. This can result in a flash injury without electrical current passing through the individual.

Question 8

What are the classifications of burn depth?

Answer 8

1) Superficial
2) Partial thickness/Dermal - Partial dermal
- Deep dermal
3) Full thickness

Question 9

Characteristics of a superficial burn

Answer 9

Erythema/Redness
Painful

Question 10

Characteristics of a superficial dermal burn

Answer 10

Blisters
Painful
Pink
Blanching

Question 11

Characteristics of a deep dermal burn

Answer 11

Blisters
Sensation reduced
Prolonged CRT
Blotchy pink/red

Question 12

Characteristics of a full thickness burn

Answer 12

Charred black or leathery white
‘Woody’ feel
Insensitive to light touch
Non-blanching

Question 13

Water temperature for cooling a burn

Answer 13

Ideally between 8 - 15 degrees Celsius.

(Cool to dissipate the heat but not ice cold which could vasoconstriction and deepen the burn)

Question 14

Signs of inhalation burn injury

Answer 14

• Burns to face/neck
• Swelling to mouth/oropharynx
• Soot in nose or mouth
• Singed nasal hair
• Cough with black sputum
• Hoarse voice or stridor
• Wheeze on auscultation
• Dyspnoea and hypoxia

Question 15

Parkland formula

Answer 15

3ml x Patient weight (kg) x TBSA (%)
- This gives the total amount to be given in a 24 hour period
- First half of this to be given in the first 8 hours
- Second half to be given in the following 16 hours.

Question 16

Carbon Monoxide (CO) has an affinity how many times more than oxygen to haemoglobin

Answer 16

240 times

Question 17

Antidote for Cyanide poisoning

Answer 17

Hydroxycobalamin (Cyanokit)

Dicobalt editate

Question 18

Half-life of CO

Answer 18

Breathing Air - 320 minutes

This can be reduced to 80 minutes breathing 100% oxygen

Question 19

Escharotomy

Answer 19

• For Circumferential full thickness burns where there is restricted ventilation or vascular compromise.

Question 20

Burns referrals - Burns unit criteria for Adults

Answer 20

≥10%<40%
or
≥10%<25% with inhalation injury

Question 21

Burns referrals - Burns unit criteria for paediatrics

Answer 21

≥5% <30%
≥5% <15% if under 1 year old

Question 22

Burns referrals - Burns centre criteria for adults

Answer 22

> 40% TBSA
or
25% TBSA with inhalation injury

Question 23

Burns referrals - Burns centre criteria for paediatrics

Answer 23

> 30%TBSA
15% TBSA in under 1
20% TBSA if full thickness

Question 24

Burns centre vs Burns unit

Answer 24

Burn Centres – This level of in-patient burn care is for the highest level of injury complexity and offers a separately staffed, geographically discrete ward. The service is skilled to the highest level of critical care and has immediate operating theatre access.

Burn Units – This level of in-patient care is for the moderate level of injury complexity and offers a separately staffed, discrete ward.

Question 25

Where would an adult with 35% TBSA burns go?

Answer 25

Burns Unit Burns unit criteria for adults: ≥10%<40% or ≥10%<25% with inhalation injury

Question 26

Where would an adult with 30% TBSA burns and inhalation injury go?

Answer 26

Burns Centre Burns Centre criteria for adults: >40% TBSA or >25% TBSA with inhalation injury

Question 27

Where would a 2 year old with 10% TBSA burns go?

Answer 27

Burns unit (Burns unit criteria for peads: ≥5% <30% ≥5% <15% if under 1 year old)

Question 28

Where would a 4 year old with 18% TBSA burns go?

Answer 28

Burns unit (Burns unit criteria for peads: ≥5% <30% ≥5% <15% if under 1 year old)

Question 29

Where would a 5 year old with 25% full thickness TBSA burns go?

Answer 29

Burns Centre Burns centre criteria for paeds: > 30%TBSA > 15% TBSA in under 1 > 20% TBSA if full thickness

Question 30

Treatment of chemical burn

Answer 30

Irrigate copiously amphoteric irrigating agent if possible such as Diphoterine Do not wrap in cling film

Question 31

Definition of major burns in Adults

Answer 31

>20% TBSA

Question 32

Clinical features correlating with the need for early intubation in burns

Answer 32

Full thickness facial burns Stridor Respiratory distress Swelling on laryngoscopy Smoke inhalation Singed nasal hairs

Question 33

Carbon monoxide severe poisoning

Answer 33

>30%

Question 34

Optimal duration of burn cooling

Answer 34

20 mins

Question 35

Optimal water temp for burn cooling

Answer 35

12oC

Question 36

Optimal Flow rate of water for burn cooling

Answer 36

1-1.5 l/min

Question 37

Burn cooling effective up to _____ hours after injury

Answer 37

3

Question 38

Which burn type should we not apply cling film?

Answer 38

Chemical

Question 39

Which type of burns should irrigation be continued for as long as practicably possible?

Answer 39

Chemical

Question 40

In burns greater than ___% fluid resuscitation should be started pre-hospitally for both adults and children

Answer 40

20%

Question 41

Which drugs should not be administered for analgesia in burns patients requiring fluid administration?

Answer 41

NSAIDS

Question 42

Indications for hydroxycobalamin

Answer 42

Smoke inhalation with altered mental status or cardiovascular instability

Question 43

Intubation of a burns patient

Answer 43

Uncut tube Largest tube possible Avoid tie around the neck/face

Question 44

Normal CO levels in non-smokers, smokers and heavy smokers

Answer 44

Non-smokers = <3% Smokers = <5% Heavy smokers = <9%