Burns

Question 1

What is the pathophysiology that occurs in burns?

Answer 1

Pathophysiology occurring in burns = increased cap permeability persists for 24 hours, starts resolving 8-12 hours

Question 2

What is the function of the skin?

Answer 2

• temp regulation
• sensory interface
• immune response/ protection from bacterial invasion
• control of fluid loss
• metabolic function

Question 3

What is the body’s response to burn injuries?

Answer 3

• proportional to area burnt
• affects all major organ systems
  
  • heart and blood vessels
  • lungs (pulmonary oedema)
  • gut
  • immune system
  • neuro-numeral regulation
  • kidney (renal failure)
  • bone mineralisation & growth

Question 4

What are the circulatory effects of a burn?

Answer 4

• increase in capillary permeability
  
  • loss of fluid from circulation
  • loss of albumin from circulation
  • oedema formation

Question 5

What are the metabolic effects of burns?

Answer 5

• secretion of stress hormones = tachycardia
• neural response via sympathetic nervous system & hypothalamus = hyperthermia
• suppression of anabolic hormones & development of catabolic response = protein wasting
• depression of immune response = susceptibility to infection

Question 6

What are the two main FIRST AID things with burns?

Answer 6

Two main things with burn first aid —> with no first aid the burn will get deeper

1. STOP the burning process
   
   • stop! Drop! Cover face and roll!
   • remove all clothing
   • if dry chemical brush off before irrigating
2. Cool the wound
   
   • ASAP
   • Window of 3 hours from time of injury
   • any fluid 8-25 degrees
   • continue for 20 mins
   • if chemical—> irrigate copiously with water
   • avoid hypothermia

Question 7

What do you not put on burns?

Answer 7

ICE = worse than nothing s cause vasconstruction

Question 8

What is the management of Burn?

Answer 8

Primary survey
- Airway & C-spine
- Breathing & Ventilation
- Circulation & Haemorrhage control
- Disability (neuro & pupils)
- Exposure (keep warm)

Intubation
- if in doubt —> intubate
- lots of swelling and oedema

Question 9

What are the depth classifications of burns?

Answer 9

Epidermal: heals 3-7 days w moisturiser and protective dressing
Superficial: 7-14 days with minimal Dx
Mid-dermal: 14-21 days, deeper areas may need surgery
Deep dermal: surgical intervention, specialist referral
Full thickness: surgical intervention, long term scar management

Question 10

What is TBSA burns assessment?

Answer 10

TBSA: Total Body Surface Area
Rule of Nine’s
Head & Neck = 9%
Arms (2x9) = 18%
Trunk (front) = 18%
Trunk (back) = 18%
Legs (2x18) = 36%
Perineum = 1%
= 100%

Question 11

Fluid restriction in burns?

Answer 11

Fluid resuscitation
Modified Parkland Formula = area burnt x weight x 3
- Hartmann’s half in first 8 hours
- Second half in next 16 hours
Monitor urine output = 1ml/kg/hr paed, 0.5ml/kg/hr adult