Burns

Question 1

IMMEDIATE FIRST AID
i) how quickly should cold water be irrigated with? how long for? how should it be covered?
ii) what should be done for electrical burns
iii) what should be done for chemical burns? should the chemical be neutralised

Answer 1

i) within 20 mins for 10-30 mins
cover with cling film - layer dont wrap
ii) switch off power supply and remove the source
iii) brush off powder then irrigate with water - dont attempt to neutralise

Question 2

EXTENT OF THE BURN
i) what is wallaces rule of nines?
ii) what is the most accurate method of assessment?
iii) what is the palmar surface roughly equal to in relation to total body SA? what is the limitation of this

Answer 2

i) head + neck = 9% TBSA, each arm, ant leg, post leg, chest, post chest, anti abdo all 9%
ii) lund and browder is most accurate
iii) palmar surface is approx 1% of total body SA but not accurate for burns >15%

Question 3

DEPTH OF BURN
i) what is first degree aka? name two features
ii) what two things are second degree aka? name three features of each
iii) what is third degree aka? what colour is seen? is there pain? is there blistering?

Answer 3

i) superficial epidermal - red and painful
ii) partial thickeness (superficial dermal) = pale, pink, pale, blistered
partial thickeness (deep dermal) = white but may have patches of non blanching erythema with reduced sensation
iii) full thickness - white/brown/black, no blisters or pain

Question 4

REFERRAL TO SECONDARY CARE
i) all of which type should be referred?
ii) more than what % of TVSA in adults and in children should be referred?
iii) superficial dermal burns involving which areas?
iv) name three other types of injury that should be referred

Answer 4

i) all deep dermal and full thickness
ii) 3% TBSA in adults or 2% in TBSA in children
iii) superficial involving face, hands, feet, perineum, genitalia
iv) any inhalation injury, electrical, chemical and suspicion of non accidental injury

Question 5

INITIAL MANAGEMENT OF BURNS
i) how can superficial epidermal be managed?
ii) how can superficial dermal be managed? what should be avoided? when should they be re reviewed?

Answer 5

i) symptomatic relief - analgesia and emollients
ii) sup dermal - cleanse wound, leave blister in tact, non adherent dressing
avoid topical creams
review in 24 hrs

Question 6

SEVERE BURNS
i) is there a catabolic or anabolic response? what is a common cause of death following major burns?
ii) what is the initial aim in management?
iii) what can smoke inhalation cause? when should early intubation be considered?
iv) how are fluid amounts calculated?
v) which burns should be refered to a burns unit

Answer 6

i) catabolic response > sepsis is a common cause of death
ii) initial aim is to stop the burning process and resus patient
iii) smoke inhalation can cause airway oedema
early intubation if deep burns to face or neck
iv) fluid amounts calc by parkland formula
v) complex burns on hand, perineum face > transfer to unit
no evidence for anti microbial prophylaxis or topical abx in burn patients