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4th year passmedicine by topic > Burns > Flashcards

Burns Flashcards

1
Q

Immediate first aid for burns caused by heat after ABCDE

A

Remove the person from the source.

Within 20 minutes of the injury irrigate the burn with cool (not iced) water for between 10 and 30 minutes.

Cover the burn using cling film, layered, rather than wrapped around a limb

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2
Q

Immediate first aid for electrical burns after ABCDE

A

switch off power supply, remove the person from the source

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3
Q

Immediate first aid for chemical burns after ABCDE

A

brush any powder off then irrigate with water.

Attempts to neutralise the chemical are not recommended

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4
Q

Assessing the extent of the burn most accurate chart?

A

Lund and Browder chart

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5
Q

Assessing the extent of the burn includes wallace’s rules of 7

A

false
Wallace’s Rule of Nines: head + neck = 9%, each arm = 9%, each anterior part of leg = 9%, each posterior part of leg = 9%, anterior chest = 9%, posterior chest = 9%, anterior abdomen = 9%, posterior abdomen = 9%

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6
Q

the palmar surface is roughly equivalent to ?% of total body surface area (TBSA)

A

the palmar surface is roughly equivalent to 1% of total body surface area (TBSA)

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7
Q

the palmar surface rule is not accurate in

A

Not accurate for burns > 15% TBSA

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8
Q

Appearance of Superficial epidermal

A

Red and painful

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9
Q

Appearance of Partial thickness (superficial dermal)

A

Pale pink, painful, blistered

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10
Q

Appearance of Partial thickness (deep dermal)

A

Typically white but may have patches of non-blanching erythema. Reduced sensation

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11
Q

Appearance of Full thickness

A

White/brown/black in colour, no blisters, no pain

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12
Q

Referral to secondary care is for all deep dermal and full-thickness burns.

A

true

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13
Q

Referral to secondary care is for superficial dermal burns involving the

A

face, hands, feet, perineum, genitalia, or any flexure, or circumferential burns of the limbs, torso, or neck

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14
Q

Referral to secondary care is for superficial dermal burns of more than ?% TBSA in adults, or more than ?% TBSA in children

A

superficial dermal burns of more than 3% TBSA in adults, or more than 2% TBSA in children

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15
Q

Referral to secondary care is for any exhalation injury

A

false

any inhalation injury

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16
Q

Referral to secondary care is for suspicion of non-accidental injury

A

true

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17
Q

Referral to secondary care is for any electrical or chemical burn injury

A

true

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18
Q

Initial management of burns

superficial epidermal

A

symptomatic relief - analgesia, emollients etc

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19
Q

Initial management of burns superficial dermal

A

cleanse wound, leave blister intact, non-adherent dressing, avoid topical creams, review in 24 hours

20
Q

Pathophysiology of severe burns cardiovascular effects

A

cardiovascular effects resulting from fluid loss and sequestration of fluid into the third space

21
Q

Pathophysiology of severe burns increased/decreased catabolic response

A

increase

22
Q

Pathophysiology of severe burns Immunosupression

A

Immunosupression is common with large burns and bacterial translocation from the gut lumen is a recognised event. Sepsis is a common cause of death following major burns.

23
Q

Management of more severe burns

The initial aim

A

stop the burning process and resuscitate the patient

24
Q

Management of more severe burns - when is IV fluids required?

A

children with burns greater than 10% of total body surface area.

Adults with burns greater than 15% of total body surface area

25
Q

Management of more severe burns

The fluids are calculated using the which formula

A

Parkland

volume of fluid= total body surface area of the burn % x weight (Kg) x4

26
Q

Management of more severe burns

how is fluid administered?

A

Half of the fluid is administered in the first 8 hours.
A urinary catheter should be inserted.
Analgesia should be given.

27
Q

Which burns should be transferred to a burns unit?

A

Complex burns, burns involving the hand perineum and face and burns >10% in adults and >5% in children

28
Q

which burns require escharotomy?

A

Circumferential burns affecting a limb or severe torso burns impeding respiration

29
Q

Conservative management is appropriate for superficial burns and mixed superficial burns that will heal in 2 weeks.

A

true

30
Q

More complex burns may require excision and primary closure

A

false
More complex burns may require excision and skin grafting. Excision and primary closure is not generally practised as there is a high risk of infection.

31
Q

anti microbial prophylaxis or topical antibiotics are indicated in burn patients.

A

false

32
Q

Escharotomies help burns by?

A

Careful division of the encasing band of burn tissue will potentially improve ventilation (if the burn involves the torso), or relieve compartment syndrome and oedema (where a limb is involved)

33
Q

Burns pathology - Extensive burns Extravasation of fluids results in?

A

Extravasation of fluids from the burn site causing hypovolaemic shock (up to 48h after injury)- decreased blood volume and increased haematocrit

34
Q

Burns pathology - Extensive burns causes curlings ulcer, what is this?

A

acute peptic stress ulcers

35
Q

Danger of full thickness circumferential burns in an extremity as these may develop

A

compartment syndrome

36
Q

ARDs, protein loss and haemolysis are complications in extensive burns

A

true

37
Q

Burns pathology Healing

Superficial burns

A

keratinocytes migrate to form a new layer over the burn site

38
Q

Burns pathology Healing - Full thickness burns

A

dermal scarring. Usually need keratinocytes from skin grafts to provide optimal coverage.

39
Q

Fluid resuscitation burns

main aim

A

resuscitation is to prevent the burn deepening

40
Q

Fluid resuscitation burns

Most fluid is lost when?

A

24h after injury

First 8-12h fluid shifts from intravascular to interstitial fluid compartments

41
Q

fluid resuscitation avoided in first 8-24h due to?

A

Starting point of resuscitation is time of injury

fluid resuscitation causes more fluid into the interstitial compartment especially colloid (therefore avoided in first 8-24h)

42
Q

Fluid resuscitation end point

A

Urine output of 0.5-1.0 ml/kg/hour in adults (increase rate of fluid to achieve this)

43
Q

fluid resuscitation after 24 hrs - colloid infusion rate

A

Colloid infusion is begun at a rate of 0.5 ml x(total burn surface area (%))x(body weight (kg))

Colloids used include albumin and FFP

44
Q

fluid resuscitation after 24 hrs Maintenance crystalloid

A

Maintenance crystalloid (usually dextrose-saline) is continued at a rate of 1.5 ml x(burn area)x(body weight)

45
Q

fluid resuscitation after 24 hrs what can be used to minimize oxidant-mediated contributions to the inflammatory cascade in burns

A

Antioxidants, such as vitamin C

46
Q

fluid resuscitation after 24 hrs Monitor:

A

packed cell volume, plasma sodium, base excess, and lactate

47
Q

High tension electrical injuries and inhalation injuries require more fluid

A

true

4th year passmedicine by topic (96 decks)

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