Burns

Question 1

Immediate first aid of burns

Answer 1

ABC

Heat burn
-remove source
-irrigate burn under cool water for 10-30mins => cover with LAYERS of cling film

Electrical burn
-turn off power supply and remove source

Chemical burn
-brush off powder
-irrigate
-DON’T TRY TO NEUTRALISE CHEMICAL

Question 2

Assessment of the extent of the burn
-Rule of 9s
-TBSA
-Lund and Browder chart

Answer 2

Wallace’s Rule of 9s
-H+N = 9
-arm = 9 x 2
-anterior leg = 9 x 2
-posterior leg = 9 x 2
-anterior chest = 9
-posterior chest = 9
-anterior abdo = 9
-posterior abdo = 9

TBSA - palmar surface roughly 1% of TBSA
-not accurate for TBSA 15%+

Lund and Browder more accurate
-considers age

Question 3

Classification of burns and their presentation

Answer 3

Superficial epidermal - red, painful, no blisters

Partial thickness (superficial dermal) - pale pink, most painful, blistered, slow cap refill

Partial thickness (deep dermal) - white with patches of non-blanches erythema, reduced sensation, painful to deep pressure

Full thickness - white/brown/black, no blisters or pain

Question 4

When to refer to secondary care

Answer 4

Deep dermal
Full thickness

Superficial dermal
-adults - 3% TBSA+
-child - 2% TBSA+

Superficial dermal involving
-face
-hands
-feet
-perineum
-genitalia
-flexure
-circumferential of limbs, torso, neck

Injury type
-inhalation
-electrical
-chemical
-suspicion of non-accidental injury

Question 5

Management of
-superficial epidermal
-superficial dermal

Answer 5

Initial first aid
Review referral criteria

Superficial epidermal
-symptomatic relief (analgesia, emollients)

Superficial dermal
-clean wound, leave blister alone, non-adherent dressing
-avoid TOP creams
-review in 24hrs

Generally will heal in 2wks

Question 6

Pathophysiology of severe burns

Answer 6

Progressive tissue loss
Release of inflammatory cytokines

Fluid loss, sequestration of fluid into 3rd space => hypovolemic shock

Immunosupression
Bacterial translocation from gut lumen common
Sepsis - most common staph aureus

Question 7

Management of severe burns
-considerations
-fluids and formula
-referral to burns unit

Answer 7

ABC resus
Consider intubation early especially if
-deep burns to H+N, blisters, edema of oropharynx, stridor

IV fluids needed if 2nd/3rd deg
-children 10% TBSA+
-adults 15% TBSA+

Parkland formula
-volume fluid = TBSA % of burn x weight x 4
GIVE HALF OF FLUID IN 1ST 8HRS

Urinary catheter
Analgesia

May need excision and skin grafts

Refer to burns unit if
-complex burn
-hands, perineum, face
-adults 10% TBSA+
-child 5% TBSA+

Question 8

Management of circumferential burns

Answer 8

Escharotomies - if circumferential full thickness to torso or limb

Divide encasing band of burn tissue to improve ventilation if torso, compartment syndrome and edema