Burns

Question 1

Immediate first aid for burns

heat, electrical, and chemical

Answer 1

airway, breathing, circulation
heat:
- remove person from source
- within 20mins, irrigate burn with cool water 10-30mins
- cover burn with clingfilm, layered rather than wrapped

electrical:
- switch off power supply
- remove person from source

chemical:
- brush any powder then irrigate with water
- do not attempt to neutralise

Question 2

Wallace’s rule of nines

Answer 2

method of assessing extent of burns

Question 3

Answer 3

Lund and Browder chart
most accurate method of assessing extent of burns

Question 4

Superficial epidermal burn

Answer 4

• red and painful
• dry
• no blisters

Question 5

Partial thickness burn (superficial dermal)

Answer 5

• pale pink
• painful
• blistered
• slow capillary refill

Question 6

Partial thickness burn (deep dermal)

Answer 6

• typically white but may have patches of non-blanching erythema
• reduced sensation
• painful to deep pressure

Question 7

Full thickness burn

Answer 7

• white (‘waxy’) or brown (‘leathery’) or black
• no blisters
• no pain

Question 8

When to refer burns to secondary care

Answer 8

• all deep dermal and full thickness
• superficial dermal > 3% TBSA adults or > 2% children
• superficial dermal of face, hands, feet, perineum, genitalia, flexures
• any inhalation injury
• any electrical or chemical burn
• suspicion of NAI

Question 9

Initial management of superficial epidermal burns

Answer 9

symptomatic relief:
- analgesia
- emollients

Question 10

Initial management of superficial dermal burns

Answer 10

• cleanse wound
• leave blister intact
• non-adherent dressing
• avoid topical creams
• review in 24hrs

Question 11

Management of severe burns

Answer 11

1. stop burning process, resuscitate patient
2. airway management - early intubation (smoke inhalation, deep burns to face or neck etc.)
3. IV fluids children > 10% or adults > 15% TBSA (Parkland formula)
4. insert urinary catheter
5. provide appropriate analgesia
6. escharotomy if indicated
7. skin grafts etc. if indicated

Question 12

Parkland formula

Answer 12

Formula for calculating fluid replacement after burns
volume of fluid = TBSA% x weight (kg) x4
half of fluid administered in first 8 hours

Question 13

Escharotomies

Answer 13

• indicated in circumferential full thickness burns to torso or limbs
• careful division of ancasing band of burn tissue will improve ventilation (torso) or relieve compartment syndrome and oedema (limb)

Question 14

Pathology of extensive burns

Answer 14

• haemolysis due to damaged erythrocytes (by heat and microangiopathy)
• loss of capillary membrane integrity -> leakage into interstitial space
• extravasion of fluids from burn site -> hypovolaemic shock (decreased blood volume and increased haematocrit)(up to 48hrs post-burn)
• protein loss

Question 15

Complications of extensive burns

Answer 15

• secondary infection (staph a.)
• ARDS
• Curlings ulcer (acute peptic stress ulcer)
• full thickness circumferential burns in an extremity as may develop compartment syndrome