Burns

Question 1

What are Burns

Answer 1

Burns are injuries characterized by coagulative necrosis of the skin and potentially deeper tissues, resulting from exposure to various sources of heat, chemicals, electricity, or radiation. The type of burn depends on the causative agent and can vary in severity from superficial to life-threatening injuries.

Question 2

What are the Types of Burns

Answer 2

1. Moist Heat Burns (Scalds):

• Caused by contact with hot liquids.
• Pathologically similar to other burns and can cause damage to the skin and underlying tissues.

2. Dry Heat Burns:

• Result from direct contact with flames, hot objects, or hot air.

3. Electrical Burns:

• Caused by electrical currents passing through the body, which can cause severe internal injuries and cardiac arrhythmias even if the skin appears superficially intact.

4. Chemical Burns:

• Result from exposure to caustic substances, such as strong acids or alkalis, which can lead to significant tissue damage.

5. Radiation Burns:

• Occur due to exposure to radiation, such as sunburn from ultraviolet light or burns from radiation therapy.

Question 3

Statistics

In the UK, burn injuries are a significant health concern, particularly among children:

• Approximately 175,000 people visit Accident & Emergency (A&E) departments annually due to burns.
• Out of these, about 13,000 require hospitalization for treatment.
• Of the hospitalized cases, around 1,000 have severe burns, with a notable 50% chance of being under 18 years old. This highlights the vulnerability of children to burn injuries.

Question 4

Statement of Surgical Importance

Burn injuries primarily affect children, especially in contexts where poor management of burns occurs. Often, initial care at home or through traditional healthcare practices is inadequate, leading to complications that may necessitate surgical intervention. Proper education on burn prevention and management is crucial to reduce the incidence and severity of burns, especially in pediatric populations.

Question 5

What are the possible Causes of Burns

Answer 5

Burns can occur due to several mechanisms, including:

1. Moist Heat:

• Hot liquids or steam leading to scalds.

2. Dry Heat:

• Flames or hot objects causing direct tissue damage.

3. Electricity:

• High-voltage or low-voltage electrical sources causing thermal and internal injuries.

4. Chemicals (Caustics):

• Strong acids (like sulfuric acid) or alkalis (like sodium hydroxide) that can cause severe damage to tissues upon contact.

5. Irradiation:

• Exposure to UV rays (sunburn) or radiation from medical treatments.

Question 6

What are the Classification of Burns

Answer 6

Burns can be classified based on their depth and the layers of skin involved. Understanding the classification helps in assessing the severity of the injury and determining the appropriate treatment. Here’s a detailed breakdown of burn classifications:.

Partial Thickness Burns

These burns involve damage to part of the skin and are further categorized into two main types:

• Superficial Partial Thickness Burns (1st Degree):
• Characteristics:
• Affect only the epidermis (the outer layer of skin).
• Present as painful redness (erythema) without blisters.
• Symptoms include swelling and discomfort.
• Healing Time:
• Typically heal within 3 to 6 days without scarring.
• Deep Partial Thickness Burns (2nd Degree):
• Characteristics:
• Involve the epidermis and part of the dermis (the second layer of skin).
• Present with red or white appearance, blisters, and significant pain.
• There may be a risk of scarring and contractures.
• Healing Time:
• Healing may take 2 to 3 weeks and can require medical intervention (e.g., skin grafts) depending on the severity.

2. Full Thickness Burns (3rd Degree)

• Characteristics:
• Involve all layers of the skin, extending through the dermis into underlying tissues.
• The affected area may appear white, charred, or leathery, and there is often a loss of sensation due to nerve damage.
• Healing is extensive and may take several weeks to months, often requiring surgical intervention such as skin grafts.
• Healing Complications:
• High risk of infection, significant scarring, and functional impairment.

Question 7

What are the Systemic Effects of Burns?

Answer 7

Burn injuries can lead to significant systemic changes due to fluid loss and the body’s inflammatory response. Here are some of the notable systemic effects:

• Hypovolemia: Significant loss of plasma can lead to decreased blood volume (hypovolemia), which is critical in managing burn patients.
• Burn Shock: This condition occurs shortly after the burn injury and can lead to reduced tissue perfusion, organ dysfunction, and increased mortality if not properly managed.

• Burns can lead to a reduction in red blood cell volume, resulting in anemia due to blood loss and fluid shifts.

• Medulla: The adrenal medulla releases catecholamines (e.g., adrenaline), which prepare the body for stress responses.
• Cortex: The adrenal cortex releases glucocorticoids (e.g., cortisol), influencing metabolism and immune responses.

• Pituitary Gland: Increased production of adrenocorticotropic hormone (ACTH), leading to further cortisol production from the adrenal cortex.
• Pancreas: Increased release of glucagon (raises blood sugar) and insulin (regulates blood sugar).
• Liver: Stimulation of lipolysis (breakdown of fats), proteolysis (breakdown of proteins), and gluconeogenesis (conversion of amino acids to glucose).

• Increased levels of pro-inflammatory cytokines (e.g., IL-1, IL-6, TNF) lead to systemic inflammation, which can result in multiple organ dysfunction.

Question 8

What are the other metabolic changes that can be caused by burns?

Answer 8

Other Metabolic Changes

• Negative Nitrogen Balance: Increased protein breakdown leads to muscle wasting and a negative nitrogen balance, reflecting catabolism exceeding anabolism.
• Hypermetabolism: The metabolic rate increases significantly after a burn, leading to weight loss and energy depletion.

Question 9

How do you access a burns depth and size?

Answer 9

Assessing Burn Size and Depth

Accurate assessment of burn size and depth is crucial for treatment planning:

1. Assessing Size:

• Small Burns: A clean piece of paper can be used to estimate the size of the burn relative to the patient’s body.
• Lund and Browder Chart: This chart is commonly used to assess the percentage of total body surface area (TBSA) affected by burns, taking into account the patient’s age and growth.
• Rule of Nines: A quick method that divides the body into sections, each representing approximately 9% of TBSA.

2. Assessing Depth:

• History: Obtain a history of the burn, including temperature and duration of exposure to heat sources.
• Temperature and Time:
• Exposure to temperatures above 44°C (111°F) for more than 6 hours can cause irreversible damage.
• Exposure to 70°C (158°F) for just 1 second can result in significant tissue damage.

Summary

Understanding the classification of burns, their systemic effects, and assessment techniques is vital for effective management and treatment. This knowledge helps guide interventions that can significantly impact patient outcomes, particularly in cases of severe burns.

Question 10

Airway Management in Burn Injuries

When managing burn injuries, especially those affecting the airway, immediate assessment and intervention are crucial to ensure patient safety and minimize complications. Below is a detailed explanation of the steps involved in airway management, history taking, examination, fluid resuscitation, and monitoring for potential complications.

1. Visual Inspection:
   
   • Burns on Face, Neck, or Chest: Check for signs of burns, which may indicate exposure to fumes or heat. This can lead to airway edema and compromise.
   • Signs of Inhalation Injury: Look for singed nasal hairs or soot in the nostrils, as these suggest potential injury to the air passages.
2. Smoke Inhalation:
   
   • Immediate Oxygen Administration: In cases of suspected smoke inhalation, administer 100% oxygen to help improve oxygenation and reduce carbon monoxide levels if inhaled.
3. Advanced Airway Procedures:
   
   • Laryngoscopy or Bronchoscopy: If there are signs of significant airway injury or respiratory distress, procedures like laryngoscopy or bronchoscopy may be necessary for direct visualization and assessment of the airway.

A systematic approach is essential for assessing the extent of injuries and planning treatment.

• Duration of Injury: How long ago the burn occurred.
• Cause of Injury: Identify whether the burn was caused by heat, chemicals, electricity, or radiation.
• Area Involved: Note the body regions affected by the burn.

1. Clothing Removal: Remove clothing carefully to avoid further injury to the burned areas.
2. Estimate Size of Burns: Use the Rule of Nines for adults and the Lund and Browder chart for children to assess the total body surface area (TBSA) affected.
3. Depth Assessment:
   
   • Use a sterile needle to apply painful stimulation.
   • Mottling or loss of sensation suggests a deep burn (deep partial thickness or full thickness).

• Blood Pressure (BP)
• Pulse Rate
• Respiratory Rate
• Monitor for changes indicating shock or respiratory distress.

• Blood Tests:
  
  • Full Blood Count (FBC) with differential
  • Urea and Electrolytes (U/E)
  • Creatinine (Cr)
  • Proteins
  • Fasting Blood Sugar (FBS)

Question 11

Explain the IV fluid resuscitation should be done in a burn patient.

Answer 11

Intravenous Fluid Resuscitation (IVF)

Effective fluid resuscitation is critical in managing burn patients, especially those with significant burns.

1. IV Cannulation: Establish an intravenous line using an 18G or 16G cannula.
2. Fluid Choices: Administer fluids such as normal saline or Ringer’s lactate.

• In severe cases, Ciet-down (i.e., compartment syndrome management) may be necessary.

3. Fluid Calculation:

• The first 24 hours require 50% of the total estimated fluid needs to be given in the first 8 hours post-injury.
• The Parkland formula can be utilized for fluid resuscitation calculation (4 mL × TBSA% × body weight in kg).

Question 12

What kind of pain management would you imploy in a burn pt

Answer 12

Analgesia and Additional Management

1. Pain Management:

• Administer IV analgesics such as morphine, pethidine, or ketorolac for pain relief.

2. Urinary Catheterization:

• In cases of burns affecting >25% TBSA, a self-retaining Foley’s catheter may be necessary for monitoring urinary output.

Monitoring

1. Vital Signs:

• Monitor every 30 minutes initially for changes indicative of shock or complications.

2. Preventing Infections:

• Start broad-spectrum antibiotic therapy and administer antitetanus as indicated.
• Keep meticulous records of wound care, treatments, and patient responses.

3. Surgical Intervention:

• Wound care may involve surgical decompression, excision of necrotic tissue, and consideration of skin grafting if indicated.

Question 13

Complications to Watch For in a burn patient?

Answer 13

Burn injuries can lead to a wide range of complications, including but not limited to:

1. Hypovolemia: Resulting from fluid loss leading to shock.
2. Infection: Increased risk of infections due to skin barrier loss.
3. Gastrointestinal Issues: Including paralytic ileus and gastrointestinal bleeding.
4. Curling’s Ulcer: A stress ulcer that can occur in patients with extensive burns.
5. Cardiovascular Problems: Such as arrhythmias and reduced cardiac output.
6. Genitourinary Problems: Kidney injury due to shock and fluid loss.
7. Vascular Issues: Risk of thrombosis.
8. Psychiatric Issues: Trauma-related stress disorders due to the injury.
9. Deformities and Contractures: Resulting from improper healing.
10. Scarring: Keloid and hypertrophic scars can develop, leading to cosmetic and functional issues.

Burn injuries are critical emergencies requiring prompt assessment, intervention, and monitoring to prevent complications. Recognizing the signs of airway injury and effectively managing fluid resuscitation are crucial components of care. Awareness and education within the community can also help prevent burn injuries and improve outcomes for those affected.