Burns

Question 1

Initial mx of burns caused by heat?

Answer 1

1) remove person from sauce

2) irrigate burn with cool (not iced) water for 10-30 mins

3) cover burn using clingfilm (layered, rather than wrapped around a limb)

Question 2

What rule can be used to assess the extent of a burn?

Answer 2

Wallace’s rule of nines

Question 3

Describe Wallace’s rule of nines

Answer 3

1) Head + neck = 9%

2) Each arm = 9%

3) Each anterior part of leg = 9%

4) Each posterior part of leg = 9%

5) Anterior chest = 9%

6) Posterior chest = 9%

7) Anterior abdomen = 9%

8) Posterior abdomen = 9%

Question 4

What is the most accurate method of assessing the extent of a burn?

Answer 4

Lund and Browder chart

Question 5

What % of total body surface area is the palmar surface roughly equivalent to?

Answer 5

1% (not accurate for burns >15% TBSA)

Question 6

Depth of burns used to be referred to as first, second & third degree.

What terminology is used now?

Answer 6

1) superficial epidermal

2) partial thickness (superficial dermal)

3) partial thickness (full dermal)

4) full thickness

Question 7

Appearance of a superficial epidermal burn

Answer 7

Red and painful, dry, no blisters

Question 8

Appearance of a partial thickness (superficial dermal) burn

Answer 8

Pale pink, painful, blistered.

Slow CRT

Question 9

Appearance of a partial thickness (deep dermal) burn?

Answer 9

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

Reduced sensation, painful to deep pressure

Question 10

Appearance of a full thickness burn?

Answer 10

White (‘waxy’)/brown (‘leathery’)/black in colour, no blisters, no pain

Question 11

What depth burns require referral to 2ary care?

Answer 11

All deep dermal & full thickness burns

Question 12

What TBSA burns require referral to 2ary care?

Answer 12

> 3% TBSA in adults

> 2% TBSA in children

Question 13

What burns require referral to 2ary care?

Answer 13

1) all deep dermal and full-thickness burns.

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

3) superficial dermal burns involving the face, hands, feet, perineum, genitalia, or any flexure, or circumferential burns of the limbs, torso, or neck

4) any inhalation injury

5) any electrical or chemical burn injury

6) suspicion of non-accidental injury

Question 14

Mx of superficial epidermal burn?

Answer 14

symptomatic relief - analgesia, emollients etc

Question 15

Mx of superficial dermal burn?

Answer 15

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

Question 16

What is a common cause of death following major burns?

Answer 16

Sepsis

Question 17

What should you consider if a patient has sustained burns in an enclosed space?

Answer 17

Smoke inhalation injury

Question 18

What is ‘eschar’?

Answer 18

A collection of tight and leathery dead tissue caused by deep partial or full thickness burns.

Question 19

What can a complication of eschar be?

Answer 19

When a constrictive eschar forms around the circumference of a limb it may constrict distal circulation causing limb ischaemia.

If eschar forms around the chest it may prevent adequate chest expansion and cause respiratory distress.

Question 20

What type of shock can burns cause?

Answer 20

Hypovolaemic shock

Question 21

Describe pain levels in different depths of burns?

Answer 21

Superficial epidermis - painful

Superficial dermal - painful

Deep dermmal - reduced sensation

Full thickness - painless

Question 22

Cause of hypovolaemia in burns?

Answer 22

In the first 8 to 12 hours after a burn, fluid rapidly shifts from the intravascular to interstitial fluid compartments, meaning that hypovolaemia can quickly occur if fluid resuscitation is inadequate.

Question 23

When should early intubation be considered in a burn?

Answer 23

If deep burns to the face or neck, blisters or oedema of the oropharynx, stridor etc

Question 24

What burn % of TBSA indicates fluid resus in:

a) children
b) adults

Answer 24

a) ≥10%
b) ≥15%

Question 25

What formula is used to calculate the patient’s additional fluid requirement after a burn? (i.e. after clinical hypovolaemic shock has been corrected)

Answer 25

Parkland formula

Question 26

What is the Parkland formula?

Answer 26

Initial crystalloid fluid requirement for the first 24h:

4ml x body weight (kg) x TBSA (%)

Question 27

Describe how fluid is given in burns

Answer 27

1) Give the first 50% of the total calculated volume over the first 8 hours since the time of the burn (not the time of hospital arrival or assessment).

2) Give the remaining 50% of the volume over the following 16 hours.5

Question 28

Should burn patients be catheterised?

Answer 28

Yes - closely monitor & maintain urine output >0.5ml/kg/hr in adults and around 1ml/kg/hour in children

Question 29

Is there evidence to support the use of anti microbial prophylaxis or topical antibiotics in burn patients?

Answer 29

No

Question 30

When is an escharotomy indicated?

Answer 30

Indicated in circumferential full thickness burns to the torso or limbs.

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)

Question 31

What is the main aim of fluid resus in burns?

Answer 31

To prevent the burn deepening

Most fluid is lost 24h after injury

Question 32

How long do superficial and superficial partial-thickness burns usually take to heal?

Answer 32

3 weeks

Question 33

What are some systemic complications of burns?

Answer 33

1) Acute lung injury: forms secondary to burns and smoke inhalation and can progress to ARDS

2) Rhabdomyolysis

3) Dehydration & shock

4) AKI: may result from SIRS, hypovolaemia, and rhabdomyolysis

5) Electrolyte imbalances: may be caused by third space losses and kidney injury

6) Hypothermia: may be secondary to large volumes of cool fluids being administered.

7) Paralytic ileus

8) Curling’s ulcer

Question 34

What is Curling’s ulcer?

Answer 34

Forms when significant hypovolaemia from severe burns causes ischaemia of the gastric mucosa.

This creates a gastric ulcer which may lead to gastrointestinal bleeding or perforation.

Question 35

What can reduce the risk of a Curling’s ulcer forming?

Answer 35

Starting patients on PPI therapy at admission

Question 36

What are some local complications of burns?

Answer 36

1) Scarring

2) Contractures: abnormal contraction or stiffening of the muscles may reduce the range of motion and ability to move joints.

3) Circumferential eschars

4) Infection

Question 37

What is an escharotomy?

Answer 37

where a scalpel incision is made down to the level of the subcutaneous fat but not into the muscle or fascia.