Burns

Question 1

Name the 6 categories used to classify burns

Answer 1

Fire, scalds, contact, chemical, electrical, and radiation.

Question 2

Describe a superficial burn

Answer 2

Minor epithelial damage of the epidermis exists. Redness, tenderness & pain are common. No blisters. Heals after several days without scarring.

Question 3

Describe a superficial partial thickness burn

Answer 3

Injury to the epidermis & superficial dermis. Ruptured weeping blistered which are erythematous and painful. Heals 1-3 weeks without scarring.

Question 4

Describe deep partial thickness burns

Answer 4

Injury to the epidermis and deeper dermis with some viable dermis remaining. Heals spontaneously 3-4 weeks.

Question 5

Describe full thickness burns

Answer 5

Injury to epidermis and entire dermis. Typically white, black or brown. Eschar is leathery and insensate. Does NOT heal spontaneously.

Question 6

List and describe Jackson’s burn zones.

Answer 6

Coagulation - cenral zone. Dead or dying cells from coagulation necrosis and absent blood flow.

Stasis - intermediate zone. Appears to have intact circulation initially then circulation of superficial ceases and by third day zone becomes white as superficial dermis is avadcular and necrotic.

Hyperaemia - outer zone. Redzone, blanches on pressure. Healing present by 7th day.

Question 7

How is the extent of a burn estimated?

Answer 7

Rule of nines. 9% - head and neck, 9% - each upper extremity, 18% - each anterior and posterior portion of trunk, 18% - each lower extremity and 1% - perineum and genitalia. Palm area = approx 1% TBSA.

Question 8

What TBSA of a burn results in SIRS?

Answer 8

20% TBSA or more results in release of cytokines and other mediators into the systemic circulation causing SIRS.

Question 9

Why does hypovolaemia occur in burns patients?

Answer 9

Vessels in burned tissues have increased vascular permeability which causes an extravasation of fluids into burned tissue.

Question 10

Describe cardiovascular clinical manifestations in burns patients.

Answer 10

Fluid shifts, decreased cardiac output, increased systemic vascular resistance, hypotension, tachycardia, decreased pulses, prolonged capillary refill, myocardial depression.

Question 11

Describe pulmonary clinical manifestations in burns patients.

Answer 11

Release of vasoconstrictive agents, decreased ability to oxygenate, airway oedema, singed nasal hairs, soot tinged sputum, change in voice, coughing, droolong, rapid or laboured breathing, crackles, stridor.

Question 12

Describe renal clinical manifestations in burns patients.

Answer 12

Decreased glomerular filtrtion rate due to hypovolaemia and redistribution of blood flow to vital organs, oliguria, increased specific gravity, acute tubular necrosis.

Question 13

Describe gastrointestinal clinical manifestations in burns patients.

Answer 13

Impaired gastric mobility and paralytic ileus due to inflammatory response, stress ulcers may result from stress response leading to Curling’s ulcer.

Question 14

What is a Curling’s ulcer?

Answer 14

An acute peptic ulcer of the duodenum. Occurs when reduced plasma volume leads to ischaemia and cell necrosis of the gastric mucosa.

Question 15

Describe the metabolic clinical manifestations in burns patients.

Answer 15

Increased secretion of catecholamines, cortisol, and glucagons to support tissue repair, hypermetabolism, protein wasting, weight loss.

Question 16

When is an escharotomy indicated?

Answer 16

When a full thickness circumferential burn of an extremity causes vascular compromise.

Loss of Doppler signals in radial and ulnar arteries and digital vessels indicate upper extremity escharotomy. Loss of dorsalis pedis or posterior tibial artery signals indicate lower extremity escharotomy.

Question 17

Describe emergency care in the hospital setting?

Answer 17

Fluid resuscitation to prevent hypovolaemic shock using a crystalloid-based formula (CSL).
Catheterize to monitor fluid replacement.
NGT for intial evacuation of fluid and air from stomach and feeding access. Early feeding diminishes the hypermetabolic response.

Question 18

List important multi-disciplinary team members.

Answer 18

Dietitian - early and aggressive nutritional support is important in preventing bacterial trans-location from the gut and systemic sepsis.
Physio - Passive ROM twice daily. Prevent contractures.
Surgical - debridement and escharotomy.
Psych - attitude and psychological well-being.

Question 19

Identify and describe potential complications.

Answer 19

Infection. S & S - spreading peri-wound erythema, warmth or tenderness of surrounding skin, rapid sloughing of eschar, conversion of superficial wounds to full thickness, focal, multifocal or generalised dark brown, black, or violet discolouration of wound.

Contractures - occur when the burn scar matures, thickens and tightens, preventing movement.