burns

Question 1

the burn injury is divided into 3 concentric zones

Answer 1

zone of coagulation,zoneof stasis, zone of hyperaemia

Question 2

zone coagulation

Answer 2

area of necrosis

Question 3

zone of stasis

Answer 3

area of ischaemia that is potentially salvageable with fluids.

Question 4

zone of hyperaemia

Answer 4

increased blood flow

Question 5

pathophysiology of burns

Answer 5

Release of inflmmatory cytokines as part of burn injury mediates altered permeability of the vasculature and allows escape of intravascular fluid.
This allows extravasation of proteins which further promotes loss of intravascular fluid.
This flow occurs over the first 36 hours post burn.
As the TBSA approaches 25% the level of fluid loss can cause a level of circulatory shock.

Question 6

types of burns

Answer 6

Flame burns
Scalds
Chemical burns
Electrical burns

Question 7

First degree burns

Answer 7

cause: sun, hot liquids,brief flash burns

Colour: pink or red

Surface: dry

Sensation: painful
depth epidermis
time of healing : a few days

Question 8

second degree burn

Answer 8

cause: hot liquids, flash or flame

Colour: pink or mottleddred

surface: moist, weeping blisters.
sensation: very painful
depths: epidermis and portion of the dermis

healing time: one ormoreweeks

Question 9

third degree

Answer 9

Cause: flame, prolonged contact with hot, liquid or object, electricity or chemical

colour: dark brown charred,pearly white
surface: dry and inelastric
sensation: anaesthetic
depth: epidermis, dermism deep structure

timr : healing by contraction

Question 10

classification of burns

Answer 10

partial thickness (superficial), deep partial thickness, full thickness.

Question 11

Signs of airway injury.

Answer 11

Signs of airway injury include :

(1) Singeing of eyebrow /nasal hairs
(2) Carbonaceous sputum
(3) Stridor ( may be a LATE finding!)
(4) Hoarseness
(5) History of burns within an enclosed space
(6) Neck swelling

Recall that presence of carbon monoxide within the blood will result in falsely elevated oxygen saturation readings. Co-oximetry is required for the monitoring of these patients.

In management of circulation, IVA should preferably be sited in areas of unburned skin, however if impossible, a burned area may be utilised.

Question 12

what is the amount of urine that should be mad in a burn person

Answer 12

30 - 50ml/kg/hr

Question 13

why should nasogastric tube placement

Answer 13

ileus may accompany major burns

Question 14

in the rule of 9, all the body’s areas are 9 except

Answer 14

upper extremity which is 4.5

Question 15

parkland formula

Answer 15

2-4ml * % burn sufface * body weight .

Question 16

special rules for parkland formula

Answer 16

To be administered in the first 24 hours post BURN (NOT POST PRESENTATION!!)
- First half administered in the first 8 hours post burn
- Second half administered over remaining 16 hours post burn.
Why does Parkland’s Formula extend only for the 1st 24 hrs post burn?
Isotonic fluids, ideally Lactated Ringer’s to be used.
Fluid rate should be adjusted based on physiologic response i.e. urine output. ( it is only a GUIDE to fluid resuscitation)

Question 17

other information for calculating fluids

Answer 17

There are several methods of calculating fluid resuscitation for infants and children. One method is to use Parkland Formula and modify it to maintain an hourly urine output of 1ml/kg/ h. Alternatively, a pediatric maintenance rate for 24 hours can be calculated and then an additional 2 to 4ml multiplied by percentage BSA burned can be added to the total. The entire amount if infused over the first 24 hours. In children weighing less than 25 kg, a urine output of 1ml/kg/hr is necessary (Tintinalli et al.)

Use of colloids for fluid resuscitation in burns has not been shown to improve outcomes and may actually complicate matters through causation of increased accumulation of water in the lungs and decreased glomerular filtration rate.

Question 18

indication for admissions

Answer 18

1.Partial Thickness Burns with Total Burn Surface Area >10%
2.Burns to the hands, face, feet, genitalia, perineum or major joints
3.Circumfrentail burns
Those crossing major joints
4.Third and fourth degree burns
(7)Presence of comorbidities which could worsen outcome
(8)Concomitant trauma which could worsen outcome
(9)Suspicion of child abuse
(10)Burn injury patients who require special social, emotional or long-term rehabilitative intervention.

Electrical burns (including lightnng injury)
Chemical burns
Inhalation injury

Question 19

complications of burns

Answer 19

Early: fluid loss and hypovolaemia, airway injury, pulmonary oedema, compartment syndrome

late: scarring, contracturs, infection, septicaemia, psychiatric

Question 20

airway/ respiratory injury

Answer 20

(1) Supraglottic Airway Injury
The hot gases can physically burn the nose, mouth, tongue, palate and larynx . Once burned, the epithelium starts to swell and may completely block the airway.
(2) Airway injury below the level of the glottis
Rare, usually mediated by steam.
(3) Metabolic poisoning
(4) Inhalational injury