Burns

Question 1

What are the 4 categories of burn thickness used? How do you distinguish between them on exam (4 main categories)?

Answer 1

Superficial - dry and without bilstering, red, brisk cap return, painful

Superficial dermal - moist with blisters, red, brisk cap return, painful

Deep dermal - moist with burst blisters, mottled-red, sluggish cap return, painless

Full thickness - dry, white, no cap return, painless

Question 2

What are the components of the primary survey in a burns case?

Answer 2

A - cervical spine control + assess need for airway control
B - expose chest, assess need for SpO2. Check for circumferential burn around chest - may need escharotomy to stop contracture and breathing restriction
C - Assess peripheral pulses, cap refill (central + all 4 limbs), signs of haemorrhage. Assess for circumferential limb burn
D - GCS/AVPU. Decreased conscious state can be from simultaneous head injury or CO intoxication
E - complete exposure, but warm the environment

Question 3

Name 2 ways of estimating %TBSA. If over 10% TBSA, what can happen? What should you always give if > 10% TBSA?

Answer 3

Rule of 9s, palmar method (patient’s hand = 1% of body). > 10% = SIRS can occur. Always start fluid resuscitation if > 10% - 3-4ml/kg * %TBSA of Hartmann’s

Question 4

What 4 things should you consider after the primary survey?

Answer 4

F - fluids
A - analgesia
T - tests (FBE, group and hold, UEC, glucose, ECG if electrical burn, beta-HCG if could be preg)
T - NGT and IDC if > 10% TBSA. Aim for fluid output 1ml/kg/hr

Question 5

What are the 5 components of a secondary survey?

Answer 5

1. Further Hx about event, first aid given, and AMPL history (allergy, meds, past Hx, last meal)
2. Head-to-toe examination
3. Tetanus status
4. Wound care (cover with 1 layer of cling film either side of burn recommended, don’t wrap)
5. Reassess primary survey

Question 6

What is the ideal first aid for a burn?

Answer 6

Put under running cold water for 20 minutes

Question 7

Name 5 indications to refer a burn on a child to the Burns speciality team

Answer 7

> 5% TBSA
Burns of special areas (genitalia, hands, face, feet, perineum, major joints, circumferential burn)
Inhalation injury
Electrical or chemical burn
Burn associated with trauma
Burn with pre-existing illness
Any burn under 1 year old

Question 8

When should you follow up a burn and why?

Answer 8

3 days after burn - burns can evolve over time (can’t declare thickness of burn until at least 3 days after incident)