Burns

Question 1

Inflammatory agents and their actions in response to burns?

Answer 1

Histamine - Leakage and fluid loss

Prostaglandins - attract WBCs - release thromboxane & interleukins - local vasodilatation and increased capillary permeability

Thromboxane - vasoconstriction in undamaged tissue adjacent to burn - burn extension

Catecholamines - reduce capillary pressure in unburnt tissue - burn extension

Free radicals - damage endothelial membranes - more leakage

Question 2

Amount to give when resuscitating with crystalloids?

Answer 2

4x weight (kg) x % burn

Question 3

How much fluid should you give within the first 8 hours of a burn?

Answer 3

Half in the first 8hrs, rest in the next 16hrs

Question 4

What percentage burn needs IV fluids?

Answer 4

> 10% BSA in children, >15% in adults

Question 5

What is the rule of 9s when referring to burn surface area?

Answer 5

Each arm is 9%
Head is 9%
Torso is 36%
Each leg is 18%

Question 6

ABCDE approach in burns?

Answer 6

Airway: intubate early, hight conc humidified o2, stabilise c-spine

Breathing: expose chest, assess chest sounds, escharotomy

Circulation: pulse, BP, cap refill, peripheral pulses, bloods, FLUIDS, haematocrit

Disability: AVPU, GCS

Exposure: Remove jewellery & clothes, at risk of hypothermia.

Question 7

What is an escharotomy?

Answer 7

a prophylactic surgical measure to release pressure, facilitate circulation and combat burn-induced compartment syndrome. Incisions are made along the eschar.

Question 8

Difference in burns in children?

Answer 8

Airway softer and narrower

More likely to have laryngo/tracheomalacia due to smaller and softer cartilage

Diaphragmatic respiration - so abdominal burns alone may warrant an escharotomy

Limited physiological circulatory reserve, increased fluid requirements

Question 9

Difference in the rule of 9 for children?

Answer 9

Each leg is worth 14% and the head is worth 18% at newborn, taking 1% off head to add to legs per year of age between years 0-10

E.g. age 5, head is worth 13%, legs are worth 16.5% each

Question 10

Potential burn complications in acute phase?

Answer 10

• Hypothermia
• Compartment syndrome
• Hypoglycaemia
• Increased haematocrit
• Acidosis/shock
• Haemo/myoglobuinuria
• ARDS
• AKI
• Contamination of the wound
• Delirium and psych problems
• High Na, Low Ca, Low PO4, Low Mg

Question 11

High and low voltage burns voltage definition?

Answer 11

1000v = high, found in high tension transmission cables

Question 12

Complications of deep tissue damage from electrical burns?

Answer 12

• Thrombosis
• Internal organ/muscle damage
• Neurological damage
• Ischaemia
• Compartment syndrome
• Heart damage

Question 13

What surgical procedure is required in full thickness burns?

Answer 13

Full excision of burnt skin.

Question 14

Common causes of burns?

Answer 14

Carelessness/accidental

Associated with extremes of age - inattention/poor reflexes and co-ordination

Epilepsy/strokes

Alcohol/substance abuse

Psychiatric/psychological problems

Question 15

What three things do you use to classify burns?

Answer 15

Area

Depth

Cause

Question 16

The three classifications of depth of burns in the UK?

Answer 16

Erythema

Partial thickness

Full thickness

Question 17

Features of partial thickness burns?

Answer 17

Blistered

Painful

Tissue paper appearance

Wet

Question 18

Features of full thickness burns?

Answer 18

Loss of skin integrity

Swelling

Fluid loss

Question 19

Acute pain relief in burns patients?

Answer 19

Entonox

Question 20

Whats a fasciotomy?

Answer 20

relieve compartment syndrome by cutting fascia after RTA, explosion, fall or electrical injuries

Question 21

Difference in surgical management with a partial thickness and complete thickness burn?

Answer 21

Partial - aim to preserve dermis

Full - aim for removal of all necrotic/infected tissue