Burns

Question 1

List 5 factors that determine the rate of heat transfer from the heating agent to the skin.

Answer 1

1. Temperature of agent
   
   2. Duration of contact
   3. Transfer coefficient of agent
   4. Heat capacity of agent
   5. Specific heat and conductivity of local tissue

Question 2

What are the 3 concentric areas of burn injury?

Answer 2

Zone of coagulation: 
- Irreversible necrosis
- White / charred
- Absent blood flow
Zone of Stasis: 
- Reduction in dermal microcirculation
- At risk tissue if perfusion not improved
- Often progresses to necrosis
Zone of hyperemia: 
- Immediate and transient increase in perfusion
- Red and blanchable
- Intact circulation
- Will heal

Question 3

List 3 groups at risk for immersion scald burns and the characteristics that make these groups susceptible.

Answer 3

1. Elderly
2. Children
3. Developmentally delayed

Question 4

List 4 reasons for the development of hypoxia in inhalational injuries:

Answer 4

• Particulate matter in the airways
• Bronchospasm
• Pulmonary edema
• Deactivation of pulmonary surfactant à atelectasis
• ARDS
• Reduced lung compliance à barotrauma
  Altered LOC from trauma or any drugs / EtOH taken before fire, or from CO / HCN toxicity

Question 5

List 7 indicators of a severe burn:

Answer 5

TBSA by demographic:
- Children, elderly: GT 10%
- Adults: GT 20%
GT 5% full thickness

Burn characteristics:

• High voltage
• Significant burn to face, ears, genitalia
• Across joints
• Associated significant trauma

Question 6

List indicators of a moderate and mild burn:

Answer 6

TBSA by demographic:
- Children, elderly: 5-10%
- Adults: 10-20%

2-5% full thickness

Burn characteristics:
- High voltage
- Inhalational
- Circumferential
Co-morbid disease

Mild:

TBSA by demographic:
- Children, elderly: LT 5%
- Adults:  GT 10%

LT 2% full thickness

Question 7

What are 5 signs of inhalation injury (although neither SN or SP)?

Answer 7

1. Stridor, wheezing, persistent cough
2. Hoarseness
3. Tachypnea
4. Carbonaceous sputum
5. Nares with inflammation or singed hair
6. Blistering or edema of oropharynx
7. History of injury within a closed space

Question 8

List 6 indications for ETT in inhalational injury (Table 63-3)

Answer 8

1. Upper airway obstruction
2. Inability to handle secretions
3. Hypoxemia despite 100% FiO2
4. Hypoventilation (PCO2 >50, pH <7.2)
5. Patient obtundation
6. Muscle fatigue à hyper or hypoventilation

Question 9

List 4 indications for escharotomy:

Answer 9

1. Circumferential burns
2. Vascular or neurologic compromise (Reduced Doppler pulses, SaO2 <90% in affected extremity NOT due to hypovolemia)
3. Extensive burns to neck
4. Extensive burns to chest
   Difficulty ventilating with high peak pressures

Question 10

What is used to dissolve tar enmeshed in hair?

Answer 10

• Olegeneous colloid suspensions of solid microcrystalline waxes in petroleum oil (Polymyxin-neomycin-bacitrin (Neosporin) (Applied hourly until removed)
• Sunflower oil (30 minutes)
• Butter (20 -30 minutes)
• Baby oil (1 – 1.5 hours)

Question 11

List 10 (or 13) indications for transfer to a burn centre:

Answer 11

- Percentage:
	o Child, elderly: >10% TBSA
	o Adult: >20% TBSA
	o Full thickness >5% TBSA
- Location:
	o Hands, feet
	o Face
	o Genitalia, perineum
	o Major joints
- Mechanism:
	o Significant electrical injury
	o Significant chemical injury
- Associated injury:
	o Inhalational
	o Trauma
	o Pre-existing medical disorders
- Special needs:
	o Psychosocial or rehabilitative care needs

Question 12

What determines the degree of skin destruction from a specific chemical agent?

Answer 12

• Concentration of the toxic agent
• Duration of contact
• Type of agent, liquid, crystal vs powder

Question 13

List the two parts of a HAZMAT contingency plan.

Answer 13

1. Initiation of the site plan

Evacuation

Question 14

List areas irrigated with water in order of priority.

Answer 14

1. Contaminated wounds
   
   2. Eyes
   3. Mucous membranes
   4. Skin
   5. Hair

Question 15

How long should hydrotherapy continue for acids and alkalis?

Answer 15

• Acids: 2-3 hours

- Alkalis: 12 hours +

Question 16

What is the grading system of eye burns?

Answer 16

• Grade I – hyperemia, conjunctival ecchymosis, corneal deficits
• Grade II – as above plus corneal haziness
• Grade III – deeper penetration, graying of iris, <50% limbus involved
• Grade IV – deeper penetration, graying of iris, >50% limbus involved

Question 17

List treatments for the injured eye after irrigation and evaluation.

Answer 17

• Emoliant broad spectrum antibiotic (gentamycin)
• Long acting cycloplegic (homatropine)
• Mydriatic
• +/- Carbonic anhydrase inhibitor after discussion with optho
• **Opthalmology consultaion

Question 18

What is the clinical presentation of HF acid inhalational injury?

Answer 18

• Patient may be initially asymptomatic and the CXR negative
• Progression over hours to several days
  o Tracheobronchitis
  o Pulmonary edema
  o Pulmonaty hemorage
  o Toxicity
• Refractory bronchitis may persist for months
• Sustained irritation of larynx or pharynx may cause a persistent cough or hoarseness

Question 19

What kind of injury results from cement?

Answer 19

• Alkali burn
  o (Also contact dermatitis)
• 3 types of burns
  chemical abrasive, heat related, blast

Question 20

What toxicity can result from absorption of nitrates from the skin?

Answer 20

Methemoglobinemia