- BURNS -

Question 1

Discuss the functions of the skin

Answer 1

• Protection of the human body.
• Sensation i.e. transmitting to the brain information about surroundings.
• Temperature regulation.
• Immunity i.e. the role of the skin within the immune system.
• Enables movement and growth without injury.

Question 2

Define thermal, chemical, eletrical, lightening, frostbite and radiation burns

Answer 2

Thermal:

• Flames or fire
• Hot, molten liquid or steam (referred to as a scald)
• Hot objects, such as cooking pans, irons, or heated appliances.

Chemical:
- Chlorine, Ammonia, Bleach acid, Strong or harsh cleaners

Electrical:
Electrical burns happen when the body comes in contact with an electric current.

Radiation:
Cancer patients undergoing radiation therapy may suffer from an injury known as radiation burn.

Question 3

Discuss the assessment of burns (depth, extent, severity)

Answer 3

• location
• depth
• severity (blanching, non-blanching, painful, numb)
• %TBSA
• consider: age, co-morbid conditions, assoc. injuries

Question 4

Describe the pathophysiology of a SUPERFICIAL burn including fluid shifting

Answer 4

SUPERFICIAL BURN

• causes damage to epidermis and upper dermis
• damages keratinocytes (cells in the epidermis)
• immune response activated (release of mast cells and macrophages)
• release of pro-inflammatory cytokines
• cytokines stimulate nerve endings around the dermis
• resulting in PAIN
• cytokines also cause an increase in vascular permeability
• this causes fluid to leak out (interstilially or as blisters) (skin MOIST)
• interstitial oedema
• hypotension
• cytokines also cause vasodilation ( skin WARM and BLANCHING)

Question 5

Discuss inhalation injury

Answer 5

Injury to the oropharynx, nasopharynx, trachea, bronchi, or lungs from exposure to smoke or heated gas.

• ACS
• Increased WOB
• Hoarseness in voice
• oedema and obstruction
• impairs gas exchange

Question 6

Discuss the oxygen requirements of the burns pt

Answer 6

• damage to vessels
• vascular
• fluid shift
• decreased affinity of O2 to Hb
• increased O2 requirement

Question 7

Discuss the cardiac monitoring of the burns pt

Answer 7

• cardiac monitoring is essential for all severe burns

- due to burns shock, risk of hypoxaemia and heart failure

Question 8

Discuss the management of circumferential burns

Answer 8

• Transfer as per ANZBA guidelines
• carefully monitor:
• Neurovascular Observations/Breathing Difficulties (circumferential chest burns)
• Elevate Affected Areas
• Consider Escharotomy

Question 9

Discuss temperature control, in the management of the burns pt

Answer 9

• initially cool the wound (first aid)
• then warm the pt:
• warm IV fluids
• cover head
• bare hugger
• atmospheric control
• do not perform dressings until pt temp>37

Question 10

Discuss pain management in the burns pt

Answer 10

• keep the wound covered
• elevate
• analgesia
• procedural pain should be considered and analgesia given pre-emptively

Question 11

Discuss infection in regards to the management of the burns pt

Answer 11

• most common cause of morbidity and mortality in burns pts
• immunocomprimised pts, necrotic tissue higher risk
• broad sprectrum antimicrobials for prophylaxis

Question 12

Outline the clinical manifestations and the ED management of carbon monoxide poisoning

Answer 12

• headache
• nausea
• dizziness
• malaise
• ACS
• cherry red lips

Question 13

Discuss the management of superficial, partial and full thickness burns

Answer 13

1. First aid
2. Provide analgesia
3. Prepare the wound
4. Assess the wound
5. Dress the wound
6. Organise follow up/Transfer

Airway – Inhalation Injury, c‐spine
Breathing – Inhalation or associated trauma ‐ ventilation
Circulation ‐ Burns Shock ‐ Fluid resuscitation, Hemorrhage
Disability – CO, Cyanide
Exposure – Assessment & Temperature control
Pain – Narcotics, Ketamine, neuropathic
Wound – cover, circumferential injury

Question 14

Discuss the indications for escharotomy

Answer 14

• Circumferential or near circumferential eschar burns
• Impending or established vascular compromise of the extremities or digits
• Impending or established respiratory compromise due to circumferential torso burns

Question 15

List the criteria for a transfer to the burns unit

Answer 15

• Burns > 10 % TBSA in an Adult
• Burns > 5 % TBSA in a Child
• Full thickness burns > 5% TBSA
• Burns of face, hands, feet, perineum, genitalia, and major joints
• Circumferential burns
• Chemical or electrical burns
• Burns in the presence of major trauma or significant co-morbidity
• Burns in the very young patient, or the elderly patient
• Burns in a pregnant patient
• Suspicion of Non-Accidental Injury

Question 16

Discuss the complications of burn injuries

Answer 16

• infection and sepsis
• burns shock
• haemodynamic and respiratory compromise

Question 17

Discuss the dressings available in ED for burns and their indications

Answer 17

Consider absorbent dressing options:

• Foams
• Alginates
• Paraffin gauze and secondary padding
• silvers if contaminated, deep, infected

Question 18

Describe the pathophysiology of a DEEP burn including fluid shifting

Answer 18

• damage to epidermis, dermis, hypodermis and blood vessels
• damaged blood vessels reduces the blood flow to the area
• this causes the skin to be NON-BLANCHING, DRY and INELASTIC
• damage to the reticular layer of the dermis cause destruction of nociceptors
• pain may be felt initially but will result in HYPOESTHESIA (reduction in sensation)
• undamaged blood vessels around the area react to cytokines
• increase in vascular permeability
• fluid shift from intravascular space into interstitium
• interstitial oedema

Question 19

Discuss the fluid management of a burns patient

Answer 19

Indication:

• Adults: TBSA>20%
• Children: TBSA>10%

Administration:
Parkland Formula
3‐4ml/kg/%burn/24hrs
(give½ in the first 8hrs
from the time of injury)

Management:
- monitor UO and titrate accordingly