Burns

Question 1

List the three zones of burn injury.

Answer 1

1. Central zone of coagulation - irreversible cellular injury
2. Zone of stasis -> vasoconstriction and coagulation - potentially salvagable
3. Zone of hyperaemia

Question 2

Describe the classification of burn severity.

Answer 2

• Superficial thickness - epidermal layer only - pain and swelling - full healing in ~7days
• Partial thickness - epidermis and some proportion of the dermis - characterised by blister formation
  
  • Superficial partial - bright red, moist, exquistely tender, heal in 2-3wks with minimal scarring
  • Deep partial - dark red, yellow/white, take >3wks to heal, often hypertrophic scarring
• Full thickness - epidermis + full dermis including all epidermal appendages (hair follicles, sweat and sebaceous glands. White, waxy and insensate. Healing by scar tissue (or grafts) only.

Question 3

Describe the “rule of nines” for the assessment of burns BSA.

Answer 3

• 9% for head and neck
• 18% front of torso
• 18% back of torso
• 9% for each arm
• 18% for each leg
• 1% for groin

Question 4

What is the name of the chart that calculates BSA burns in children?

Answer 4

Lund and Browder chart.

Question 5

List the management priorities in a walk-in patient with severe burns.

Answer 5

Primary survey:

• Airway assessment and definitive mgt if required. C-spine precautions if mechanism suggests injury.
• Breathing assessment w/ supplemental O2 and venitlatory support if req’d
• Circulation - IV access, assessment of HR and BP, signs of additional trauma, FAST scan
• Disability - GCS assessment with definitive mgt of airway if req’d
• Exposure - Expose patient, remove burnt clothing, keep the patient warm

Simultaneous administration of opioid analgesia

Provide first aid if not already completed - 20mins cool running water.

Administration of IVFs - pending accurate calculation of fluid req’ts

Dressing of wounds - cling wrap esp’lly if trf to burns centre req’d

Remember: bronchospasm, CO or cyanide poisoning, trauma

Question 6

List the signs of CO poisoning.

Answer 6

• Headache
• Nausea + vomiting
• Tachycardia
• Confusion
• Irritability
• Dec’d LOC

Question 7

What % of COHb suggests CO poisoning? How is it measured?

Answer 7

>15%

VBG

Question 8

What is the dissociation half life of CO?

How can this be reduced (treated)?

What is the dissociation half life with this treatment?

Answer 8

• 3-4hrs
• High FiO2
• ~50mins

Question 9

What is the biochemical finding common to cyanide poisoning.

Answer 9

HAGMA w/ persistent lactic acidosis.

Question 10

What is the antidote treatment for cyanide poisoning?

Answer 10

1. Hydroxocobalamin 2.5g in 100ml normal saline over 15mins
2. Repeat above dose again over 15mins
3. If no improvement:
   
   1. Repeat above dose OR
   2. consider Sodium thiosulphate 200mg/kg over 10mins
   3. can repeat Na thiosulphate dose if no improvement

Question 11

Name and describe the formula for calculating fluid resuscitation in burns.

What %TBSA does this formula apply to?

What type of fluid?

Answer 11

1. The Parkland Formula = 4ml/kg x TBSA % X Wt (kg)
   
   1. Give 50% over first 8h
   2. Give 2nd 50% over next 16h
   3. Add maintenence in paeds
   4. Monitor and titrate against
      
      1. BP, HR
      2. UO (0.5-1ml/kg/hr in adults; >1ml/kg/hr in paeds)
2. >15% TBSA in adults, >10% in kids
3. Hartmann’s

Question 12

List the criteria for referral to a Tertiary Burns Centre.

Answer 12

• >20% TBSA partial thickness in any age group
• >10% TBSA partial thickness in <10y or >50y
• >5% TBSA full thickness in any age group
• Involvement of special areas:
  
  • face (inc’g eyes, ears)
  • hands or feet
  • genitalia or perineum
  • major joints
• Inhalational injury
• Other sig’t injuries
• Electrical burns
• Sig’t co-morbidities