Burns

Question 1

What is a thermal burn, what determines severity

Answer 1

Burn due to direct contact with hot object or hot vapour

temperature, duration of exposure and thickness of the skin

Question 2

What does severity of an electrical burn depend on

what are the associated injuries

Answer 2

voltage, duration of contact

deep tissue damage eg. blood vessel thrombosis, muscle damage

Question 3

What substance causes worse chemical burns, and why are chemical burns difficult to manage

Answer 3

Alkali substances, because they are difficult to remove to cause ongoing damage

Question 4

What are the main types and subtypes of depths of burns

Answer 4

Full

partial thickness: superficial erythema, superficial partial thickness, deep partial thickeness

Question 5

What defines a superficial erythema burn

Answer 5

Blanching erythema with/without blistering, germinal layer in tact
healing is days

Question 6

What defines a superficial partial thickness burn

Answer 6

involves germinal layer, intense blisterinf and sloughing of the skin
healing is 10 days

Question 7

What defines a deep partial thickness burn

Answer 7

extends to germinal layer, destroys dermis and appendages, slow healing associated with scarring

Question 8

What defines a full thickness burn

Answer 8

non-blanching, do not bleed on needle testing and absent sensation
complete destruction of skin and germinal layer, inital blistering and then slough which takes 3-4 weeks to go leaving underlying granulation tissue. Causes dense scarring

Question 9

What is the rule of 9s

Answer 9

used to estimate the surface area of the burn
9% for head, neck and each arm
18% for each leg, front of trunk and back of trunk
1% for the perineum
(palm and finders also 1%)

Question 10

What parts of the history are suggestive of airway burn

Answer 10

fire in an enclosed space, signs of stridor, tachypnoea, or dyspnoea, singed nasal hair, facial burns, harsh cough or carbonaceous sputum (black)

Question 11

How is the amount of fluid lost estimated

Answer 11

using surface burnt not depth, leads to intravascular depletion and shock

Question 12

What percentage burns require admission for iv fluids

Answer 12

> 15% (eg a whole leg or an arm and some of the head)

Question 13

What are the steps in initial systemic management

Answer 13

Pain requires iv opiates
Fluid replacement with hartmanns
4ml x total burns surface x kg- half given in first 8 hours and other half given in the next 8-24 hours from the time of the burn
consider antibiotics and parenteral nutrition if indicated

Question 14

What is the local treatment of a partial thickness burn

Answer 14

non-adherent dressing with/without topical antibiotics

Hands may be covered in sulfadiazine (Abx) cream and covered with a plastic bag

Question 15

What is the local treatment of a full thickness burn

Answer 15

total excision of the burn wound, may require grafting for large areas

Question 16

What is the danger with full thickness circumfrential burns

Answer 16

can constrict the blood flow to limbs or breathing in chest so must be excised

Question 17

What is the complication of full thickness burns to the hands

Answer 17

risk of contractures and severe disability so should be splinted in a position

Question 18

what are some early and late complications of burns

Answer 18

early- wound sepsis (strep pyogenes, or pseudmonas), wound contractures
late- sepsis, acute peptic ulceration, AKI (hypovolaemia), psychological disturbance

Question 19

When should grafting take place

Answer 19

5 days after burn if the wound is free of infection

Question 20

What is the maximum burns that can be managed as an outpatient

Answer 20

adults- partial thickness <10%
children- partial thickness <5%
full thickness <1%

Question 21

What are some indications for referral to specialist burns centre management

Answer 21

burns >30% of total body area (both legs)
partial thickness >10%
full thickness >1%
circumfrential injury 
inhalation injury
chemical or electrical injury
extremes of age