Burns

Question 1

What is occurring during a hypermetabolic response to burns?

Answer 1

• The stress caused by the burn increases the nutritional and metabolic need of the body, this can be characterised by the following.
  o Increase oxygen need
  o Increase glucose use
  o Protein and fat wasting
• Heat production is also increased to balance heat loss from the burned areas.

Question 2

Why may renal failure occur in the burn victim?

Answer 2

• Haemolysis (destruction or rupture of red blood cells)
• Rhabdomyolysis
• Decreased fluid volume
• Drugs

Question 3

What GIT issue may occur in the burn’s patient?

Answer 3

• Gastric dilation (may lead to ischemia, its bad news)

- Decreased peristalsis (moving of food and stomach content) caused by drugs.

Question 4

What Nervous system dysfunctions may be caused by burns?

Answer 4

• Periods of hypoxia
• Fluid volume deficits
• Electrical burns

Question 5

What 3 considerations need to be made in regards to burns classification?

Answer 5

• Depth
• Surface area
• Location

Question 6

What layer of the skin is involved in superficial burns and are they included in total body surface area calculations?

Answer 6

• Only the epidermis is involved, example of these burns would be sunburn. Superficial burns are not included in the total body surface area calculation.

Question 7

What layer of the skin is involved in Partial thickness burns?

Answer 7

• They involve the destruction of the epidermis and superficial dermis. Blistering will occur in these burns.

Question 8

What are the two forms of partial burns and how do they present?

Answer 8

• Superficial partial thickness
  o Will present bright red and moist
• Deep partial thickness
  o Will present dark red or yellow white

Question 9

What layers of the skin are involved in a full thickness burn and how do they present?

Answer 9

• Full thickness burns involve the epidermis, dermis and dermal appendages.
• They appear charred or pearly white, brown or black colour and feel dry and leathery.

Question 10

How does healing occur in full thickness burns?

Answer 10

• Because of the depth only able to heal through scarring or skin grafting.

Question 11

What causes relative fluid loss in burns patients?

Answer 11

• Tissue oedema

Question 12

What are the causes of absolute fluid loss in burns patients?

Answer 12

• Evaporation due to the exposed dermis

- Cardiac output may drop by 30-50% resulting in a shock response

Question 13

What are the two-surface area of burn classification calculations?

Answer 13

• Wallace rule of nines

- Lund and Browder Charts

Question 14

What are the classifications for Minor Burns

Answer 14

• <10% TBSA in adults
• <5% TBSA in 10yo or >50yo
• <2% full thickness burns

Question 15

What is true about the dermal layer in paediatrics and geriatrics in regards to burns?

Answer 15

• Their dermal layer is much thinner and has a greater capacity for more sever burn and fluid loss.

Question 16

What are the classifications for moderate burns?

Answer 16

• 10-20% TBSA in adults
• 5-10% TBSA in <10yo or >50yo
• 2-5% full thickness burns
• Suspected inhalation injury
• Circumferential burn

Question 17

What are the classifications of Major burns?

Answer 17

-	Partial or full thickness burns with.
o	TBSA >10% in patients <10yo or >50yo
o	TBSA >20% in patients of any age group
-	High voltage burn
-	Known inhalation injury
-	Significant burn to face, hands, feet, genitalia, perineum or major joints

Question 18

What types of burns are there?

Answer 18

• Thermal
• Chemical
• Electrical
• Radiation

Question 19

What is the most common type of burn and what age group is at the highest risk for this burn type?

Answer 19

• Thermal burns are the most common type of burn,

- The 18-35yo age group is at most risk

Question 20

What temperatures need to be present for a thermal burn to occur?

Answer 20

• The soft tissue is burned when temperatures reach >45 degrees c or with a lower temperature that are in constant contact with the soft tissue for >6 hours.v

Question 21

What are the causes of coagulation of soft tissue in thermal burns (the denaturation)?

Answer 21

• Capillary permeability increases
• Fluid loss occurs
• Plasma viscosity increases
• Resultant microthrombi formation

Question 22

Describe Jackson’s burn wound model 1?

Answer 22

Zone of coagulation
Zone of status
Zone of Hyperamia

Question 23

What is the zone of coagulation in Jacksons burn model?

Answer 23

• Centre of the wound, the area of most intense contact

- Coagulation and necrosis of cells, this tissue is nonviable

Question 24

What is the zone of stasis in Jackson’s burn model?

Answer 24

• This zone surrounds the coagulation zone and this tissue is potentially viable.

Question 25

What is the zone off Hyperaemia?

Answer 25

• This is seen at the periphery of the wound; the tissue of this site is viable.
• There is an increase blood flow due to inflammatory response.
• This site will recover within 7-10 days if no infection or shock is present.

Question 26

What are complications associated with thermal burns?

Answer 26

ccelerated evaporation of fluid, 5 -15 x regular rate.
- Fluid loss due to shock occurs between 8 -12 hours
o Decreased venous return
o Decreased cardiac output
o Increased vascular resistance

Question 27

What is the parkland formula?

Answer 27

• 4mls/Kg x BSA% given over 24hours

Question 28

What is AV initial fluid administration?

Answer 28

% of Burn surface area x Weight in KG to be given over 2 hours from time of burn.
- 50% TBSA x 80kg = 4000mls

Question 29

What is the initial fluid administration for paediatrics?

Answer 29

• 3x % of BSA x Weight in KG, given over 24 hours.

- 3 x 50% BSA x 20kg = 3000mls with half does to be given in first 8 hours.