Burns

Question 1

Initial assessment

Answer 1

Sensation, blanching and check tetanus status
Determine % of body area
Classify burn depth

Question 2

Superficial

Answer 2

Red and dry, blanches with pressure (like sunburn)

Simple moisturiser / aloe vera gel

Question 3

Partial-thickness (superficial / deep)

Need re-epitheliarisation +- granulation to heal

Answer 3

Red and moist, with blisters, does not blanch

Use systemic analgesia
Cleanse with soap and water, then thoroughly rinse
Scrub off any necrotic tissue
Dress simple low exudate burns with multiple layers of low-adherent impregnated tulle gauze. Cover with sterile non-adherent absorbent pad dressing with bandages or dressing fixing tape
Review in 48 hours to look for signs of infection
Redress every 2 days

Question 4

Full-thickness

Answer 4

White / grey / scalded, insensate, solid, dry

Skin graft

Question 5

Initial management

Answer 5

Airway burns: call anaesthetist and intubate asap
Breathing: non-rebreather mask, nebs for smoke inhalation
Circulation: 2 large bore cannulas and commence IV fluid resus
Disability: check responsiveness and give strong analgesia
Exposure: examine entire skin and look for other injuries. Large burn areas: cover with sterile sheets or cling film until specialist review. Minor burns: immerse in cool water for 30 mins

Question 6

Parkland formula - estimates fluid requirements in 24 hours

Answer 6

Fluid requirement (mL) = 4 x total burn surface area (%) x body weight (kg)

50% of this given in first 8 hours and 50% in next 16 hours

Children should be given maintenance fluids

Question 7

Burns requiring specialist opinion / admission

Answer 7

Full thickness
>10-15% body surface
Elderly / significant comorbidities
Hands
Genitalia / perineum
Over major joints
Chemical
Electrical 
Inhalation injuries
Circumferential burns