Burns

Question 1

1st, 2nd, 3rd degree burns
(thermal)

-What is the difference in appearance, layers of skin affected, and pain

Answer 1

1st - (e.g sunburn)

• Erythema, warmth, pain
• epidermis intact
• -> no treatment

2nd degree - partial thickness of dermis

• Broken epidermis
• Blister (infection and fluid an issue)
• increased pain

3rd degree - full thickness of dermis (muscle and bone may be exposed)

• No pain
• White charred region, surrounded by second degree burns

Question 2

Chemical burn
Alkali or acid - skin or ingested

-What do you do for both?

Answer 2

NEVER BUFFER chemical, irrigate till its gone

Ingested - NEVER BUFFER or get thermal burn

• -> dont want to burn oesophagus
• Serial exams (NPO, Xray - free air in mediastinum) –> wait and watch

Question 3

Respiratory burn (hot stuff into resp tract e.g smoke or chemicals)

-What to do?

Answer 3

-Oedema and airway can close off
-Worried - stridor, or signed nares
-Monitored closely (oxygen and peak flows)
if these deteriorate then –> need to intubate

-if want to check if bronchoscopy - see edema then intubate

(want to intervene early so you dont have a closed airway)

Question 4

Electrical burns

What to do?

Answer 4

e. g lightening strike
- entrance and exit wound

-Electricity passes through least resistance

• People die due to arrythmia
• bones also get hot, and burn muscles

-Muscles - can lead to rhabdo

Dx - ecg, creatatnine

(treat both)
-can get a dislocated shoulder due to strong contractions)

Question 5

Circumferential (e.g burn to arm but all the way)

Answer 5

• burn will go in and close off and compromise vascular supply to low
• -> cut the eschar to stop obstruction

Question 6

When to refer to a burns unit?

Answer 6

2nd and 3rd degree burns
-hands, face, genitals, feet, perineum, joints
-circumferential burns
->10% surface area (age less than 10 and over 50)
>20% rest of people

Question 7

Parklan formula

rule of nines

Answer 7

(look at diagram) 
For 2nd and 3rd degree burns 
-Head = 9
-Front and back of chest = 9 each
-Front and back of abdomen = 9 each 
-front of each leg and back of each leg = 9 
-each side of arm 4.5 (arm total 9) 
-1% genital 

4x kg BW x surface burn

• -> give in 24 hours
• 50% in first 8 hours, then next 50% in 16 hours

Question 8

Burn - History, exam, diagnosis, treatment

Answer 8

Exam

• airway/lung exam - inhalational injury
• carbon monoxide poisoning (inhalational or fire injury)
• Cyanide poisoning (fire, burning materials)

Diagnosis

• ABCs (intubate?)
• Assess for - shock, inhalation injury, carbon monoxide poisoning
• CXR, carbyoxyhaemoglobin level
• Evaluate % body burned

Treatment

• early movement
• early graft
• control pain
• temperature management
• Infection prophylaxis (silver sulfasizdine)
• Fluid replcement in first 24hrs , then adjust fluids to get at least 1ml/kg/hr of urine output

Question 9

Most likely infective agent

Answer 9

-psudomonas

-