Burns

Question 1

Wallace rule of nines

Answer 1

Front (chest and abdomen): 18%

Back: 18%

Right leg: 18%

Left leg 18%

Head and neck: 9%

Right arm: 9%

Left arm: 9%

Perineum: 1%

Question 2

Parkland formula

Answer 2

4 x body weight (kg) x TBSA

=ml of fluid to be given over 24 hours

1/2 in 8 hours
1/2 in subsequent 16 hours

Be guided by urine output, aim for urine output 0.5–1mL/kg/h in adults and 1–1.5mL/kg/h in children

Question 3

Indications for referral to a burns unit

Answer 3

> 10% TBSA in adult

> 5% TBSA in children

Burns to:

• face
• hands
• genitalia
• perineum
• major joints

Full thickness burns >5%

Electrical burns

Chemical burns

Inhalation injury

Circumferential burns to the trunk or limbs

Burns associated with major trauma

Very old, very young, or pregnant

Question 4

Burn depth

Answer 4

Epidermal (superficial): erythema only

Question 5

Acid burns

Answer 5

Causes coagulative necrosis

Penetrates skin rapidly, but is easily removed.

Question 6

Alkali burns

Answer 6

Causes liquefactive necrosis so needs longer irrigation (>1h)

Question 7

Hydrofluoric acid burn

Answer 7

Fluoride ions penetrate burned skin, causing liquefactive necrosis and decalcification; 2% TBSA burn can be fatal.

• Irrigate with water.
• Trim fingernails.
• Topical calcium gluconate gel, 10%.
• Local injection of 10% calcium gluconate.
• IV calcium gluconate.
• May need urgent excision of burn.

Question 8

Elemental Na, K, Mg, Li bruns

Answer 8

Will ignite with water irrigation

Brush off particles initially

Clean with high-pressure jet of water

Question 9

Initial management of burns

Answer 9

ATLS A–> E

Early intubation if signs of inhalation injury

100% humidified oxygen and check carbon monoxide on ABG

Wash burn and apply cling film

Opiate analgesia

NG tube and catheter

Tetanus prophylaxis