Burns

Question 1

What are the 4 different types of burn?

Answer 1

Thermal
Chemical
Frictional
Electrical

Question 2

What are the three zones of a burn?

Answer 2

Coagulative necrosis
Stasis
Hyperaemia

Question 3

What is the zone of coagulative necrosis?

Answer 3

In the middle of the burn

Irreversible cell death

Question 4

What is the zone of stasis?

Answer 4

Compromised circulation
Potentially salvageable if treated
Progresses over the first 3-5 days

Question 5

What is the zone of hyperaemia?

Answer 5

Widespread erythema around the burn

Will recover

Question 6

What are the CV effects of a large burn?

Answer 6

Widespread release of inflammatory mediators–>
Leaky capillaries –> loss of protein and fluids (third spacing)
–> hypotension and reduced organ perfusion

Question 7

What other systemic effects occur following a large burn?

Answer 7

ARDS
Increased BMR –> hypermetabolism
Immunosuppression
Loss of gut barrier function –> bacterial translocation and sepsis

Question 8

Which two rules are used to calculate % total body surface area (TBSA) of a burn?

Answer 8

Wallace rule of 9s

Palmar rule

Question 9

What does Wallace rule of 9s state?

Answer 9

9% for head, each arm
18% of each leg, front of trunk, back

–> different in children

Question 10

What does the palmar rule state?

Answer 10

Palm surface (including fingers)
= 1% of TBSA

Question 11

What are the different depths of burn?

Answer 11

Epidermal
Superficial dermal
Mid dermal
Deep dermal
Full thickness

Question 12

Describe an epidermal burn in terms of colour, blistering, capillary refill, sensation and healing:

Answer 12

Red
No blistering 
Brick cap refill
Painful
Heals < 7 days

Question 13

Describe a superficial dermal burn in terms of colour, blistering, capillary refill, sensation and healing:

Answer 13

Pale pink
Small blisters
Slow cap refill
Very painful
Heals <14 days

Question 14

Describe a mid dermal burn in terms of colour, blistering, capillary refill, sensation and healing:

Answer 14

Dark pink
Blistering
Slow cap refill
Reduced sensation
May or may not heal

Question 15

Describe a deep dermal burn in terms of colour, blistering, capillary refill, sensation and healing:

Answer 15

Blotchy red
May or may not blister
No cap refill
No sensation
Required surgery to heal

Question 16

Describe a full thickness burn in terms of colour, blistering, capillary refill, sensation and healing:

Answer 16

White eschar
No blistering
No cap refill
No sensation
Requires surgery to heal

Question 17

What is the system for managing a large burn?

Answer 17

ABCDE
FATT - fluids, analgesia, tests, tubes
Secondary survey

Question 18

How do you work out how much fluids to give in burn management?

Answer 18

Parkland’s formula: use Hartmann’s
3-4ml x TBSA x weight (kg)
- give half of fluid in first 8 hours from burn
- give next half in next 16 hours

*different for children

Question 19

Which analgesia should you give?

Answer 19

Morphine

Question 20

Which bedside tests should be done?

Answer 20

Observations
Urinalysis --> myoglobin, protein
Glucose (increased metabolism)
ECG --> hypokalaemia --> arrhythmia
ABG --> hypoxia, CO poisoning, acidosis

Question 21

Which blood tests should be done?

Answer 21

Standard baseline bloods
Group and save
Clotting
Bone profile (calcium)
CK
Cardiac enzymes

Question 22

Which imaging should be done?

Answer 22

CXR for ARDS

Question 23

Which tubes need to be put in and why?

Answer 23

NG tube –> empty bowel as low of barrier function can lead to sepsis
Urinary catheter –> monitor output

Question 24

Which aspects should be included in your secondary survey?

Answer 24

AMPLE history
Tetanus jab (large wound)
Photograph injuries