Burns

Question 1

What is the immediate first aid in burns caused by heat?

Answer 1

Remove person from source

Within 20 mins - irrigate with cold water for 10-30 mins

Cover burn with cling film

Question 2

What is the immediate first aid in electrical burns?

Answer 2

Switch off power supply

Remove person from source

Question 3

What is the immediate first aid in chemical burns?

Answer 3

Brush any powder off
Irrigate with water

DO NOT attempt to neutralise the chemical

Question 4

How can you assess the extent of the burn?

Answer 4

Wallace’s rule of Nines

Lund + Browder chart

Palmar surface

Question 5

What is Wallace’s rule of nines?

Answer 5

Head + neck = 9%
Each arm = 9%
Each anterior part of leg = 9%
Each posterior part of leg = 9%
Anterior chest = 9%
Posterior chest = 9%
Anterior abdomen = 9%
Posterior abdomen = 9%

Question 6

How is the palmar surface used to asses the extent of the burn?

Answer 6

Palmar surface is approximately 1% of the body surface area

Not accurate for >15%

Question 7

What is the terminology used to assess depth of burn?

Answer 7

Superficial epidermal

Partial thickness (superficial dermal)

Partial thickness (deep dermal)

Full thickness

Question 8

What is superficial epidermal also known as?

Answer 8

First degree

Question 9

What is partial thickness also known as?

Answer 9

Second degree

Question 10

What is full thickness also known as?

Answer 10

Third degree

Question 11

What is the appearance of a superficial epidermal burn?

Answer 11

Red

Painful

Question 12

What is the appearance of a partial thickness (superficial dermal) burn?

Answer 12

Pale
Pink
Painful
Blistered

Question 13

What is the appearance of a partial thickness (deep dermal) burn?

Answer 13

White
+/- non-blanching erythema
Reduced sensation

Question 14

What is the appearance of a full thickness burn?

Answer 14

White/brown/black
No blisters
No pain

Question 15

When should burns be referred to secondary care?

Answer 15

All deep dermal + full thickness burns

Superficial burns >3% TBSA in adults

Superficial burns >2% TBSA in children

Superficial dermal involing

• face
• hands
• feet
• perineum
• genitalia
• circumferential

Inhalational injury

Electrical/chemical burn

Question 16

How are superficial epidermal burns managed?

Answer 16

Symptomatic relief

Question 17

How are superficial dermal burns managed?

Answer 17

Cleanse wound 
Do not burst blister
Non-adherent dressing 
Avoid topical creams 
Review in 24 hours

Question 18

What is the pathophysiology of severe burns?

Answer 18

Local response

• progressive tissue loss
• release of inflammatory cytokines

Systemic response

• fluid loss
• loss of fluid into third space
• catabolic response

Immunosuppression

Question 19

How are severe burns managed?

Answer 19

ABCDE

IV fluids - use Parkland formula

Escharotomy - divide burnt tissue (circumferential burns)