Burns

Question 1

What is the immediate management of burns?

Answer 1

First aid - ABCDE

Question 2

What is the treatment of burns caused by heat?

Answer 2

Remove source
Irrigate burn with cool water for 10-30 minutes
Cover burn using cling film, layered rather than wrapped around a limb.

Question 3

What is the treatment of an electrical burn?

Answer 3

Switch off power supply, remove person from source.

Question 4

What is the treatment of a chemical burn?

Answer 4

Brush off any powder

Irrigate with water

Question 5

How is the extent of burns calculated?

Answer 5

Wallace's rule of nines: 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%

Lund and Browder chart: more accurate method of circulation.
(Palmar surface approx. 1%)

Question 6

How is the depth of a burn assessed?

Answer 6

First degree - Superficial epidermal - Red and painful

Second degree - Partial thickness/superficial dermal - Pale pink, painful, blistered.

Second degree - Partial thickness/deep dermal - Typically which but may have patches of non-blanching erythema, reduced sensation

Third degree - Full thickness - White/brown/black in colour, no blisters, no pain.

Question 7

When should burns be referred to secondary care?

Answer 7

All deep dermal and full-thickness burns.

Superficial dermal burns >3% or involving face, hands, feet, perineum, genitalia, any flexure or circumferential burns.
Inhalation injury
Chemical or electrical burn
Suspicion of non-accidental injury

Question 8

What is the initial management superficial epidermal and dermal burns?

Answer 8

ABCBE + minor
Superficial epidermal - analesia/emollients
Supericial dermal - cleanse wound, leave blister intact, non-adherent dressing, review in 24 hr

Question 9

What is the pathophysiology of severe burns?

Answer 9

Local response with progressive tissue loss and release of inflammatory cytokines.
Hypovolaemic shock
Protein loss
Secondary infection - staph, aureus
ARDS
Catabolic response
Immunosupression
Sepsis and bacterial translocation from the gut.

Question 10

What is the management of more severe burns?

Answer 10

Stop burning and resuscitate patient.
IV fluids (Parkland formula)
Urinary catheter, analgesia.
Burns unit
Escharotomy (circumferential burns)
Excision and skin grafting
(Not primary closure, increased risk of infection)

Question 11

What is the healing process in superficial burns?

Answer 11

Keratinocytes migrate to form a new layer over the burn site

Question 12

What is the healing process in full thickness burns?

Answer 12

Dermal scarring, usually need keratinocytes from skin grafts to provide optimal coverage.