Burns

Question 1

What’s Burns

Answer 1

A coagulative or liquefactive necrosis of the skin with or without systemic involvement

Question 2

Causes of burns

Answer 2

1)Thermal:
Dry heat
Flame
Smoke 
Inhalational injuries 

2)Chemical:
Acid
Alkali

3) Electric: too high or too low
4) Cold burns: frostbite
5) Radiation
6) Sunburn

Question 3

Jackson’s zones of burns in 1947

Classification of Burns based on affected zones

Answer 3

1) Zone of hyperemia: vasodilation from inflammation. Cells recover within 7 days
2) Zone of stasis: decreased perfusion. Thrombosis and cellular death occurs within 24-48hrs if no tx
3) Zone of coagulation: no blood flow. Irreversible necrosis has occurred.

Question 4

Classification of burns using surface area

Answer 4

1) Mild or minor: <15% in adults or <10% in children of TSA excluding electrical burns and physical abuse.
2) Moderate: 15-25% in adults or 10-15% in children of TSA
3) Severe: >25% adults, >15% children, >5% neonates of TSA

Question 5

Degrees of burns

Answer 5

1)First-degree burns (superficial thickness)

affect only the outer layer of the skin(epidermis), blisters,red and moist ,blanching and swelling. Normal pinprick . Cause: weak acid

2)Second-degree burns: superficial (papillary dermis) and deep (recticular dermis)

affect up to reticular dermis., redness/cream colour, swelling, and blisters maybe broken. No blanching, some sensation on pinprick,They are also called deep thickness burns.

3)Third-degree burns

affect the whole dermis of skin. They are also called full thickness burns. They cause white or blackened, burned skin. The skin may be numb.

4) fourth degree goes beyond dermis, affects tendons muscle ligaments and bones

Question 6

A 66yr old man weighing 200lbs presents with severe burns on the entire Anterior surface of both thighs he suffered an hour ago

A) what % BSA is burnt?
B) Calculate the total amount of IV fluid she should receive in the first 8hrs

Answer 6

A)Using Wallace rule of nines, 18% of he BSA is burnt.

B) For fluid administration, using parkland formula
4ml x Body weight (kg) x TBSA (%)
200Ibs=90kg
4x90x18 = 6480ml in total
he will be given half of this which is 3240ml in the first 8 hours, then the remaining in 16 hours.

Ps: Evans formula: 2ml x %BSA x weight of patient

Question 7

Preferred fluid for burns mgt?

Answer 7

Ringer’s lactate.

Others: albumins, dextran, fresh frozen plasma.

Question 8

List 5 steps in management of Burns patient.

Answer 8

Using the 4’As

Adequate fluid
Antibiotics
Anti tetanus (tetanus toxoid)
Analgesics (IV morphine) 
H2 blocker (to prevent stress ulcer)

Question 9

Burns First-aid

Answer 9

• Remove the patient from the source of burn
-Patient under running water for like 20min
-cover with clean cloths to prevent heat loss
-Transport to the hospital
-do not puncture the blisters because it’s like protective factor cos of the protein content in d fluid except it ruptures itself
• At the hospital, you will do ABC of resuscitation,
-Give Fluid
-Give analgesics and prophylactic Antibiotics
-Give 0.5ml of T.T Intramuscularly
-Apply silver sulfurlaxine
-Take sample for investigation(Urgent E/u/Cr, PVC etc)
-Catheterization to monitor Urine output(Normal is 25mls/hrs).
-Escharotomy (If needed)
-Debridement
-Split thickness skin graft.

Question 10

Complications of Burns

Answer 10

1)Local

Scars
Keloids 
Contracture
Infections
Majorlins ulcer
Compartment syndrome 

2)Systemic

Shock
Sepsis 
Stress ulcer (curling’s ulcer)
Anemia 
Hyperkalemia 
Renal and organ failure

Question 11

Wallace rule of nine

Answer 11

Found in the year 1951

• Head and neck -9%
• Upper arm 4.5, lower arm 4.5, anterior arm=9% entire arm 18%
• Legs same as arms
• Perinuem 1%
• Trunk and chest anterior 18%, posterior 18%