Burns

Question 1

What immediate advice would you give to someone with a heat burn?

Answer 1

Remove the person from the source

Within 20 minutes of the injury irrigate the burn with cool water for between 10 minutes and 30 minutes. Cover the burn using cling film, layered rather than wrapped around a limb

Question 2

What immediate advice would you give to someone with an electrical burn?

Answer 2

Switch off power supply, remove the person from the source

Question 3

What immediate advice would you give to someone with a chemical burn?

Answer 3

Brush any powder off then irrigate with water

Attempts to neutralise the chemical are not recommended

Question 4

Describe what specific things you would be looking for in an A-E assessment of someone presenting with a burn?

Answer 4

A – facial oedema? Stridor?

• Intubate if signs of oedema

B – circumferential burn of chest causing restrictive breathing? CO poisoning (sats will be normal, need ABG)?

• Give high-flow oxygen if any evidence of burn

C – hypovolaemia due to transdermal water loss?

• IV fluid replacement

D

E – assess extent of burn with Lund and Browder chart

Question 5

How would you assess the extent of a burn?

Answer 5

• Wallace’s Rule of Nines for TBSA

Head and 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 – picture (most accurate)

Question 6

A burn is red and painful. How deep is it likely to be?

Answer 6

Question 7

A burn is pale pink, painful and blistered. How deep is it likely to be?

Answer 7

Question 8

A burn is white but has patches of non-blanching erythema and reduced sensation. How deep is it likely to be?

Answer 8

Question 9

A burn is white/brown/black in colour with no blisters and pain. How deep is it likely to be?

Answer 9

Question 10

Which burns should be referred to secondary care?

Answer 10

All deep dermal and full-thickness burns

Superficial dermal burns of more than 3% TBSA in adults, or more than 2% TBSA in children

Superficial dermal burns involving the face, hands, feet, perineum, genitalia, or any flexure, or circumferential burns of the limbs, torso, or neck

Any inhalation injury

Any electrical or chemical burn injury

Suspicion of non-accidental injury

Question 11

How do severe burns lead to hypotension?

Answer 11

Systemically, there are cardiovascular effects resulting from fluid loss and sequestration of fluid into the interstitial space. This 3rd space loss can result in hypotension.

Question 12

How do severe burns lead to sepsis?

Answer 12

The protective barrier function of the skin is lost, predisposing to infection and sepsis is a common cause of death

Question 13

When do you need to give IV fluids for a burn?

Answer 13

Children – burns >10% of total body surface area

Adults – burns >15% of total body surface area

Question 14

How do you calculate how much IV fluids to give to someone with a burn?

Answer 14

Parkland formula

Volume of fluid = total body surface area of burn (%) x weight (kg) x 4

Half of the fluid is administered in the first 8 hours

Monitor fluid balance

Catheter

Fluid balance chart

Question 15

How are severe burns managed?

Answer 15

IV fluids - Parklands formula + catheterise + monitor fluid balance

Analgesia

Complex burns involving hands, face, perineum transferreed to burns unit for possible excision + skin grafting

Question 16

What is an escharotomy?

Answer 16

Surgical procedure used to treat full-thickness circumferential burns of the torso or limbs

Careful division of the encasing band of burn tissue will potentially improve ventilation (if the burn involves the torso), or relieve compartment syndrome and oedema (where a limb is involved)