Burns and Suturing

Question 1

Describe one aspect of an erythema (sunburn).

Answer 1

Red. Brisk capillary refill. Skin is dry and intact. No blisters. Painful.

Question 2

Describe one aspect of a superficial partial thickness.

Answer 2

Pale pink/red. Brisk capillary refill. Exudate present. Intact/collapsed blisters. Pain.

Question 3

State 4 different types of burns/suturing.

Answer 3

Superficial/erythema. Superficial partial thickness. Deep dermal. Full thickness.

Question 4

Describe one characteristic of a deep dermal burn.

Answer 4

Dark pink/red or white. Mottled, stained, cherry red. Delayed or absent. Capillary refill. Dull/variable sensation.

Question 5

Describe one characteristic of a full thickness burn.

Answer 5

White, black, brown or yellow. Dry and leathery. Thrombosed vessels may be visible. Eschar may be present. No capillary refill. No sensation.

Question 6

State 2 parts to an assessment.

Answer 6

Assess. Cover.

Question 7

What 2 parts do you assess?

Answer 7

Extent of the burn. Depth of the burn (partial thickness - painful, red, blistered; full thickness - insensate/painless, grey-white).

Question 8

What is meant by cover?

Answer 8

Loose longitudinal strips. Chemical injuries must be fully decontaminated.

Question 9

Describe a feature of airways - inhalation injury.

Answer 9

Respiratory distress. Voice changes. Signs of upper airway oedema. Deep facial burns. Sooty sputum. History of burn in enclosed organ.

Question 10

State a feature of breathing.

Answer 10

Suspect smoke inhalation injury (if raised COHb level). Administer 100% flow oxygen if carbon monoxide injury suspected. Establish baseline ABG’s and SaO2 (greater than 95%).

Question 11

State a feature of the circulation assessment.

Answer 11

Insert 2 large bore peripheral IV lines. Take baseline bloods (e.g. U&E, FBC, LFT, CRP, amylase, CK, X-match, Drug/Toxicity). Discuss the need for escharotomy (surgical division of tough elastic, burnt tissue) - treats full thickness circumferential burns.

Question 12

State a feature of the disability score.

Answer 12

Assess pain score. Administer IV opiate analgesia.

Question 13

State a feature of the fluids.

Answer 13

Assess patient’s weight. Use the Parkland formula to estimate fluid resus requirements from time of injury, administer warmed Hartmann’s. Insert urinary catheter and titrate fluids to urine output (adult, children, electrical).

Question 14

Define the Parkland formula.

Answer 14

4ml x Body Surface Area (%) x weight (kg)

Question 15

State 3 features of toxic shock syndrome/burns sepsis syndrome.

Answer 15

Temperature > 38 degrees. Rash. Diarrhoea and vomiting. General malaise. Not eating or drinking. Tachycardia/tachypnoea. Hypotension. Reduced urine output.

Question 16

State an objective of wound management.

Answer 16

Preserve viable tissue. Restore tissue and continuity and function. Reduce infection. Minimise scar tissue.

Question 17

State an evaluation of wound management.

Answer 17

Time of incident. Size of wound. Depth of wound. Position of joint. Tendon/nerve involvement. Bleeding at the site.

Question 18

Give an example of a type of wound.

Answer 18

Incision. Laceration. Puncture. Bite. Burn. Deglowing. Abrasion.

Question 19

State one aspect of the history of a patient requiring wound management.

Answer 19

Diabetic. Age > 50. Chronic alcoholic. HIV, chronic steroids. Peripheral vascular disease. Prosthetic cardiac valve.

Question 20

State an example of a wound closure.

Answer 20

Hair ties. Steristrips e.g. lacerations under little tension/forehead. Tissue adhesive - not below surface of skin, over joints. Staples. Suture - absorbable/non-absorbable.

Question 21

State the steps to wound management.

Answer 21

1) Inspection
2) Preparation
3) Anaesthesia - lignocaine (lidocaine) or bupivacaine (anaesthetic)
4) Irrigation - remove out dead, fragmented tissue using fluid
5) Exploration
6) Debridement - removal of foreign matter, bacteria and devitalized tissue
7) Closure
8) Dressings