Burns Injury

Question 1

Define burns injury.

Answer 1

Burns are very common injuries, predominantly to the skin and superficial tissues, caused by heat from hot liquids, flame, or contact with heated objects, electrical current, or chemicals.

Question 2

Explain the aetiology/risk factors of burns injury.

Answer 2

Thermal burns
Electrical burns
Chemical burns
Non-accidental burns

Question 3

Summarise the epidemiology of burns injury.

Answer 3

In the UK, 250,000 people are injured by burns. Approximately 175,000 people visit accident and emergency departments with burn injuries. Around 13,000 of them are admitted to hospital for treatment.

Question 4

Recognise the presenting symptoms of burns injury. Recognise the signs of burns injury on physical examination.

Answer 4

Pain
Redness

Question 5

Identify appropriate investigations for burns injury and interpret the results.

Answer 5

Full blood count
Metabolic panel
Carboxyhaemoglobin
Arterial blood gas
Fluorescein staining
Computed tomography scan of head and spine
Wound biopsy culture
Wound histology

Question 6

Generate a management plan for burns injury.

Answer 6

Fluid resuscitation with Hartmann’s, 14/16G, even through burn site

Dressing:

• Temporary: Saline gauze, paraffin gauze, clingfilm
• Definitive:
  
  • Partial thickness: Biological, synthetic, silver sulfadiazine cream ± cerium nitrate
  • Full thickness: Early excision and split-skin graft

Escharotomy

Question 7

What is the Parkland formula?

Answer 7

4 (mL) x weight (kg) x % burn = mL Hartmann’s in first 24 hours (50% in 1st 8 hours)

Used for a child with >10% total surface area, adult >15%

Question 8

What is an escharotomy?

Answer 8

Removal of tough leathery-like eschar following rehydration of burned skin which when left can contribute to impaired circulation and a burn-induced compartment syndrome – i.e. in torso burns.

Question 9

Identify the possible complications of burns injury and its management.

Answer 9

Risk of infection

Compartment syndrome

Inability to regulate temperature

Scarring

Question 10

What is the prognosis of burns?

Answer 10

It can vary from excellent to poor depending on the severity of the burn. Most burns are minor and the prognosis in these patients is excellent; however, major burns can be fatal.