Burns injury

Question 1

Define burns injury

Answer 1

Injuries predominantly to the skin and superficial tissues, caused by heat (from hot liquids or flame) or contact with heated objects, electrical current, or chemicals.

Question 2

Signs of burns injury on physical examination (generally)

Answer 2

• Erythema
• Clouded cornea
• Burns
• Cellulitis

Question 3

Which layer(s) of skin does first degree burns affect and what does it feel like?

Answer 3

Epidermis

Dry, painful

Question 4

Signs of first degree burn

Answer 4

• Redness
• Tenderness
• Pain
• No blistering
• 2-point discrimination

Question 5

Causes of first degree burn (2)

Answer 5

Flash burns

Sunburn

Question 6

Which layer(s) of skin does second degree burns affect and what does it feel like?

Answer 6

Epidermis, upper dermis

Wet, painful

Question 7

Signs of a superficial second degree burn

Answer 7

o Some portion of the skin appendages remain viable
o Thin-walled fluid filled blisters
o Pink, moist and soft
o Very tender

Question 8

Signs of a deep second degree burn

Answer 8

o Red-blanched white skin colour
o Slow capillary refill
o Thick-walled blisters
o Pinprick sensation intact

Question 9

Causes of a second degree burn

Answer 9

Splash scalds

Question 10

Which layer(s) of skin does third degree burns affect and what does it feel like?

Answer 10

Epidermis, dermis

Dry, insensate

Question 11

Signs of 3rd degree burn

Answer 11

• White, leathery appearance

* Anaesthetic

Question 12

Causes of 3rd degree burn

Answer 12

o Immersion scalds, flame burns, chemical injury, high-voltage electrical injury

Question 13

Which layer(s) of skin does 4th degree burns affect?

Answer 13

subcutaneous tissue/tendon/bone

Question 14

Causes of 4th degree burn?

Answer 14

o Prolonged exposure to third degree burn

Question 15

Investigations for burns injury

Answer 15

•	FBC
o	Low haematocrit, hypovolaemia, neutropenia, thrombocytopenia
•	Metabolic panel
o	High levels of urea, creatinine, glucose
o	Hyponatraemia
o	Hypokalaemia
•	Carboxyhaemoglobin
o	High levels in (inhalation injury)
•	ABC
o	Metabolic acidosis (in inhalation injury)
•	Fluorescein staining
o	Damaged corneal epithelial cells (in corneal burns)
•	CT head/spine
•	Wound biopsy culture
o	Wound infection
•	Wound histology

Question 16

Epidemiology of burns injury

Answer 16

• 250,000 injuries in the UK each year
o Half visit A+E
o 5% are admitted
• 98% survival rate
• More common in males and white individuals
• 45% caused by fire/flame, 35% caused by scald, 10% caused by hot object and 5% caused by electrical
• 75% happen in the home

Question 17

Aetiology of burns injury

Answer 17

• 70% of burns in young children come from hot liquids
• 20% of burns in young children involve abuse or neglect
• Flame injuries more likely in older children/young adults
• Scalds and cooking accidents more likely in older adults
• 26% of flame injuries involve alcohol

Question 18

Risk factors burns injury

Answer 18

• Young children
• Age > 60
• Male
• Alcohol use

Question 19

How do you measure burn size?

Answer 19

RULE OF 9S
•	Head = 9%
•	Neck = 9% 
•	LHS arm = 9%
o	Palm = 1%
•	RHS arm = 9%
•	Anterior trunk = 18%
•	Posterior trunk = 18%
•	LHS leg =18%
•	RHS leg = 18%
•	Perineum = 1%
•	Genitalia = 1%