Burns Injury

Question 1

What is a Burns injury?

Answer 1

When tissue damage occurs by thermal, electrical or chemical injury

Question 2

List 5 causes of a burns injury

Answer 2

Contact with hot objects  
Electricity  
UV light  
Irradiation  
Chemicals

Question 3

Give 2 patient groups at higher risk of burns injury

Answer 3

Young children

Elderly

Question 4

Describe the epidemiology of burns injuries

Answer 4

UK has > 12,000 admission per year

Question 5

List 4 symptoms of inhalational injury or airway compromise in a burns injury

Answer 5

Dyspnoea
Hoarse voice
Harsh cough
Soot in nose/ sputum

Question 6

What is used to describe size of burn?

Answer 6

Described as a percentage of body surface area

Question 7

List 3 signs that suggest patient may be at risk of smoke inhalation or CO poisoning

Answer 7

Hx or exposure to fire + smoke in enclosed space
Stridor
Face burns/ singed nose hairs

Question 8

List 3 features to establish in a burns injury?

Answer 8

Site
Depth
Distribution

Question 9

Which 2 parameters can be used to characterise a burns injury?

Answer 9

Size: influences inflammatory response (vasodilatation + increased vascular permeability) + thus fluid shift from intravascular volume
Burn depth: determines healing/scarring; distinction between partial + full thickness

Question 10

What is a partial thickness burn?

Answer 10

1st degree burns
Involve the epidermis only
Painful, red + blistered

Question 11

What is a full thickness burn?

Answer 11

Charred leathery eschars
Firm + PAINLESS with loss of sensation
Healing will occur by scarring or contractures + requires skin grafting
Insensate, painless, grey-white

Question 12

What are the subdivisions of full thickness burns?

Answer 12

2nd degree burns: epidermis + upper dermis
3rd degree: epidermis + dermis + appendages
4th degree burns: affect SC tissue, tendon + bone

Question 13

What are the 2 subdivisions of partial thickness burns?

Answer 13

Superficial: red, oedematous skin + PAINFUL
Heals within ~7 days with peeling of dead skin
Deep: blistering, mottling + PAINFUL
Heals over 3 weeks, usually without scarring

Question 14

What bloods should be taken in a burns injury?

Answer 14

Oxygen sats, ABG + carboxyhaemoglobin (if inhalational injury)
FBC: looking for sepsis
Met panel: high urea, creatinine, glucose, hyponatremia + hypokalaemia
Group + Save: determining ABO group

Question 15

How do you determine amount of IV fluids required? Give an example

Answer 15

Use a burns calculator flow chart or formula
Muir + Barclay formula::
Fluid per period (mL) = weight (kg) × % burn area/2
The periods are as follows:
Every 4 hours for first 12 hours then
Every 6 hours for next 12 hours then
Over 12 hours for next 12 hours
Thus, 6 volumes given over the 1st 36 hours. (in addition to pt’s normal fluid replacement)