Burns (Sources: Revision notes)

Question 1

What are the possible mechanisms of burns?

Answer 1

heat (dry and wet)
cold
electrical
chemical

Question 2

Describe superficial epidermal burns?

Answer 2

Dry, red
Involves the epidermis only
No blistering
Painful
Heals completely with no scarring

Question 3

Describe a superficial dermal burn

Answer 3

Partial thickness
Pale pink
Blisters within a few hours
Involves the epidermis and upper layers of the dermis
Painful

Question 4

Describe mid-dermal burns

Answer 4

Partial thickness
Darker red
Involves the epidermis, dermis and some of the more superficial adnexal structures e.g.sweat glands
May be painful

Question 5

Describe deep dermal burns

Answer 5

Blotchy red with absent capillary refill
Reduced sensation
Epidermis and dermis including adnexal structures are involved
Large, early blisters are common

Question 6

Describe full-thickness burns

Answer 6

White, waxy with no sensation
Epidermis, dermis, and all adnexal structures involved
No blisters
No potential for spontaneous healing

Question 7

Describe the rule of nines

Answer 7

Skin is divided into areas - each representing 9% of body surface

• head and face
• each arm
• front of each leg
• back of each leg
• front of chest
• back of chest
• front of abdomen
• back of abdomen incl buttocks
• groin = 1%

Question 8

What are the 3 methods for estimating area involved in a burn?

Answer 8

1. Rule of nines
2. Lund-Browder chart
3. The area of the patients palm = 1% body surface

Question 9

What is the initial management of a burn?

Answer 9

ATLS approach
Severe burns often occur in the context of major trauma
The burn should not distract you from the identification and management of life-threatening injuries

Question 10

How do you asses an airway in a burns patient?

Answer 10

Look for airway burns

• facial burns
• singed nasal hairs
• hoarse voice
• stridor
• carbonaceous sputum

Question 11

How should you manage a patient with suspected airway burns?

Answer 11

Early tracheal intubation
Uncut ETT
If facial swelling becomes severe the ET may need to be secured using interdental wiring

Question 12

What respiratory problems may occur in a burns patient?

Answer 12

Smoke inhalation - resulting in direct lung injury, CO poisoning, cyanide poisoning
Circumferential chest wall burns - restricting ventilation

Question 13

Which burns patients require fluid replacement?

Answer 13

> 15%

or >10% with inhalational injury

Question 14

How do you calculate fluid replacement in a burns patient?

Answer 14

Parkland formula
4mls x kg x BSA in the first 24 hours, with half given in the first 8 hours
The 24 hours starts from time of injury and not calculation
Should be used in conjuction with other clinical assessment e.g. urine output, lactate and base excess

Question 15

What is a burn facility? (According to the National Network for Burn Care)

Answer 15

Standard plastic surgical input can provide inpatient care for non-complex burns

Question 16

What is a burn unit?

Answer 16

Offer a specific burn ward

Manage moderately complex burns

Question 17

What is a burn centre?

Answer 17

Offer burn specific ward and critical care areas
Immediate access to burn theatres
Can cater for the most complex burn patients

Question 18

Which patients should be referred for specialist burn care?

Answer 18

> 40% BSA or > 25% with inhalational injury should be managed at a burn centre
10-40% should be managed in a burn unit
3-10% should be managed in a burn facility
Also for referral are:
Full thickness burns
Circumferential burns
Burns not healed within 2 weeks
NAI suspected as mechanism
Burns to hands, feet, perineum, genitalia, face
Chemical, electrical or friction burns
Cold injuries
Significant co-morbidities which may impact on treatment or healing
(See the UK National Network for Burn Care’s National Burn Care Referral Guidance)

Question 19

What are the possible causes of shock in a burns patient?

Answer 19

Fluid leak resulting in hypovolaemia
Inflammatory response - vasodilatation, cardiac dysfunction
Sepsis

Question 20

How is inhalational injury managed?

Answer 20

Lung protective strategy
Early bronchoscopy and bronchial toilet
Nebulised heparin may have anti-inflammatory effects and may have a survivial benefit in those with inhalational injury