Essentials of Burn Management

Question 1

Types of burn

Answer 1

• Scald
• Flame
• Flash
• Contact
• Chemical
• Electrical
• Friction

Question 2

Respiratory response to burn

Answer 2

• Bronchoconstriction
• Adult respiratory distress syndrome

Question 3

Metabolic response to burn

Answer 3

Basal metabolic rate increased threefold

Question 4

Immunological response to burn

Answer 4

Reduced immune response

Question 5

Cardiovascular response to burn

Answer 5

• Reduced contractility
• Increased capillary permeability
• Peripheral and splanchnic vasoconstriction

Question 6

General principles of any burn

Answer 6

• Rescue
• Resuscitate
• Resurface
• Reconstruct
• Rehabilitate

Question 7

First aid for a burn

Answer 7

• Stop burning process
• Cool the burn
• Cover the burn
• Keep warm

Question 8

What approach is used to assess a burn?

Answer 8

ABC approach:
- Airways
- Breathing
- Circulation

Question 9

What is an escharotomy?

Answer 9

Cutting of hardened and constricting skin to allow expansion

Question 10

What type of burn is an escharotomy used in?

Answer 10

Circumferential burns in chest, neck, limbs and digits

Question 11

What is total body surface area?

Answer 11

% of body burnt

Question 12

How is % mortality after a burn calculated?

Answer 12

TBSA + age (+17 if inhalation injury)

Question 13

Methods of assessing burn size

Answer 13

• Rule of nines
• Lund and Brower chart

Question 14

How does the rule of nines work?

Answer 14

• Head = 9%
• Arms = 9% each
• Back = 18%
• Chest = 18%
• Legs = 18% each
• Perineum = 1%

Question 15

Types of burns by depth (and what layers they are in)

Answer 15

• Erythema (epidermis)
• Superficial partial thickness (epidermis + dermis)
• Deep partial thickness (epidermis + dermis)
• Full thickness (epidermis, dermis + subcutaneous)

Question 16

Features of erythema

Answer 16

• Red
• Blanching
• Painful

Question 17

Features of superficial partial thickness burn

Answer 17

• Skin loss
• Blistering
• Wet
• Red
• Blanching
• Painful

Question 18

Features of deep partial thickness burn

Answer 18

• Drier
• Paler
• Cherry red appearance
• No blanching
• Reduced sensation

Question 19

Features of full thickness burn

Answer 19

• Dry
• Leathery
• Painless

Question 20

What TBSA value for fluid resuscitation?

Answer 20

• Adult = >15%
• Child = >10%

Question 21

What is the Parkland formula used for?

Answer 21

Calculating the fluids to be given in the first 24h (first half in 8h, second in 16h)

Question 22

Parkland formula

Answer 22

Fluid (ml) = 4 x weight (kg) x TBSA (%)

Question 23

Target urine output in adults when using fluid resuscitation

Answer 23

0.5ml/kg/hour

Question 24

3 zones in Jackson’s burn model

Answer 24

• Zone of hyperaemia
• Zone of stasis
• Zone of coagulation

Question 25

Which zone is lost when fluid resuscitation is insufficient?

Answer 25

Zone of stasis

Question 26

When would a burn need to be referred?

Answer 26

• Burns to hands, face, feet, perineum
• Age <5 or >60
• Inhalation injury
• TBSA >10% (5% in child)
• Full thickness burn >5% TBSA
• Complex burns (eg. pregnancy)
• Suspected non-accidental injury

Question 27

Pros of excising a burn

Answer 27

• Potential source of infection
• Burn stimulates inflammatory effects
• Early excision and grafting may leave better scars

Question 28

Cons of excising a burn

Answer 28

• Non-full thickness burns may heal spontaneously
• Burn surgery can be hazardous
• Leaves additional wound (donor site)

Question 29

Priority areas for burn surgery

Answer 29

• Neck
• Central line sites
• High functional importance
• Protective (eg. eyelids)