FN: Burns

Question 1

RF

Answer 1

Age: children and elderly
Co-mobidities: epilepsy, CVA, dementia, mental illness
Occupation

Question 2

Classification

Answer 2

Superficial
Partial thickness
Full thickness

Question 3

Superficial

Answer 3

Erythema
Painful
e.g. sunburn

Question 4

Partial thickness

Answer 4

• heal w/i 2-3 weeks if not complcaited

Question 5

Superficial partial thickness

Answer 5

No loss of dermis
Painful
Blisters

Question 6

Deep partial thickness

Answer 6

Loss of dermis but adnexae remain
Healing from adnexae e.g. follicles
V. painful

Question 7

Full thickness

Answer 7

• complete loss of dermis
• charred, waxy, white, skin
• Anaesthetic
• Heal from the edges - scar

Question 8

Complications early

Answer 8

• Infection: loss of barrier function, necrotic tissue, SIRS, hospital
• hypovolaemia: loss of fluid in skin + raised cap permeability
  Metabolic syndrome: hyperkalaemia, hypermyoglobin, raised Hb - AKI
• Compartment syndrome: circumferential burns
• Peptic ulcers: Curlings ulcers
• Pulmonary: CO, poisoning, ARDS

Question 9

Intermediate complications

Answer 9

VTE

PRessure sores

Question 10

Late complications

Answer 10

Scarring
Contractures
Psychological problems

Question 11

Assessment

Answer 11

Wallace rule of 9s: % BSA burnt

• head and neck:9%
• Arms: 9% each
• Torso: 18% front and back
• Leg: 18% each
• Perineum: 1%
• (Palm:1%)

N.B. may also use Lund and Browder charts

Question 12

Management

Answer 12

• Based on ATLS principles

- Specific concerns with burns

Question 13

Specific concerns with burns

Answer 13

• Secure airway
• Manage fluid loss
• Prevent infection

Question 14

Airway management

Answer 14

Examine for respiratory burns

• soot in oral or nasal cavity
• burnt nasal hairs
• hoarse voice, stridor

Flexible laryngoscopy can be helpful
Consider early intubation + dexamethasone (reduced inflammation)

Question 15

Breathing management

Answer 15

• 100% oxygen
• Exclude constricting hours
• Signs of CO poisoning
• ABG

Question 16

Signs of CO poisoning

Answer 16

Headache
n.v
confusion
Cheery red appearance

Question 17

ABG results

Answer 17

CoHb level

SpO2 unreliable of CO poisoning

Question 18

Circulation

Answer 18

• Fluid losses may be huge
• 2x large-bore cannulae in each ACF
• Bloods: FBC, U+E, G+S/XM
• Start 2L warmed - Hartmann’s immediately

Question 19

Parkland Formula to guide replacement in 1st 24 hrs

Answer 19

• 4 xwt. (kg) x % burn = mL of Hartmann’s in 24h
• replace fluid from time of burn
• Give half in 1st 8h
• Best guide is UO:30-50mL/h

Question 20

Muir and Barclay Formula to guide fluid replacement

Answer 20

• (wt, x % burn)/2 = mL of Colloid per unit time
• Time units: 4,4,4,6,6,12 = 36 hours
• may need to use blood

Question 21

Partial thickness burns

Answer 21

1. Analgesia: morphine
2. Dress partial thickness burns
   - Biological e.g. cadaveric skin
   - Synthetic
   - Cream e.g. Flamazine (silver sulfadiazine) + sterile film

Question 22

Full thickness burn Rx

Answer 22

• Tangenital excision debridement
• Split-thickness skin grafts
• Anti-tetanus toxoid (0.5ml ATT)
• Consider prophylactic Abx: esp. anti-pseudommonal

Question 23

Circumferential burns

Answer 23

May require excharotomy to prevent compartment syndrome