MSPA- Dermatology: Burns

Question 1

what is a first degree burn ?

Answer 1

A first degree burn only affects of the epidermis. This never causes blisters. An example is sunburn.

Question 2

What is a second degree superficial burn ?

Answer 2

A Second-degree superficial burns (also called partial-thickness burns) involve the epidermis and top two layers of the dermis (The whole papillary layer) . These burns form blisters, are very painful, may seep fluid, and blanch when pressed. They typically heal within 7 to 21 days.

Question 3

An example of a second degree superficial partial thickness burn is ?

Answer 3

Scalding from thermal sources.

Question 4

What is a second degree deep burn?

Answer 4

It is a burn that involves the epidermis and the lower portion of the dermis ( papillary layer + half of the reticular layer). They take longer than 3 weeks to heal.

Question 5

What is a third degree burn ?

Answer 5

A third degree burn generally involves the full thickness of epidermis and the dermis.

Question 6

What is a fourth degree burn ?

Answer 6

A fourth degree burn involves the epidermis, dermis, hypodermis, subcutaneous fat, soft-tissue and even bones.

Question 7

71% of paediatric burn injuries in Ireland occurs at ?

Answer 7

Home and 2/3rd occurs in the kitchen or bathroom.

Question 8

What are the key elements of a burn injury history taking ?

Answer 8

• identify the type and mechanism of burn
• Identify the time of injury
• Identify the approximate time of exposure to the source of burn.
• identify the temperature of the source of burn in thermal injuries.
• Identify whether the burn occured in an enclosed space to screen for airway involvment.

Question 9

What is the clinical presentation of first degree burn ?

Answer 9

The clinical presentation of first degree burn consist of localised erythema, pain and tenderness to palpation. The capillary refill time is intact with no edema, blisters or post burn scars.

Question 10

What is the clinical presentation of second degree superficial burns?

Answer 10

The lesions consist of localised erythema, moist and weeping blisters . They are very painful and tender to palpation. However, the capillary refill time is intact.

Question 11

What is the clinical presentation of a second degree deep burn ?

Answer 11

The lesions consist of ruptured blisters with the skin appearing red, yellow or whitish. Patient may feel pain only with deep palpation pressure. There is impairment of two point discrimination and capilary refill. The healing occurs through scar formation.

Question 12

What is the clinical presentation of a third degree burn ?

Answer 12

The lesions are charred leather-like burns with absent capillary refill, absent pain and sensation. there will be no blisters. The lesions are often surrounded by a rim of second degree painful burns. The treatment requires debridement and grafting.

Question 13

What is the clinical presentation of a fourth degree burn ?

Answer 13

The skin is black and charred with no pain, sensation or blistering as it involves skin, fascia, muscles and even bones. Treatment require, debridement, grafting and in some cases amputation.

Question 14

What is the clinical presentation of electric burn ?

Answer 14

The electric burn superficially may only have an entrance lesion and an exit lesion. However, there is often muscle, nerve and myocardial damage.

Question 15

What are the factors that determine the clinical presentation of chemical burns?

Answer 15

• pH of agent
• Concentration
• Length of contact time
• Physical form (e.g., solid vs liquid)
• Site of contact
• Swallowed or inhales
• Exposure to intact skin

Question 16

What is the definition of a minor burn?

Answer 16

It involves <10% of the BSA and the lesions should have only < 2% full thickness involvement. In addition, they should not be circumferential in shape. The minor burns should not involve face, hand, perineum, feet and should not cross the major joints.

Question 17

What is the definition of a major burn ?

Answer 17

A major burn is defined as burn that consist of > 10% full thickness lesions involving > 25% BSA. The burns should have a circumferential appearance and should involve face, perineum, hand, feet and major joints.

Question 18

What is the first step in burn management?

Answer 18

Prevent further burns by removing the patient from the scene of injury. check ABC, remove all clothing &
jewelry, cool with room temp water (cold water can worsen injury).

Question 19

What is the management of minor burns ?

Answer 19

• Outpatient management
• Clean with soap and water
• ± Apply Topical antibiotics
• ± Apply dry bandages

Question 20

What is the management of major burns?

Answer 20

• Admit/Transfer to Burns Unit
• IV fluids and electrolytes
• IV antibiotics
• Urinary catheter
• Same skin care as minor burns
• Skin debridement, grafting, or
  amputation

Question 21

What are the evidence of airway involvement in burns?

Answer 21

• Look for burns to the naso-oral skin and burned facial or nasal hair.
• Look for soot in the airway.
• Rule out oropharyngeal edema.
• Look for respiratory distress, stridor, hoarseness, drooling and hypoxia.

Question 22

What are steps in fluid resucitauon in burns?

Answer 22

• calculate BSA based on rule of nines.
• Use parkland formula to decide large bore IV fluid infusion.
• The urine output goal is at least 0.5ML/KG/ Hrs for adults.

Question 23

What is the skin care approach in burns?

Answer 23

• Clean with soap and water.
• Debridement of tissue if needed.
• Topical antibiotics such as silver sufadiazine, Mafenide acetate, silver nitrate etc.
• change sterile dressing daily.

Question 24

What is the treatment of eschar ?

Answer 24

Eschar is a nidus for infection, ischemia secondary to compartmental syndrome. Therefore, escharectomy is often needed followed by skin grafting.

Question 25

What is the pain control strategy in burns ?

Answer 25

For minor burns paracetamol. For major burns IV opioids with respiratory function monitoring. Drugs can be benzodiazepines and Ketamine.

Question 25

What is the treatment for Burns related stress ulcers and GI mucosal damage ?

Answer 25

IV PPIs.

Question 26

How to provide nutritional support in major burns ?

Answer 26

NG tube or TPN if NG tube not tolerated.

Question 27

What to do, if patient never received tetanus immunisation in childhood ?

Answer 27

Tetanus immunoglobulin. in vaccinated patients administer tetanus toxoid, if it has not been given in last 5 years.

Question 28

What is the Tx approach in electrical burns ?

Answer 28

• Continuous cardiac monitoring.
• Serum CK to monitor rhabdomyolysis.
• Urine alkalisation with IV manitol to enhance myoglobin elimination.
• Monitor serum potassium to screen for tissue necrosis induced hypokalaemia.

Question 29

What is the management of chemical burns ?

Answer 29

• Remove clothing- brush off any chemical agent prior to rinsing with copious amount of running water - cover the wound with mineral oil and remove as much material as possible manually. Follow general burn care recommendations.