Plastics Teaching

Question 1

25 YO gentleman is BIBA to ED resus after a RTA
He is responsive but has sustained large burns to his abdomen and legs
How would you immediately manage this gentleman?

Answer 1

ABCDE

Intubate early in an inhalation burn

Question 2

Immediate burns management

Answer 2

ABCDE approach
?inhalation - intubate
Oxygenate
Immediate burn management - irrigate with lukewarm water/cool for 20 minutes
Cover with cling film or similar - not sticky
Fluid requirements - parkland formula - 4ml x burns surface area % x body weight (kg) give 1/2 over 8 hours then 1/2 over next 16 hours

Question 3

How to calculate severity of burns

Answer 3

% surface area - Wallace’s rule of 9s, Lund and browder charts - more accurate, can be used in children as charts for differing ages
Depth - superficial vs partial (superficial partial vs deep partial) and full thickness

Question 4

Full thickness burns are what colour?

Answer 4

White and insensate, skin may be charred and sunken

Question 5

Burn reconstruction

Answer 5

aims to improve function, comfort and appearance
Flap vs graft
Graft - needs blood supply from site, can fail
Skin flap - better cosmetic results and less chance of failure

Question 6

Split thickness skin graft vs full thickness skin graft

Answer 6

SSG - does not contain the whole dermis

FTSG - contains the whole dermis, high energy requirement