Burn Injuries

Question 1

What are the three determinants of mortality for a burn injury?

Answer 1

-Extent of burn
-Age of patient
-Burn wound depth

Question 2

Which is the most common type of burn injury?

Answer 2

Scalds - 60% of children’s burns

Question 3

Outline the local effects of burns

Answer 3

-Fluid/electroltye leak into ISS
-Pain
-Conductive & Evaporative heat loss
-Loss of skin protection

Question 4

Outline the systemic effects of burns

Answer 4

-Insulin suppression
-bone marrow suppression
-hypovolaemia (shock)
-stress ulceration (GI tract)
-collagen fibre denaturing

Question 5

What is Lactatet Ringer’s?

Answer 5

The best fluid to use for fluid resuscitation following a burn wound

Question 6

When should skin grafting be considered?

Answer 6

Not healed within 3 weeks (adults) or 2 weeks (children)

Question 7

Outline the management of burns by fluid resuscitation

Answer 7

• Fluid resuscitation time calculated from burn injury time and extent.
• Adequacy measured by urine output.
• Lactated Ringer’s preferred due to similarity to normal fluid.
• Avoid NaCl to prevent metabolic acidosis.
• Fluids with dextrose not used due to lack of electrolytes and potential glucose intolerance.

Question 8

What are the goals of IV therapy in a burns patient?

Answer 8

• Goal: Perfusing kidneys.
• Adequate kidney perfusion ensures sufficient urine output.
• Inadequate urine output indicates insufficient fluid resuscitation.
• Adjust IV fluid rate if necessary; do not administer diuretics.

Question 9

What other special considerations should you be aware of with fluid resuscitation with a burns patient?

Answer 9

• Electrical injuries or deep tissue damage may result in myoglobin in urine.
• Myoglobin necessitates double urine output to flush kidneys.
• Assess fluid needs based on urine output, not just burn size.
• Dark urine indicates insufficient fluid; increase IV rate to maintain urine output (100 ml/hr).

Question 10

What is the Parkland Formula for fluid resusciation?

Answer 10

4ml x TBSA (%) x body weight (kg)

Timing:
50% given in first 8 hours
50% given in next 16 hours

Children’s Dosing: Maintenance fluid added:
4ml/kg for first 10kg
Plus 2ml/kg for second 10kg
Plus 1ml/kg for weight >20kg

Endpoint:
Adult urine output: 0.5–1.0 ml/kg/hour
Children urine output: 1.0–1.5 ml/kg/hour