Burn Management

Question 1

Definition of burn

Answer 1

Thermal injury which caused a break in the line of the epidermis

Question 2

List 4 functions of skin

Answer 2

Microbial barrier
Fluid and temperature homeostasis
Sensation
Physical/UV protection

Question 3

Main causes of burns

Answer 3

Flame (55%)
Scald (40%)
Chemical/electrical (5%)

Question 4

What is AMPLE? (history taking)

Answer 4

Allergies
Medications
PMH
Last food/fluid
Events leading up to/mechanism of injury

Question 5

What 3 factors looked at in GCS?

Answer 5

• Eye opening
• Best verbal respones
• Best motor response

Question 6

Severity of head injury according to GCS?

Answer 6

Minor 13-15
Moderate 9-12
Severe <9

Question 7

4 important factors to know regarding the burn?

Answer 7

1. Duration of exposure
2. Type of clothing worn
3. Temp and nature of fluid
4. Adequacy of first aid measures

Question 8

4 examples of when to refer to burns unit?

Answer 8

1. Any full thickness burn
2. Children >10%, adult >15%
3. Inhalational injury
4. Chemical/electrical burns

Question 9

3 classes of burns?

Answer 9

Superficial
Partial thickness (superficial and deep)
Full thickness

Question 10

Superficial burn

Answer 10

Not technically a burn; no loss of epidermis
Erythema present
Painful
E.g. sunburn

Question 11

Partial thickness burn

Answer 11

Superficial- no loss of dermis, painful, presence of blisters.

Deep- loss of dermis but adnexae remain. Very painful

Question 12

Full thickness burn

Answer 12

Complete loss of dermis. Appears charred, white, waxy, leathery.
No pain/sensation.

Question 13

What to assess regarding the burn?

Answer 13

Depth

TBSA% affected

Question 14

What is the rule of nines?

Answer 14

Face 9%
Each arm 9% 
Front 18%
Back 18%
Each leg 18%
Patient's closed palm = 1%

Question 15

Classes of inhalational injury

Answer 15

Supraglottic (due to extreme heat)

Subglottic (due to combustion products)

Systemic (CO or cyanide poisoning)

Question 16

5 example signs of inhalational injury?

Answer 16

1. Soot & burns in mouth/nose
2. Increased RR + use of accessory muscles.
3. Confusion, irritability & disorientation.
4. Hoarse voice
5. Stridor/wheeze

Question 17

What % CO poisoning will cause death?

Answer 17

60%

Question 18

Signs of CO poisoning?

Answer 18

Confusion
N&V
Headache
Cherry red appearance

Question 19

What formula used for fluid resuscitation?

Answer 19

Modified Parkland formula:
4ml x kg x TBSA%

Give first half within 8 hrs

Question 20

What formula for calorific requirements?

Answer 20

Curreri

Question 21

What to do with chemical & electrical burns?

Answer 21

IMMEDIATE IRRIGATION

Question 22

Prognosis of burns depends on 3 factors:

Answer 22

Age
% BSA
+/- inhalational injury

Question 23

Treating partial thickness burns involves…?

Answer 23

Analgesia

Dress (biologic or synthetic) + cream (flamazine)

Question 24

Treating full thickness burns involves?

Answer 24

Excisional debridement

Split-thickness skin graft

Question 25

When is escharotomy indicated?

Answer 25

Circumferential burns; reduces risk of compartment syndrome