Burns

Question 1

Name 6 cardiovascular complications of burns

Answer 1

• Increased capillary permeability (fluids-protein loses)
• vasoconstriction
• decreased myocardial contractility - TNFA
• systemic hypotension, organ hypoperfusion
• organ damage
• sepsis- leading to multiple organ failure

Question 2

Name 4 respiratory complications of burns

Answer 2

. Bronchoconstriction (histamine)
. Ards
• effects of inhalation injury
. Co toxicity
Pneumonitis

Question 3

Name 3 metabolic complications of burns

Answer 3

• Increased metabolic rate, 3-4x normal
• catabolism (sepsis, non healing)
• disruption gut integrity (sepsis)
Renal failure
Curling ulcers

Question 4

Name 2 immunologic complications of burns

Answer 4

• Down regulation of both humoral and cell mediated responses → immunosupression
• inflammation
Infection

Question 5

State depth, sensation, heal time, and appearance of superficial thickness burns

Answer 5

• Epidermis only
• pink/red, dry, small blisters , non-blanching
• Heal in 5-10 days without scar. Can give moisturizer
• very painful

Question 6

State depth, sensation, heal time, and appearance of superficial partial thickness burns

Answer 6

• Superficial dermis
• Red, blistering, wet,
• extremely painful
• heal in 3 weeks without need skin graft

Question 7

Most serious complication acid Burns?

Answer 7

Coagulative necrosis

Question 8

Most serious complication alkaline burns?

Answer 8

Liquefactive necrosis

Question 9

State depth, sensation, heal time, and appearance of deep partial thickness burns

Answer 9

• Deep dermis
. Minimally painful
. Yellow, white, dry leathery, blanching (ischaemia) and Petechiae appearance
•Heal in 3-8 weeks with scarring. Always need skin graft

Question 10

Name 3 occult complications of electrical injuries

Answer 10

• Acute renal failure
• cardiac arrhythmia
• compartment syndrome

Question 11

Classify the burn in picture 30

Answer 11

Superficial burn

Question 12

Classify the burn in picture 31

Answer 12

Superficial partial thickness burn

Question 13

Classify the burn in picture 32

Answer 13

See picture 33

Question 14

Classify the burn in picture 34

Answer 14

Deep partial thickness burn

Question 15

Classify the burn in picture 35

Answer 15

Full thickness

Question 16

What is considered a minor burn in adults and children in terms of TBSA?

Answer 16

Adults <15%

Children <10%

Question 17

What is considered a moderate burn in adults and children in terms of TBSA?

Answer 17

Adults 15-25%

Children 10-15%

Question 18

What is considered a severe burn in adults and children in terms of TBSA?

Answer 18

Adults > 25%

Children > 15%

Question 19

Describe the rule of nines for burns

Answer 19

See picture 36

Question 20

Name 7 criteria for admission for burns

Answer 20

• Severe and moderate burns
• facial
• hands
• genitals
• electrical
• chemical
• inhalation
• extremes of age
• Full thickness
• circumferential burns

Question 21

Which surgical procedure should be done after burns to enable chest expansion?

Answer 21

Escarotomy

Question 22

Definitive management of burns (2)

Answer 22

• Sloughectomy and temporary wound coverage

* skin graft once wound granulated

Question 23

Name the 3 local effects of burns

Answer 23

• Coagulation - worsen hyperaemia (inflamm)
• stasis -worsen both
. Hyperaemia - worsen coag

Question 24

Treatment Co toxicity?

Answer 24

High concentration oxygen

Question 25

Appropriate way to position shoulder joint following burn injury?

Answer 25

Abduction

Question 26

Appropriate way to position mp joint following burn injury?

Answer 26

Flexion

Question 27

Appropriate way to position neck joint following burn injury?

Answer 27

Extension

Question 28

Appropriate way to position wrist joint following burn injury?

Answer 28

Extension

Question 29

Appropriate way to position thumb joint following burn injury?

Answer 29

Abduction

Question 30

Which 2 signs are most indicative of inhalation burns?

Answer 30

Stridor and sternal retraction during ventilation

Question 31

Which type electrical burns have best prognoses?

Answer 31

Flash burns

Question 32

Treatment electrical burns?

Answer 32

* Initial debridement * decompression fasciotomy * aggressive planned debridement and early skin coverage

Question 33

Name 3 late complications electrical injuries

Answer 33

* Delayed cardiac arrhythmia - uncommon * complex regional pain syndrome * cataracts

Question 34

Management burns? (3)

Answer 34

• atls - airway; if inhalation burn suspected, intubate. Progressive swelling may occur and make intubation difficult. - breathing: escharotomy to enable chest expansion -Circulation: parkland formula . Definitive = sloughectomy and temporary wound coverage. • skin graft once wound granulated

Question 35

Describe the parkland formula for burns.

Answer 35

•4ml x % TBSA according to rule of nines x body mass • 50% in first 8 hours from time of burn. So if present late, give all fluid • 50% in last 16 hours Isotonic ringers lactate = fluid of choice. (do blood gas to confirm no hyperkaelemia - in that case saline)

Question 36

Physiology and complications of burns? (5)

Answer 36

• Direct coagulation of microvasculature with extension of injury • large area skin exposed with secondary infection and activation vasoactive substance → systemic inflammatory response. • this causes capillary permeability with leakage fluids and interstitial oedema. • cardiac output reduced and low metabolic rate. . After full resuscitation, hyper metabolism and increased cardiac output. Here nutritional support should be considered (initially diabetic diet, then high protein. Nb vitamin c)

Question 37

Name 5 signs inhalation burns

Answer 37

* Singing nasal hair and eyebrows * carbonaceous sputum * closed environment * burns to face * voice change- hoarse