Burns

Question 1

Presentation of patient with superficial burn

Answer 1

General
Painful distress
Hypovolemic shock (tachycardia, hypotension, decreased urine output)
Anaemia (MM pale, pallor of nail bed)

Specific
I - erythema, hair follicles, no blisters
P - painful to touch, blanchable

Question 2

Presentation of patient with superficial partial thickness burns

Answer 2

General
Painful distress
Hypovolemic shock (tachycardia, hypotension, decreased urine output)
Anaemia (MM pale, pallor of nail bed)

Specific
I - erythema, blisters with clear fluid, hair follicles
P - painful, sensation intact, blanchable

Question 3

Presentation of patient with deep partial thickness burns

Answer 3

General
Minimal pain (varies)
Hypovolemic shock (tachycardia, hypotension, decreased urine output)
Anaemia (MM pale, pallor of nail bed)

Specific
I - mottled appearance, blisters, few intact hair follicles
P - sluggishly blanch, minimal pain with deep pressure

Question 4

Presentation of patient with full thickness burns

Answer 4

General
Hypovolemic shock (tachycardia, hypotension, decreased urine output)
Anaemia (MM pale, pallor of nail bed)

Specific
I - Leathery, stiff, dry appearance, no hair follicles, thrombosed veins
P - painLESS, non blanchable

Question 5

Heals in 10 days with no scarring

Answer 5

Superficial partial
7 - 14 days

Question 6

Heals in 14 days with scarring

Answer 6

Deep partial
14 - 35 days

Question 7

3 zones of a burn wound

Answer 7

Zone of hyperaemia
Zone of Stasis/oedema
Zone of Coagulation/ischemia

Question 8

Zone where appropriate early intervention has most profound effect in minimizing injury

Answer 8

Zone of stasis/oedema

Question 9

Entirely viable, cells recover within 7 d; contributes to systemic consequences seen with major burns

Answer 9

Zone of hyperemia

Question 10

Explain zone of stasis

Answer 10

Decreased perfusion; microvascular thrombosis of vessels results in progressive tissue necrosis and cellular death in 24-48 hrs without proper treatment

Question 11

Explain zone of hyperaemia

Answer 11

Vasodilation of blood vessels due to inflammation
Cells entirely viable and recover in 7 days

Question 12

Burn surface area guides

Answer 12

Wallace rule of 9s (2nd and 3rd degrees burns ONLY)
Patients palm for patchy burns (1%)
Lund Browder chart (<10yrs)

Question 13

Severe burns criteria

Answer 13

TBSA >20%
3rd degree TBSA > 5%
Inhalation Injury
Burn to face, hands, feet, perineum

Question 14

Pathophysiology of inhalation injury

Answer 14

Smoke inhalation leading to pulmonary injury

Thermal injury
Chemical injury to alveolar BM with pulmonary oedema

Question 15

Worse prognosis with these factors

Answer 15

Extremes of age (<3 or >60)
Burn size
Inhalation injury
Associated injuries
Comorbidities

Question 16

General management for all burns

Answer 16

ATLS guidelines
AB - identify life threatening airway and breathing complications
(INHALATION INJURY AND CO POISONING)
Intubate if suspect inhalation injury
Give 100% oxygen via non re breather face mask for CO poisoning

C - Fluid resuscitation
(IVF if TBSA >15%)
Parklands Formula ( CANNOT use if TBSA > 50%)
=
Insert Foley catheter monitor UO (BP and CVP for further monitoring)
Take off bloods for Hb, BUN, Cr, GXM, ABG, U&E, urinalysis

Question 17

Aim of general management for burns

Answer 17

Clear mental status
HR < 120
MAP > 70
Urine output =>.5ml/kg/hr (adult)
=>1ml/kg/hr (child)

Question 18

Specific management of superficial and superficial partial burns

Answer 18

Pain management (WHO step up ladder)
Tetanus (.5ml cc tetanus toxoid)
Curling ulcer prophylaxis - Ranitidine H2antagonist
Cleanse, debride, daily dressing
Topical antibiotics

Nutrition
Hyper metabolism: TBSA > 40% have BMR 2-2.5x predicted
Calories, vitamin C, vitamin A, Ca2+, Zn2+, Fe2+
Prevent contractures: Splinting and physiotherapy

Question 19

Management of deep partial or full thickness burns

Answer 19

Pain mgt
Tetanus
Stress ulcer prophylaxis
Early wound cleaning, debridement of necrotic tissue
Antimicrobial dressing
Early flap or graft coverage (eyelids, hands, feet, joint flexures)

Nutrition
Hyper metabolism: TBSA > 40% have BMR 2-2.5x predicted
Calories, vitamin C, vitamin A, Ca2+, Zn2+, Fe2+
Prevent contractures: Splinting and physiotherapy

Question 20

Common infections to deep partial and full thickness burn sites

Answer 20

Day 1-3 gram positive
Day 3-5 gram negative (Pseudomonas aureginosa, Klebsiella, Proteus)