Burns

Question 1

Immediate management of of superficial burns

Answer 1

• ABCDE
• Superficial epidermal = analgesia, emollients
• Partial thicknes (superficial dermal) = cleanse, leave blister intact, non-adherent dressing, avoid topical creams, review in 24 hrs

Question 2

Immediate manageent of burns caused by heart

Answer 2

• Within 20 minutes of the injury irrigate the burn with cool (not iced) water for between 10 and 30 minutes.
• Cover the burn using cling film, layered, rather than wrapped around a limb

Question 3

How is the extent of a burn assessed ?

Answer 3

Wallace’s rule of NINES

Question 4

Explain wallace’s rule of nine’s

Answer 4

• Head + neck = 9%
• Each arm = 9%
• Each anterior part of leg = 9%
• Each posterior part of leg = 9%
• Anterior chest = 9%
• Posterior chest = 9%
• Anterior abdomen = 9%
• Posterior abdomen = 9%

Question 5

Appearace of superficial epidermal burns

Answer 5

FIRST degree
Red and painful, dry, no blisters

Question 6

Appearance of partial thickness burn - Superficial dermal

Answer 6

• Second degree
• Pale pink, painful, blistered. Slow capillary refill

Question 7

Appearance of partial thickness (deep dermal) burn

Answer 7

• Second degree
• Typically white but may have patches of non-blanching erythema.
• Reduced sensation, painful to deep pressure

Question 8

Appearance of full thickness burn

Answer 8

• Third degree
• White (‘waxy’)/brown (‘leathery’)/black in colour, no blisters, no pain

Question 9

5 reasons for secondary referral with burns

Answer 9

• All deep dermal and full-thickness burns.
• Superficial dermal burns of more than 3% TBSA in adults, or more than 2% TBSA in children
• Superficial dermal burns involving the face, hands, feet, perineum, genitalia, or any flexure, or circumferential burns of the limbs, torso, or neck
• Any inhalation injury
• Any electrical or chemical burn injury
• Suspicion of non-accidental injury

Question 10

Stepwise appraoch to more severe burns

Answer 10

1. AIRWAY
2. IV fluids (children >10% surface area, adults >15%)
3. Catheter
4. Analgesia

Question 11

How are the fluids required for burns calculated

Answer 11

PARKLAND FORMULA

• Volume of fluid = total body surface area of the burn % x weight (Kg) x4.
• Half of the fluid is administered in the first 8 hours.

Question 12

who should be transferrred to burns unit

Answer 12

• Complex burns, burns involving the hand perineum and face and burns >10% in adults and >5% in children should be transferred to a burns unit.

Question 13

when is an escharotomy considered

Answer 13

• Indicated in circumferential full thickness burns to the torso or limbs.
• Careful division of the encasing band of burn tissue will potentially improve ventilation (if the burn involves the torso), or relieve compartment syndrome and oedema (where a limb is involved)

Question 14

Signs of potential smoke inhalation

Answer 14

Productive cough
SOB
Wheezing

Question 15

effect of carbon monoxide onoxygen dissociation curve

Answer 15

1. Shifts it to the LEFT
2. Greater affinity for oxygen
3. Hb holds the oxygen and less is released to the tissues.
4. Leads to hypoxia and associated symptoms
5. Less O2 = headaches, confusion, reduced consciousness