Burns

Question 1

4 types of burns (definition of burns)

Answer 1

1. Thermal
2. Electrical
3. Chemical
4. Radiation induced
   injury to the skin and underlying structures

Question 2

Depth classification of burns

Answer 2

1. Superficial
2. Superficial partial thickness
3. Deep partial thickness
4. Deep/full thickness

Question 3

How do we quantify the extent of a burn?

Answer 3

Using total body surface area (TBSA%) estimation

Question 4

Major TBSA burns are associated with … and require …

Answer 4

Major TBSA burns are associated with SEVERE SYSTEMIC RESPONSE and require RESUSCITATION

Question 5

Mortality from major TBSA burns is estimated using…

Answer 5

the BAUX score

Question 6

Key features of superficial burns (4)

Answer 6

• red
• painful
• no blisters
• blanching

Question 7

What layers of the skin are affected by superficial burns?

Answer 7

Epidermis

Question 8

Key features of superficial partial thickness burns (3)

Answer 8

• pink
• blanching
• blisters

Question 9

What layers of the skin are affected by superficial partial thickness burns?

Answer 9

Epidermis & papillary dermis

Question 10

Key features of deep partial thickness burns (3)

Answer 10

• Blotchy red, or pale
• Non-blanching
• Ruptured blisters

Question 11

What layers of the skin are affected by deep partial thickness burns?

Answer 11

Epidermis, papillary and reticular dermis

Question 12

Key features of deep/full thickness burns (4)

Answer 12

• White/red/yellow
• Non-blanching
• Leathery
• Asensate

Question 13

What layers of the skin are affected by deep/full thickness burns?

Answer 13

Epidermis, dermis +/- underlying structures

Question 14

Differences between superficial and deep partial thickness burns (5)

Answer 14

Superficial partial thickness:
- Blisters with erythematous base
- Adnexal structures are not damaged
- Blanching
- Sensate
- Papillary dermis only

Deep partial thickness:
- Blisters with white base
- Adnexal structures are damaged
- Non-blanching
- Insensate
- Papillary & reticular dermis

Question 15

Jackson zones (3)

Answer 15

1. Zone of coagulation
2. Zone of stasis
3. Zone of hyperaemia

Question 16

Point of maximum damage (irreversible tissue loss due to coagulation of constituent proteins)

Answer 16

Zone of coagulation

Question 17

Zone of decreased tissue perfusion that is potentially salvageable

Answer 17

Zone of stasis

Question 18

Outermost zone where tissue perfusion is actually increased and where tissue will invariably recover

Answer 18

Zone of hyperaemia

Question 19

Burn resuscitation aims to…

Answer 19

save the zone of stasis

Question 20

When is fluid resuscitation required?

Answer 20

Pediatrics: 10% TBSA or more
Adults: 20% TBSA or more

Question 21

What is the Parkland Formula for fluid resuscitation?

Answer 21

4cc x kg of body weight x TBSA (in %)

Question 22

What is the timing of fluid resuscitation?

Answer 22

First half within 8 hours of the burn incident, second half within the next 16 hours of the incident.

Make sure to account for delayed resuscitation based on when the patient presented to the ER

Question 23

What fluid do we administer to resuscitate burn patients?

Answer 23

Ringer’s lactate

Question 24

What is the target urine output during fluid resuscitation of a burn patient?

Answer 24

0.5-1cc/kg/hour

Question 25

How do we assess burn size (adults vs peds)?

Answer 25

Adults: Rule of 9s Kids: Lung Browder chart

Question 26

Explain the rule of 9s

Answer 26

Head: 9% Anterior torso: 18% Posterior torso: 18% Entire upper extremity: 9% each Entire lower extremity: 9% each Genitals: 1% Palm of hand: 1%

Question 27

Rule of 9s only applies to...

Answer 27

partial thickness burns and above

Question 28

Indications for transfer to a burn centre (10)

Answer 28

1. Partial thickness burn of over 10% TBSA 2. Any full thickness/deep burn (3rd degree) 3. Chemical burn 4. Electrical burn 5. Inhalation injury 6. Patients with comorbidities 7. Patients who will need social support/rehab 8. If the hospital cannot care for the burn patient 9. Burns to face, hands, genitalia 10. Burns + trauma, if burns>trauma

Question 29

List the elements of the primary survey of a burn patient (ABCDE)

Answer 29

A: Airways B: Breathing C: Circulation D: Disability (neurologic exam) E: Exposure

Question 30

Initial interventions for burn patients

Answer 30

1. Early endotracheal intubation (as needed) 2. Support oxygenation & ventilation 3. Obtain vascular access 4. Fluid resuscitation Also - Remove clothing and debris - Immediately cool areas using NS/cool water soaked gauze - Pain and anxiety management (sedation)

Question 31

3 factors that affect burn mortality (used to estimate mortality in the Baux score)

Answer 31

1. Age 2. TBSA 3. Inhalation injury