Burns

Question 1

Define burn

Answer 1

A burn is a type of injury typically to the skin that is caused by heat, electricity, chemicals or radiation.

Question 2

which type of burn is the most common

Answer 2

Thermal

Question 3

what are thermal burns

Answer 3

flames, scalds, contact with hot objects

Question 4

what are chemical burns

Answer 4

acids, alkalis, organic compounds

Question 5

Define Superficial burns

Answer 5

burns affecting the epidermis only

Question 6

Superficial (1st degree) burns Sx

Answer 6

• erythematous
• Painful
• Dry (no blisters)
  Signs: blanching, rapid CRT

Question 7

Define Superficial partial-thickness burn

Answer 7

burns affecting the epidermis and upper dermis

Question 8

Superficial partial-thickness (2nd degree) Sx

Answer 8

• Erythematous
• Painful
• Blisters
• Wet
• Blanching
• CR present

Question 9

Define Deep partial-thickness burn

Answer 9

Burns affecting all dermis layers (epidermis/dermis)

Question 10

Deep partial-thickness (2nd degree) burn Sx

Answer 10

• Yellow/white
• dry
• non-blanching
• Decreased sensation
• Delayed CR

Question 11

Define Full thickness burns

Answer 11

Burns extending through the dermis/subcut tissue

Question 12

Full thickness (3rd degree) burn Sx

Answer 12

• Leathery/waxy white
• non-blanching
• dry
• Painless

Question 13

Complex burns

Answer 13

• > 15% total BSA (adults)
• > 10% BSA (children)
• > 5% BSA (aged 1 year)
• Critical area (face, perineum, genitals, hands, feet)
• Circumferential or cross a joint

Question 14

Non-complex burns

Answer 14

Partial-thickness
- < 15% total BSA (adults)
- < 10% BSA (children)
- < 5% BSA (aged 1 year)
- Not affecting critical areas

Question 15

Signs of inhalation injury during burns

Answer 15

• Hoarse voice
• Charred sputum

Question 16

e.g. sunburn

Superfical burn Mx

Answer 16

• Aloe vera gel
• Safety net: seek advice if new blisters are formed (indicate a deeper burn)

Question 17

The Wallace ‘Rule of 9s’

Answer 17

• Head = 9%
• Whole arm = 9%
• Front of torso = 18%
• back of torso = 18%
• Whole leg = 18%
• Genitalia / Perineum 1%

Question 18

Parkland formula for fluid resus

Answer 18

Total vol. of IV fluids in the first 24 hours:
4ml x weight (kg) x TBSA%

Question 19

choice of fluid for fluid resus in burn Mx

Answer 19

Warm Hartmann’s solution

Question 20

Fluid resus distrubution within 24h

Answer 20

50% in the first 8h
50% over the next 16h

Question 21

Referral to a burns unit criteria

Answer 21

TBSA: > 10%
Depth: Full thickness
Site: Critical areas/circumferential
Causes: Chemical/electrical/cold/friction
Other: suspect safe-guarding, co-morbid patients, immunosuppresed, pregnant

Question 22

when is fluid resus warranted for burn

Answer 22

TBSA >15% (adults)
OR
TBSA >10% (children)

Question 23

Superficial partial-thickness Burn Mx

Answer 23

Initial acute Mx:
1. Remove clothing
2. Cool tap water 20mins (within 3 hours of the burn)
3. Irrigations
4. Analgesia before deroofing the burn wound
5. Assess the burn: remove all blister
6. Check tetanus imms status
7. Clean wound with saline
8. No routine Abx prophylaxis
Cover: non-adherent (atrauman)/gauze/crepe

Question 24

Burn degree classifications

Answer 24

1st: Superficial burn
2nd: Superficial/Deep Partial-thickness burn
3rd: Full thickness burn

Question 25

Define eschar

Answer 25

a collection of **tight and leathery dead tissue** caused by deep partial or full-thickness burns.

Question 26

Eschar Mx

Answer 26

Escharotomy

Question 27

Urine output monitoring in fluid balance in burns

Answer 27

Adult: 0.5ml/kg/hour Children: 1ml/kg/hour

Question 28

Chemical burn Mx

Answer 28

1. Remove all clothing/jewllery 2. Irrigation 30mins 3. Refer to burn unit

Question 29

Electrical burn Mx

Answer 29

1. A-E 2. ECG, UEs, CK 3. Monitor urine output

Question 30

Electricla burn complications

Answer 30

- rhabdomyolysis - compartment syndrome if burn to limbs

Question 31

When to initiate IV fluids for children

Answer 31

Burns > 10% of TBSA