Burns

Question 1

6 functions of the skin

Answer 1

Sensory organ
Endocrine
Thermoregulatory
Immunotherapy
Barrier to fluid loss
Social

Question 2

6 causes of burns

Answer 2

Heat
cold
electrical
chemical
radiation
mechanical (eg friction)

Question 3

Who is more at risk of burns?

Answer 3

Mad (psychological/pyschiatric problems, drugs)
Bad (Violence)
Glad (arson)
Sad (self harm, substance misuse)
Epilepsy/stroke

Question 4

Why are the extremes of age more at risk of burns?

Answer 4

Poorer reflexes and spatial awareness
Inattention/carelessness
Inability to fend for themselves
Thinner and more frail skin

Question 5

5 types of shock

Answer 5

Hypovolaemic (burns)
Septic
Anaphylactic
Vasovagal
Cardiogenic

Question 6

How do burns cause hypovolaemic shock?

Answer 6

Tissue damage
Inflammatory mediators
Leaking vessels
Increased vascular resistance
Hypovolaemia

Question 7

Name the 3 zones of a burn

Answer 7

Centre: Zone of coagulation/necrosis
Zone of stasis
Outer: Zone of hyperaemia

Question 8

Role of histamine in the inflammatory response

Answer 8

Released by mast cells
Creates large endothelial gaps
Leakage

Question 9

Role of prostaglandins in inflammatory response

Answer 9

Released from damaged tissue
Attract neutrophils and macrophages
Release thromboxane and interleukins
Local vasodilation and capillary leakage

Question 10

Role of thromboxane in inflammatory response

Answer 10

Produced by platelets in the zone of injury
Vasoconstriction in undamaged tissue adjacent to the burn
Results in damage extension

Question 11

What inflammatory mediator is released by platelets

Answer 11

Thromboxane

Question 12

What inflammatory mediator causes thromboxane and interleukins to be released?

Answer 12

Prostaglandins

Question 13

Role of catecholamines in the inflammatory response?

Answer 13

Reduces capillary pressure in unburnt tissue

Causes burn extension

Question 14

Role of oxygen free radicals in the inflammatory response?

Answer 14

Produced by neutrophils and macrophages
Damage endothelial cell membranes
Increase capillary leakage

Question 15

What is found in the urine after a burn?

Answer 15

Haemaglobin
Red cells lost
Intensifies the effect of plasma loss
50% burn, 10% loss of red blood cells

Question 16

What is the rule of nines?

Answer 16

Body surface area can be estimated using 9%
Each leg 18%
Torso 18%
Each arm 9%
Head 9%

Question 17

How do you classify depth of burns?

Answer 17

Erythema
Partial thickness
Full thickness

Question 18

How do you recognise a partial thickness burn?

Answer 18

Painful
Blistered
Tissue paper appearnace
Wet

Question 19

How do you recognise a full thickness burn?

Answer 19

Painless
Thick and leathery
Dark red/brown/balck/white
No blisters
Swelling in limbs
Dry
Non blanching

Question 20

When do you need to IV fluid resuscitate someone after a burn?

Answer 20

If adult>15% BSA affected

In children>10%BSA

Question 21

What is the aim for adequate fluid balance?

Answer 21

Urine output of 0.5-1 ml/kg/hour

Question 22

What type of fluid should be used in IV fluid resus after burns? And rate?

Answer 22

Crystalloid (Ringer’s lactate)

4ml/kg/%burn for 1st 24hrs

Question 23

When would more fluid need to be replaced?

Answer 23

In myoglobinuria, electrical injury or associated skeletal injury

Question 24

How much fluid needed for a 70kg man with 45% BSA burns?

Answer 24

4 x 70 x 45 = 12600ml in 24hours
6300ml in first 8 hours
6300ml in next 16 hours

Question 25

When would you intubate early in emergency burns management?

Answer 25

Facial burns Singeing of facial/nasal hair Inflammation of oropharynx Carbonaceous sputum

Question 26

What would you do to manage circumferential full thickness burns?

Answer 26

Escharotomies | Slice through lengthways to allow breathing

Question 27

What blood test is needed after being in a fire?

Answer 27

HbCO

Question 28

How do you estimate BSA in children with burns?

Answer 28

``` Head 18% Torso 18% Each arm 9% Each leg 14% at aged 0 For each year between 0 and 10 take 1% off head and add 0.5% to each leg ```

Question 29

How do you stop the burning process immediately after a burn?

Answer 29

25ºC water for 10 mins | Beware of hypothermia

Question 30

Causes of electrical burns?

Answer 30

``` Improper insulation Intense curiosity of children Occupation hazards DIY maintenance attempts Illegal attempts to obtain electricity High voltage wire exposure ```

Question 31

What counts as a low voltage burn & causes

Answer 31

Below 1000 volts Household and industrial Not usually associated with deep tissue damage

Question 32

What counts as high voltage burns & common causes

Answer 32

``` >1000volts 10000-40000 High tension transmission cables Flash burns or damage due to transmission of current Cutaneous and deep damage ```

Question 33

What are the concerns with high voltage burns?

Answer 33

Internal organ damage (cardiac/brain) Release of haemochromatogens? Vessel thrombosis (ischaemia, peripheral circulation) Compartmental pressure

Question 34

Treatment of electrical burns?

Answer 34

``` Turn off electrical current and remove victim from source Primary survey (CPR?) Associated skeletal injury? Fluid resus Monitor (ECG for hyperkalaemia?) Heparinisation? Fasciotomies/debridement surgery ```

Question 35

What happens in chemical burns?

Answer 35

Alkalis-> saponification | Acids-> coagulative damage

Question 36

Treatment of chemical burns?

Answer 36

Decontaminate Dilute Antidote

Question 37

Treatment of mustard gas burns?

Answer 37

Dilute hydrochlorite

Question 38

Treatment of phosgene Burns?

Answer 38

Irrigation/water

Question 39

Treatment of Lewisite burns?

Answer 39

Dilute hypochlorite

Question 40

Treatment of white phosphorus burns?

Answer 40

Water/1% CuSO4

Question 41

Caustic soda burn treatment?

Answer 41

1% acetic acid

Question 42

Treatment of hydrofluoric acid burns?

Answer 42

1% Calcium gluconate

Question 43

What is used in burn excision/debridement?

Answer 43

Repeated shaving of burn in very thin layers until visible dermic & punctate bleeding Done using Watson knife or Dermatome