Burns

Question 1

epidemiology of burns

Answer 1

69% male
chuldren <5yr old - 20%
seniors >60yr old - 12%
most occur at home

Question 2

etiology of thermal burns

Answer 2

scald
flame
flash
contact

Question 3

etiology of other burns

Answer 3

electrical
chemical
less common than thermal

Question 4

severity of scald burn depends on:

Answer 4

length of contact and temperature
nature of substance (steam, hot water, hot oils)
depth and extent of burn

Question 5

what may indicate a non-accidental burn in pediatrics

Answer 5

symmetrical burns
cigarette burns
mandatory to report

Question 6

burn severity assessment with depth

Answer 6

superficial - 1st degree
partial thickness -2nd degree
full thickness - 3rd degree (epi, dermis, subcut fat)
underlying muscle and bone - 4th degree

don’t underestimate depth

Question 7

signs of superficial burn

Answer 7

only inflammation
no blisters
heal within 2-5days
no scar/pigment changes

Question 8

signs of superficial partial thickness

Answer 8

all of epidermis and into paillary dermis
pink/red, moist, swelling, blisters
7-10 days w/o significant scarring
e.g. scald burns

Question 9

signs of deep partial thickness

Answer 9

all of epidermis and into reticular dermis
red to white, blistered, moist, moderate swelling
painful
longer than 14 days to heal
hypertrophic scarring

Question 10

signs of full thickness burns

Answer 10

all of epidermis and dermis and into subcut tissue 
white or black, charred, leathery 
does not blanch 
NOT painful 
long time to heal by secondary healing 
e.g. flame burns, electrical burns

Question 11

how to calculate total body surface area (TBSA) in adults

Answer 11

rule of nines 
head: 9
chest/abd: 18
back: 18
arms: 9+9
legs: 18+18
genitals: 1 
caution over-estimating TBSA

Question 12

how to calculate total body surface area (TBSA) in children

Answer 12

Lund & Browder chart

Question 13

local effects of burns

Answer 13

barrier to evaporation lost

increased cellular vascular permeability in area of burn

Question 14

zones of thermal injury

Answer 14

zone of coagulation (necrosis)
zone of stasis (alive, microvascular damage, can convert to necrosis)
zone of hyperemia (inflammation)

Question 15

systemic effects of major burns

Answer 15

inflammatory mediators (histamine, prostaglandins, cytokines) causes fluid leaks from intravascular space

Question 16

physiology of burn shock

Answer 16

fluid loss and decreased cardiac output 
increased systemic vascular resitance 
decreased RBCs 
impaired host defense 
decreased perfusion of kidneys

Question 17

what occurs after acute resuscitation

Answer 17

hypermetabolic and hypercatabolic response

impaired cellular and humoral immune response (no rejection of graft)

Question 18

mechanism of inhalation injury

Answer 18

CO poisoning
direct heat injury (upper airway)
chemical injury (lower airways)

Question 19

pathophysiology of CO poisoning

Answer 19

greater affinity for Hb than oxygen, oxygen deprivation

measure carboxyhemoglobin levels (ABGs)

Question 20

presentation of smoke inhalation injury

Answer 20

face and neck burn 
singed facial hair 
soot in sputum 
redness and swelling of oropharynx
increase mortality from burns

Question 21

Tx for smoke inhalation

Answer 21

intubate immediately
Bronchoscopy: Dx
therapeutic: clear soot away from lower airways

Question 22

guidelines for fluid resuscitation for burns

Answer 22

first 24h
Parkland formula
4cc/kg/%TBSA burn/day
1/2 first 8hrs, 1/2 next 16 hrs from time of burn

for children add isotonic maintenance fluids
first 10kg: 4cc/kg/hr
second 10kg: 2cc/kg/hr
after 20kg: 1cc/kg/hr

Question 23

what to monitor during fluid resuscitation

Answer 23

urine output (0.5-1cc/kg/hr)
mental status
cap refill 
temp of extremities 
lytes, base deficit, serum lactate

Question 24

what is escharotomy

Answer 24

checkerboard cuts to release tension on skin

Question 25

wound care for burns

Answer 25

pre hospital: stop burning process, clean coverings, warm blanket
ED: warm saline-gauze, dressings, topical antimicrobials
add splint so no joint contractures occur

Question 26

topical antimicrobials for burns

Answer 26

silver sulfadiazine
polymyxin B
mupirocin

silver dressings

Question 27

describe sepsis in burns

Answer 27

leading cause of death post-resuscitation
larger burns
preexisting disease

Question 28

nutrition requirements in burns

Answer 28

high protein, high calories
vitamins and minerals
monitor blood sugar, albumin

Question 29

indications for debridement and skin grafting

Answer 29

deep partial thickness burns and full thickness burns

surgery is the ‘conservative’ treatment in severe burns

Question 30

timing of operative burn treatment

Answer 30

<20% TBSA: decide bw 7-10 days if it will heal

burns >20%: within first week

Question 31

describe complications with electrical burns

Answer 31

cardiac monitoring
compartment syndrome
myoglobinuria
can be unrecognized