Week 10

Question 1

what is a burn?

Answer 1

a burn is an injury to the skin or tissue caused by heat or due to radiation, radioactivity, electricity, friction or contact with chemicals

Question 2

what are the WHO recommendations for treating burns?

Answer 2

• stop burning process - remove clothes and irrigate (20mins)
• extinguish flames, drop & roll, apply blanket, use water
• use cool running water to reduce temp of burn
• chemical burns - remove or dilute the agent by irrigating with large volumes of water
• wrap patient in clean cloth or sheet, transport to the nearest appropriate facility for medical care

Question 3

what are the common burns for adults and paeds?

Answer 3

paeds - scalds (13-24mths)
adults - flames (20-29 yrs)

mostly at home

Question 4

what is the burn rate for indigenous?

Answer 4

double in major cities

quadruple in regional areas

Question 5

what is a burn injury?

Answer 5

more heat is absorbed by the body’s tissue than can be managed,

Question 6

What are the types of burn?

Answer 6

thermal
chemical
mechanical
friction
radiation
electrical exposure

Question 7

What is the depth of the burn proportional to?

Answer 7

the duration of the exposure and the conductivity of the tissue

Question 8

what are the layers of the skin?

Answer 8

epidermis
dermis
subcutaneous tissue

Question 9

What is a superfiscial epidermal burn?

first degree burn?

Answer 9

superfiscial epidermal
eg. sunburn

Pathology: involves dermis only
Appearance: dry and red
Sensation: maybe painful
Circulation: normal, increased
Colour: red, warm
Blisters: none

Question 10

What is a superfiscial dermal thickness burn (partial)?

second degree burn

Answer 10

Superfiscial dermal thickness (partial)

Pathology: involves epidermis and upper dermis, most adnexal structures intact
Appearance: pale pink, small blisters, wound base blanches with pressure
Sensation: increased sensation, very painful and tender
Circulation: hyperaemic, rapid cap refil
Colour: pink
Blisters: yes (within hours)

Question 11

What is a mid dermal thickness burn (partial)?

second degree burn

Answer 11

Pathology: involves epidermis and upper dermis, most adnexal structures intact
Appearance: pale pink, small blisters, wound base blanches with pressure
Sensation: increased sensation, very painful and tender
Circulation: hyperaemic, rapid cap refil
Colour: pink
Blisters: yes (within hours)

Question 12

What is a deep dermal thickness burn (partial)?

second degree burn

Answer 12

Pathology: involves epidermis and significant part of dermis, only deeper adnexal structures in place
Appearance: blotchy red or pale deeper dermis where blisters have ruptured
Sensation: decreased sensation
Circulation: Sluggish cap refil
Colour: white/pale pink/blotchy red
Blisters: Early, usually large which rupture

Question 13

What are full thickness burns (3rd degree)

Answer 13

Pathology: epidermis, dermis and cell adnexal structures destroyed
Appearance: white waxy charred. no blisters. no cap refil
Sensation: none
Circulation: none
Colour: white/charred/black
Blisters: epidermis and dermis destroyed. No blisters

Question 14

what are the burns zones?

Answer 14

Zone of coagulation
Zone of stasis
Zone of hyperaemia

Question 15

What is the zone of coagulation

Answer 15

occurs at the point of maximal damage

irreversible tissue loss due to coagulation of the constituent proteins

Question 16

What is the zone of stasis?

Answer 16

decreases tissue perfusion

tissue is potentially salvagable. Aim of burn mgmt is to increase tissue perfusion & prevent further damage

Question 17

What is the zone of hyperaemia?

Answer 17

Outermost tissue zone, perfusion is increased and tissue will likely recover

Question 18

What is the systemic response to burns

Answer 18

over 30% TBSA:
- cytokines & other inflammatory mediators released from burn site

Cardiovascular system:
- capillary permeability

overall result: systemic hypertension and organ hypoperfusion

Question 19

what is the cardiovascular system response to burns?

Answer 19

capillary permeability:

• loss of intravascular proteins and fluids into interstitial space
• peripheral & splanchnic vasoconstriction
• decreased myocardial contractility
• fluid loss from burns

Question 20

what is the respiratory systemic response to burns

Answer 20

bronchoconstriction
ARDS (adult resp distress syndrome)

Question 21

what is the metabolic systemic response to burns

Answer 21

basal metabolic rate 3x normal rate

Question 22

what is the immune systemic response to burns?

Answer 22

decreased regulation of response

- cell mediated and humoral pathways

Question 23

wat should you consider with electrical burns?

Answer 23

• extent of injury may not be apparent
• look for entry and exit points
  dmage occurs deep
• damage progresses
• electricity contracts muscles so look for other injuries
• cardiac arrythmias may occur
• compartment syndrome is common

Question 24

how do you treat chemical burns?

Answer 24

brush off powder

prolonged irrigation

Question 25

what does hydrofluoric acid do?

Answer 25

doesn;t burn but pentrates the skin
intereferes with body calcium metabolism
can kill weeks later

Question 26

what are some issues with smoke inhalation?

Answer 26

• co (carbon monoxide) poisoning - Cherry red

- Cyanide poisoning

Question 27

How do you manage burns?

Answer 27

• cooling water for 20 minutes (effective for 3 hours)
• remove burnt clothing (leave if stuck to skin)
• remove constrictive objects (rings)
• o2 100%

Question 28

what is the ffluid TBSA burn percenatge as per av CPGS?

Answer 28

Adult:
if TBSA >15%
%burns x weight - volume
Administered 2 hours from burn injury

Patient aged 12 - 15:
if TBSA >10%
FLuids
3 X %TBSA x weight

given over 24 hours - first half in 8 hours

Question 29

What is the parkland formula for fluid in burns? For adults?

Answer 29

> 15% of TBSA
4ml/kg/ %burn / 24 hours
1st half over 8 hours
BP> 80/50 (MAP >60)

Question 30

What is the parkland formula for fluid in burns? For paeds?

Answer 30

>10% TBSA
4ml/kg/ %burns / 24 hours
1st halkf over 8 hours
birth - 1 = not <60sBP
1 - 12 = not < 70 SPB
1 - 14 = not under 70 SPB +(age x2)

Question 31

what is the rule of 9 proportions?

Answer 31

head = 9%
Arms = 9% each
Chest = 18%
Back = 18%
Legs = 18% each
Groin = 1%