Burns

Question 1

Functions of the skin

Answer 1

Thermoregulation
Sensory input
Immune response
Control fluid loss
Metabolic 
Psychosocial

Question 2

Jackson’s burn wound model

Answer 2

Zone of coagulation: irreversible
Zone of stasis: changing
Zone of hyperaemia: reversible

Question 3

Systemic effects of burns

Answer 3

• Release of inflammatory mediators
• Release of stress hormones
• Suppress immune response system
• Acute respiratory distress syndrom

Question 4

Circulatory effects of burns

Answer 4

• Increases capillary permeability
• Loss of fluid
• Loss of albumin
• Oedema formation

Question 5

Metabolic effects of burns

Answer 5

• Increases HR
• Increase temp
• Protein wasting
• Infection

Question 6

First aid

Answer 6

1. Stop the burn
   - Stop, drop, cover, roll
   - Remove clothes
   - Brush off dry chemical
2. Cool the burn
   - 20-30mins under water
   - Avoid hypothermia

Question 7

Burns depth

Answer 7

Epidermal burn

• Red
• Brisk cap refil
• Heal 3-7 days: moisturiser, protective dressing

Superficial dermal burn

• Pink
• Brisk cap refil
• Blisters
• 7-14 days: min dressing (antimicrobial, silicone, hydrocolloid)

Mid dermal burn

• Dark pink
• Sluggish cap refil
• Heterogenous
• 2-3 weeks: ?Surgery

Deep dermal burn

• Blotchy red/white
• Absent cap refil
• Heterogenous
• Surgery, referral

Full thickness burn

• White, brown, red, black
• Dead tissue and skin
• Surgery, long-term scar management

Question 8

Surface area assessment

Answer 8

Rule of 9s

• F+N: 9
• Arms: 18
• Front: 18
• Back: 18
• LL: 18
• RL: 18
• Perineum: 1

Question 9

Fluid management

Answer 9

• Modified parkland formula: TBSA x weight x 3
• Hartmanns solution: 8hrs 1/2, 16hrs 1/2
• Revise according to urine output: 0.5mL/hr (reflects perfusion)

Extra fluid:

• Inhalation injury
• Electrical injury
• Delayed resus
• Dehydration

Question 10

Escharotomy

Answer 10

Full circumferential burn to relieve pressure from rigid burnt skin

• Limbs: venous occlusion
• Chest: limit expansion

Question 11

Burns pt nursing management

Answer 11

Acute:

• First aid
• Primary survey
• Fluid resuscitation
• Cling wrap, dry sheet
• Oxygenation (early intubation)
• Escharotomy
• Transfer: analgesia, wrap, keep warm, documentation

Long-term:

• Referral
• Pain management
• Blisters
• Dressing

Question 12

Complications of burns patients

Answer 12

Acute:

• Hypothermia
• Hypovolaemia
• Infection

Further:

• Shock
• Sepsis
• Pulmonary
• Heart failure
• Cerebral oedema
• Death

Question 13

Burns A-E assessment

Answer 13

A: intubate early
B: oxygenation, circumferential burn
C: fluid resus
D: GCS, pupils
E: prevent hypothermia