Burns

Question 1

What are some signs and symptoms of an airway burn?

Answer 1

• evidence of burns to upper torso, neck and face
• facial and upper airway oedema
• sooty sputum
• burns that occurred in an enclosed space
• singed facial hair (nasal, eyebrows, eyelashes, beards)
• respiratory distress (Dyspnoea +/- wheeze and associated tachycardia, stridor)
• hypoxia (restlessness, irritability, cyanosis, decreased GCS)

Question 2

What are intubated burns patients at risk of?

Answer 2

hypothermia. Once a long term paralytic is administered, temperature management becomes a more significant priority

Question 3

If a patient has a burn and requires fluid for another reason which guideline do you follow?

Answer 3

volume replacement is calculated for the burn injury only. Manage other injuries accordingly including the requirement for additional fluid

Question 4

what are patients with electrical burns at risk of?

Answer 4

acute kidney injury secondary to profound muscle damage, they may require extra fluid

Question 5

Can you use the treat and refer guideline for a burn?

Answer 5

only if the burn is small, isolated, superficial burn with unbroken skin or sunburn

Question 6

what is the time critical trauma criteria for burns? where should they be transported? and in what time frame?

Answer 6

• >20% TBSA
• >10% TBSA (<15 years old)
• suspected airway burns
• >1000 volt electrical burns
• Alfred/RCH
• <60mins

Question 7

Burns in what area of the body require assessment by a major burns service?

Answer 7

• burns involving the face, hands, feed, genitalia, major joints or circumferential burns of the chest or limbs

Question 8

What is the best way to cool a burn?

Answer 8

• with cool running water between 5-15 degrees for 20 mins

Question 9

When do you stop cooling a burn?

Answer 9

• if the patient begins shivering or has a temp <35 degrees

Question 10

How do you cool a burn if running water is not available?

Answer 10

cooling can be achieved by immersing the injury in still water, using a spray bottle or applying moist towels

Question 11

how long should a chemical burn be irrigated?

Answer 11

For along as the pain persists. avoid washing chemicals onto unaffected areas, especially eyes

Question 12

can you removed burnt clothing, or clothing with chemicals or hot liquid on it?

Answer 12

Remove burnt clothing or clothing containing chemicals or hot liquid when safe to do so. Do not remove any matter that is adhered to underlying tissue. Remove jewellery prior to swelling occuring

Question 13

how do you minimise swelling?

Answer 13

if clinically appropriate, elevation of the affected area during transport will minimise swelling and oedema, especially in circumferential burns

Question 14

Can you use cling wrap on a burn?

Answer 14

Cling wrap is an appropriate burns dressing and is preferred for all burns. It should be applied longitudinally to allow for swelling

Question 15

What is the breakdown of the Wallace rule of nines?

Answer 15

• Head 9%
• Torso 18% (abdo and chest) and 18% back
• Arm 9% in total cirumference (each)
• Leg 18% in total circumference (each)
• groin 1%

Question 16

What age group does the Wallace rule of nines cover?

Answer 16

10 years - adult

Question 17

Recite the Burns CPG

Answer 17

Question 18

What is the fluid formula for patients >15 yrs with TBSA burns >15%

Answer 18

% TBSA x pt weight (kg) = vol (mls)

Question 19

What is the fluid formula for patients 12-15 yrs with TBSA burns >10%

Answer 19

3 x %TBSA x pt weight (kg) = vol (ml)

Question 20

What is the Jackson Burn Wound Model?

Answer 20

• Zone of hyperaemia
  
  • This area is hyper-perfused and will recover if there are no complications (superficial/1st degree)
• Zone of Stasis
  
  • Tissue directly surrounding the burn that is hypo-perfused. This may be salvageable with appropriate treatment (partial thickness)
• Zone of coagulation
  
  • Irreversible damage to cell and coagulation of proteins (full thickness)

Question 21

What are the 3 layers of skin?

Answer 21

• Epidermis
• Dermis
• Subcutaneous fat

Question 22

When layer of skin do superficial burns effect?

Answer 22

Epidermis

Question 23

What layers of skin do partial thickness burns affect?

Answer 23

• superficial dermal
• mid dermal
• deep dermal

Question 24

What layers of skin do full thickness burns effect?

Answer 24

• epidermis
• dermis
• and possibly subcut
• maybe even muscle and bone