Environmental

Question 1

Difference between acid and alkali burns

Answer 1

Alkalis penetrate deeper than acids and those presenting with alkali burns (commonly due to cement) will require immediate attention.

Question 2

Key Ix after any electrical burn

Answer 2

ECG

Question 3

Jackson’s Burn wound model is made up of 3 zones

Answer 3

Zone of Coagulation: occurs at the point of maximum damage i.e. the nearest point to the heat source. There is irreversible tissue necrosis here due to coagulation of proteins.

Zone of Stasis: surrounding the zone of coagulation, this area is characterised by decreased tissue perfusion. It is damaged but potentially viable. If the burn is managed correctly it has the potential to be salvaged, otherwise it could evolve into an area of necrosis.

Zone of Hyperaemia: the outermost zone as its name suggests is where there is increased tissue perfusion. This is a reversible zone.

Question 4

Important to check what on the VBG of a burns patient?

Answer 4

Carbon monoxide

Question 5

If there is any restriction to chest movement in a burns patient, where should they be referred to?

Answer 5

Burns centre

Question 6

What burns % is fluid resus needed?

Answer 6

Adults TBSA 15%
Children TBSA 10%

Question 7

In limb circumferential burns what should be re-assessed regularly?

Answer 7

Perfusion / pulses

Question 8

Blood test for muscle breakdown

Answer 8

CK

Question 9

What burns are not included when calculating the burn %TBSA

Answer 9

Epidermal burns

Question 10

When is a burn considered tetanus prone?

Answer 10

in conjunction with signs of systemic sepsis

Question 11

Parklands formula

Answer 11

3mlxkgxTBSA

Half given in the 1st 8hrs

Question 12

In patients with electrical burns to a limb always be highly suspicious of…

Answer 12

Compartment syndrome

Question 13

Tissue damage from electrical burns can lead to failure of what?

Answer 13

Kidney failure

If urine is pigmented - double UO targets

Question 14

UO targets in burns patients

Answer 14

0.5ml/kg/hr

Children = 1ml/kg/hr

Question 15

The minimum threshold for referral to burns centre:

Answer 15

All burns ≥2% TBSA in children or ≥3% TBSA in adults
All full thickness burns
All circumferential burns
Any burn not healed in 2 weeks
Any burn with suspicion of non-accidental injury should be referred to a burn unit/centre for expert assessment within 24 hours

Question 16

Escharotomy - cut down to

Answer 16

Fat

Question 17

When are antibiotics needed for dog bites

Answer 17

Considerable tissue damage
High risk areas (hands, feet, face, genitals)
Immunocompromised

Question 18

Abx for cat & human bites

Answer 18

Short course co-amox (or doxy and metro if pen allergic)

+ tetanus

Question 19

In a clinical setting, after a sharps injury from a known infected source, the risk of seroconversion (becoming infected) is

Answer 19

Hepatitis B (HBV): Approximately a 1 in 3 chance (or 30%) of transmission if the healthcare worker is not immunised.

Hepatitis C (HCV): Approximately a 1 in 30 chance (or 3%) of transmission.

HIV: Approximately a 1 in 300 chance (or 0.3%) of transmission

Question 20

Vaccine hx in BBV exposure?

Answer 20

Hep B
Tetanus

Question 21

Which acid is neutralised as part of burns treatment

Answer 21

Hydrofluoric acid with calcium gluconate gel

Question 22

Mainstay of chemical burns treatment

Answer 22

Continuous irrigation for 30 mins