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Questions and Answers
What is the underlying process that defines a burn?
What is the underlying process that defines a burn?
- Liquefactive necrosis of the epidermis
- Coagulative destruction of tissues (correct)
- Ischemic infarction of dermal layers
- Fibrotic replacement of subcutaneous fat
Which type of burn is caused by contact with electricity?
Which type of burn is caused by contact with electricity?
- Chemical burn
- Electrical burn (correct)
- Thermal injury
- Contact burn
According to the Rule of Nines, what percentage of the total body surface area (TBSA) does the chest and abdomen represent in an adult?
According to the Rule of Nines, what percentage of the total body surface area (TBSA) does the chest and abdomen represent in an adult?
- 9%
- 18%
- 36% (correct)
- 27%
A patient has burns covering 30% of their body. According to burn severity grades, how would this burn be classified?
A patient has burns covering 30% of their body. According to burn severity grades, how would this burn be classified?
Which of the following best describes a superficial burn?
Which of the following best describes a superficial burn?
How long does a superficial partial thickness burn typically take to heal?
How long does a superficial partial thickness burn typically take to heal?
What is the primary method of epithelial regain in full thickness burns?
What is the primary method of epithelial regain in full thickness burns?
Why is skin grafting typically required for full thickness burns?
Why is skin grafting typically required for full thickness burns?
Which of the following is NOT apart of the pathophysiology of burns?
Which of the following is NOT apart of the pathophysiology of burns?
What is the zone of stasis in a burn injury?
What is the zone of stasis in a burn injury?
What is the most common cause of death in the early stages (within 4-7 days) following a major burn injury?
What is the most common cause of death in the early stages (within 4-7 days) following a major burn injury?
What is the immediate treatment for constricting eschar in circumferential burns?
What is the immediate treatment for constricting eschar in circumferential burns?
What is a Marjolin's ulcer?
What is a Marjolin's ulcer?
After ensuring breathing and circulation, what is the next immediate step in the initial management of a burn victim?
After ensuring breathing and circulation, what is the next immediate step in the initial management of a burn victim?
Why is intramuscular (IM) administration of pain medication generally avoided in the initial management of burn patients?
Why is intramuscular (IM) administration of pain medication generally avoided in the initial management of burn patients?
In the context of burn management, what is the purpose of using a Foley catheter?
In the context of burn management, what is the purpose of using a Foley catheter?
According to the fluid resuscitation guidelines, what type of intravenous fluids are typically administered in the first 24 hours post-burn?
According to the fluid resuscitation guidelines, what type of intravenous fluids are typically administered in the first 24 hours post-burn?
According to the Parkland formula, how is the total amount of Ringer's Lactate to be administered in the first 24 hours calculated?
According to the Parkland formula, how is the total amount of Ringer's Lactate to be administered in the first 24 hours calculated?
What is a key difference between the exposure method and the occlusive method in local burn wound care?
What is a key difference between the exposure method and the occlusive method in local burn wound care?
In which of the following situations would the exposure method of local burn wound care be most appropriate?
In which of the following situations would the exposure method of local burn wound care be most appropriate?
What is the purpose of tangential excision in surgical burn treatment?
What is the purpose of tangential excision in surgical burn treatment?
When is the optimal timing for surgical excision and grafting of burn wounds, relative to bacterial contamination?
When is the optimal timing for surgical excision and grafting of burn wounds, relative to bacterial contamination?
A patient presents with a burn that involves the epidermis and the first layer of the dermis with erythema. Which type of burn does this describe?
A patient presents with a burn that involves the epidermis and the first layer of the dermis with erythema. Which type of burn does this describe?
What systemic complication of burns is most directly related to loss of fluids?
What systemic complication of burns is most directly related to loss of fluids?
What is the purpose of chemoprophylaxis in initial burn management?
What is the purpose of chemoprophylaxis in initial burn management?
What is the appropriate management for minor burns that can be treated on an outpatient basis?
What is the appropriate management for minor burns that can be treated on an outpatient basis?
What is NOT an advantage of the occlusive method for local care of a burn wound?
What is NOT an advantage of the occlusive method for local care of a burn wound?
What are the hot gases inhalation under inhalation burns?
What are the hot gases inhalation under inhalation burns?
Which of the following best explains the primary mechanism by which burns cause tissue damage?
Which of the following best explains the primary mechanism by which burns cause tissue damage?
A patient presents with a burn characterized by blisters and significant pain, involving both the epidermis and a portion of the dermis. Which classification of burn is most consistent with these findings?
A patient presents with a burn characterized by blisters and significant pain, involving both the epidermis and a portion of the dermis. Which classification of burn is most consistent with these findings?
A patient has a burn that extends through the epidermis and dermis, with visible eschar formation. After eschar separation, granulation tissue is evident. What is the most appropriate next step in management?
A patient has a burn that extends through the epidermis and dermis, with visible eschar formation. After eschar separation, granulation tissue is evident. What is the most appropriate next step in management?
According to the 'Rule of Nines' in adults, what percentage of total body surface area (TBSA) is represented by the entire back?
According to the 'Rule of Nines' in adults, what percentage of total body surface area (TBSA) is represented by the entire back?
A patient has full thickness burns covering 40% of their total body surface area (TBSA). Which systemic response is LEAST likely to occur during the acute phase?
A patient has full thickness burns covering 40% of their total body surface area (TBSA). Which systemic response is LEAST likely to occur during the acute phase?
What is the primary rationale for avoiding intramuscular (IM) injections in the initial resuscitation of a patient with extensive burns?
What is the primary rationale for avoiding intramuscular (IM) injections in the initial resuscitation of a patient with extensive burns?
According to the Parkland formula, how would the estimated fluid requirement be calculated for a 70 kg patient with burns covering 50% of their total body surface area (TBSA) in the first 24 hours?
According to the Parkland formula, how would the estimated fluid requirement be calculated for a 70 kg patient with burns covering 50% of their total body surface area (TBSA) in the first 24 hours?
In the context of burn wound management, what is the primary purpose of tangential excision?
In the context of burn wound management, what is the primary purpose of tangential excision?
A patient with circumferential full thickness burns on the chest develops respiratory distress. What is the MOST appropriate immediate intervention?
A patient with circumferential full thickness burns on the chest develops respiratory distress. What is the MOST appropriate immediate intervention?
What is the MOST concerning long-term complication associated with a non-healing burn wound?
What is the MOST concerning long-term complication associated with a non-healing burn wound?
Which of the following is the MOST critical factor in determining the need for transfer to a specialized burn center?
Which of the following is the MOST critical factor in determining the need for transfer to a specialized burn center?
During the acute phase of burn management, which of the following is the MOST important strategy to prevent bacterial colonization and subsequent infection?
During the acute phase of burn management, which of the following is the MOST important strategy to prevent bacterial colonization and subsequent infection?
A patient with a significant burn injury develops acute oliguria. What is the MOST likely underlying cause in the first 48 hours post-burn?
A patient with a significant burn injury develops acute oliguria. What is the MOST likely underlying cause in the first 48 hours post-burn?
Which of the following is the MOST significant advantage of using the exposure method in local burn wound care?
Which of the following is the MOST significant advantage of using the exposure method in local burn wound care?
In the management of inhalation burns, what is the rationale for considering early bronchoscopy?
In the management of inhalation burns, what is the rationale for considering early bronchoscopy?
A patient with extensive burns develops Curling's ulcer. What is the underlying mechanism leading to the formation of this type of ulcer?
A patient with extensive burns develops Curling's ulcer. What is the underlying mechanism leading to the formation of this type of ulcer?
Which of the following best describes the zone of stasis in a burn wound, according to Jackson's burn zones?
Which of the following best describes the zone of stasis in a burn wound, according to Jackson's burn zones?
What is the MOST appropriate initial step in managing a patient with suspected inhalation injury from a fire?
What is the MOST appropriate initial step in managing a patient with suspected inhalation injury from a fire?
A patient with extensive burns develops septic shock five days post-injury. What is the MOST likely source of infection in this scenario?
A patient with extensive burns develops septic shock five days post-injury. What is the MOST likely source of infection in this scenario?
Which of the following is the MOST appropriate method for providing analgesia in the acute management of a patient with severe burns?
Which of the following is the MOST appropriate method for providing analgesia in the acute management of a patient with severe burns?
Which of the following is a key advantage of using silver sulfadiazine in local burn wound care?
Which of the following is a key advantage of using silver sulfadiazine in local burn wound care?
A patient with a burn injury is being resuscitated with intravenous fluids. What clinical parameter is the MOST important to monitor to ensure adequate fluid resuscitation?
A patient with a burn injury is being resuscitated with intravenous fluids. What clinical parameter is the MOST important to monitor to ensure adequate fluid resuscitation?
Which of the following systemic complications is MOST directly associated with the loss of skin integrity and barrier function in burn patients?
Which of the following systemic complications is MOST directly associated with the loss of skin integrity and barrier function in burn patients?
Why is tetanus prophylaxis a routine component of initial burn management?
Why is tetanus prophylaxis a routine component of initial burn management?
What is the key difference between the exposure method and the occlusive method in local burn wound care, concerning bacterial control?
What is the key difference between the exposure method and the occlusive method in local burn wound care, concerning bacterial control?
What is the most concerning risk associated with hot gases inhalation under inhalation burns?
What is the most concerning risk associated with hot gases inhalation under inhalation burns?
What is the primary advantage of using crystalloids over colloids for initial fluid resuscitation in burn patients?
What is the primary advantage of using crystalloids over colloids for initial fluid resuscitation in burn patients?
Which of the following factors primarily dictate the choice between using crystalloids alone versus a combination of crystalloids and colloids in burn resuscitation?
Which of the following factors primarily dictate the choice between using crystalloids alone versus a combination of crystalloids and colloids in burn resuscitation?
Flashcards
Burn definition
Burn definition
Coagulative destruction of tissues.
Contact burn
Contact burn
Scalds caused by contact with boiled liquids.
Chemical Burns
Chemical Burns
Burns caused by acids or alkalis.
Wallace's Rule of Nines
Wallace's Rule of Nines
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Head & neck % in burns
Head & neck % in burns
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Major burn
Major burn
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Superficial burn
Superficial burn
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Superficial Partial Thickness Burn
Superficial Partial Thickness Burn
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Deep partial thickness
Deep partial thickness
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Full Thickness Burn
Full Thickness Burn
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Pathophysiology of burns
Pathophysiology of burns
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Zone of coagulation
Zone of coagulation
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Zone of stasis
Zone of stasis
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Neurogenic shock after a burn
Neurogenic shock after a burn
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Hypovolemic shock after burns
Hypovolemic shock after burns
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Curling's ulcer
Curling's ulcer
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Early Infection post-burn
Early Infection post-burn
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Escharotomy
Escharotomy
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Scar formation
Scar formation
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Marjolin's ulcer
Marjolin's ulcer
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Cooling the burn
Cooling the burn
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Pain killer route
Pain killer route
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Parkland formula
Parkland formula
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Type of Fluids
Type of Fluids
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Constricting eschar
Constricting eschar
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Topical antimicrobials
Topical antimicrobials
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Occlusive Method
Occlusive Method
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Timing
Timing
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Thermal Injury
Thermal Injury
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Electrical Burns
Electrical Burns
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Cold Injury
Cold Injury
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Burn Percentage Estimation
Burn Percentage Estimation
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Chest & abdomen % in burns
Chest & abdomen % in burns
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Upper limb % in burns
Upper limb % in burns
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Lower Limb % in burns
Lower Limb % in burns
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Perineum % in burns
Perineum % in burns
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Intermediate burn
Intermediate burn
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Fourth Degree Burn
Fourth Degree Burn
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Zone of Hyperemia
Zone of Hyperemia
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Inhalation Injury
Inhalation Injury
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Renal Failure after a burn
Renal Failure after a burn
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Causes Death in Burn
Causes Death in Burn
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IV Cannulation
IV Cannulation
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Checking UOP
Checking UOP
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Fluid Therapy Timing
Fluid Therapy Timing
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Fluid Amount
Fluid Amount
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Study Notes
- Burn is the coagulative destruction of tissues
Types of Burns
- Physical burns include contact burns (scalds from boiled liquids), thermal injury (flame burns), exposure to irradiation, electrical burns (contact with electricity), and cold injury (frost bite)
- Chemical burns are caused by acids, alkalis, and corrosives/caustics
- Inhalation burns come from hot gases
Classification of Burn by Area Affected (Adult Wallace's Rule of 9)
- Head & neck: 9% (4.5% front & 4.5% back)
- Chest & abdomen: 36% (18% front & 18% back)
- Upper limb: 9% (4.5% front & 4.5% back)
- Lower limb: 18% (9% front & 9% back)
- Perineum: 1%
- Major burn: more than 25% of body
- Intermediate burn: 15-25% of body
- Minor burn: less than 15% of body
Classification of Burn by Depth of Tissue
- Superficial burn (1st degree): involves the epidermis only, like a sunburn, and heals rapidly within 5-10 days
- Partial thickness burn (2nd degree), Superficial: involves the epidermis and 1st layer of dermis, causes erythema, and heals rapidly within 10-14 days
- Partial thickness burn (2nd degree), Deep: involves the epidermis and 2nd layer of dermis, heals within 3-6 weeks from remnants of hair follicle & sweat glands, may become full thickness if infected
- Full thickness burn (3rd degree): involves the epidermis and dermis completely, epithelial regain by epithelial migration is slow, requires skin graft after eschar separation in the 3rd week
- Fourth degree burn: involves underlying tissues like tendon, muscle & bone
Pathophysiology
- Protein denaturation occurs because of very high temperatures
- Increased capillary permeability
- Excessive loss of water
- Bacterial colonization
Burn Zones (Jackson's Zones)
- Central inner zone: zone of coagulation
- Intermediate zone: zone of stasis
- Outer zone: zone of hyperemia
Systemic Complications
- Inhalation injury: can cause asphyxia, pneumonia, atelectasis, emboli, edema, emphysema, and respiratory failure
- Neurogenic shock: occurs immediately due to pain
- Hypovolemic shock: occurs in the first 48 hours due to fluid loss
- Renal failure: can be acute due to prolonged hypovolemia, resulting in oliguria
- CVS: anemia
- Endocrine changes: increased ADH, cortisol, and catecholamines
- Septic shock: due to infection
- GIT: acute ulcer development in the stomach and duodenum (Curling's ulcer) & ileus
- Multiple organ failure: due to respiratory failure and sepsis
Local Complications - Early
- Infection (1st cause of death): within 4-7 days, can cause septicemia & septic shock and is prevented by antibiotics & proper wound care
- Constricting eschar: deep circumferential burns in chest & limbs, treated by escharotomy
- Edema in face & neck burns: causes suffocation, treated by tracheostomy
Local Complications - Delayed
- Contracture around joints
- Scar formation (hypertrophic scar/keloid)
- Malignant transformation (Marjolin's ulcer)
Causes of Death in Burn
- Hypovolemia & shock
- Renal failure
- Pulmonary oedema & ARDS
- Septicemia
- Multiorgan failure
- Acute airway block in head & neck burns
Management - Initial (1st Aid)
- Clothing should be removed
- Cooling the part by running water for 20 minutes
- Cleaning the part to remove dust & mud
- Chemoprophylaxis: tetanus toxoid, antibiotics & local antiseptics
- Covering with dressings
- Comforting the patient with sedation & pain killer (IV 50 mg pethidine, not IM due to poor absorption)
Management - Minor Burns (Outpatient)
- Dressing
- Antibiotics prophylaxis
- Analgesics
Management - Moderate & Major Burns (Burn Unit Hospitalization)
- Insert a wide bore IV cannula rapidly before veins get collapsed
- Foley's catheter to check UOP
- Fluid therapy
- Local care of the burn wound
Fluid Therapy (Depends on Percent of Burn & Weight of Patient)
- In the first 24 hours, give 2 ml/percent area burnt/kg weight (half in first 8 hours, the rest in the next 16). Give half the calculated amount on the 2nd day
- Use only crystalloids (saline or Ringer's lactate) or half crystalloids and half colloids (dextran)
- Caloric daily needs are supplemented by 2000 ml of glucose 5%
Fluid Therapy Formulas
- Evan's formula (1st day): 1 ml/kg/% burn normal saline + 1 ml/kg/% burn colloid + 2000 ml glucose, (2nd day): 0.5 ml/kg/% burn normal saline + 0.5 ml/kg/% burn colloid + 2000 ml glucose
- Modified Brook's formula (1st day): 2-3 ml/kg/% burn Ringer's lactate + 2000 ml glucose, (2nd day): 1 ml/kg/% burn Ringer's lactate + 0.5 ml/kg/% burn colloid + 2000 ml glucose
- Parkland's formula: 4 ml/kg Ringer's lactate x percent area per day
Local Care of Burn Wound
- Constricting eschar: only constricting eschars are released immediately
- Deep burns: need fasciotomy to save limbs
- Topical antimicrobials: silver nitrate & silver sulphadiazine
- Good cleansing: conservative debridement & remove loose skin
- Exposure method: isolate the patient in a complete aseptic room and use complete aseptic techniques, this is indicated in neck, face, perineum & side of trunk and has advantages such as inhibiting bacteria and increased comfort for patients
- Occlusive method: Clean the wound by aseptic solution, apply silver sulphadiazine ointment, and cover with vaseline gauze that is changed every 2-3 days. Indicated in circumferential burns, hands, and limbs. Advantages ↓ fluid loss evaporation, ↓ edema of tissues & ↓ pain
Surgical Treatment
- Timing: 3-5 days before bacterial contamination
- Procedure: tangential excision of dermis with immediate grafting or grafting delayed until granulation tissue is present
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