Burn Initial Assessment and Management

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Questions and Answers

What is the primary aim of the 'E' component in the initial assessment of a burn patient?

To perform a secondary survey

To initiate fluid resuscitation

To expose the patient to assess the burn area and check for concomitant injuries (correct)

To provide analgesia to the patient

What should be considered when estimating the burn area?

The Lund and Browder chart is only used for pediatric patients

The patient's age should be considered

Erythema should be included in the estimation

Erythema should not be included in the estimation (correct)

What is the purpose of using the palmar surface method in assessing burn area?

To estimate small burns in adults (correct)

To estimate the total body surface area

To estimate large burns in adults

To estimate small burns in children

What is the recommended airway management for patients with >60% FT with inhalation?

Secure airway but don't ventilate Signup and view all the answers

Why is the Lund and Browder chart preferred in children?

Because it compensates for variation in body shape with age Signup and view all the answers

Which of the following is not a criterion for transferring children to a burn center?

Inhalation injuries Signup and view all the answers

Why is it important to touch the wounds during the assessment of burn area?

To accurately assess the burn area Signup and view all the answers

What is the primary goal of fluid resuscitation in burn patients?

Resuscitate Signup and view all the answers

What is the recommended analgesic for patients with large burns?

IV morphine Signup and view all the answers

What type of dressings are used for transfer wound coverage?

Cling-wrap Signup and view all the answers

What is the recommended percentage of BSA for skin grafting per sitting?

20% BSA Signup and view all the answers

Why is a urinary catheter mandatory in burns >20% TBSA?

To monitor urine output Signup and view all the answers

Which of the following is not a part of the rehabilitation team?

Orthopedic surgeon Signup and view all the answers

What is the purpose of the secondary survey?

To identify concomitant injuries Signup and view all the answers

What type of energy is responsible for burns?

Thermal energy Signup and view all the answers

What is the primary focus of the primary survey in a major burn patient?

Assessment of the airway and breathing Signup and view all the answers

What is an indication for intubation in a major burn patient?

Erythema or swelling of oropharynx on direct visualisation Signup and view all the answers

What is the effect of carboxyhaemoglobin on the body?

It leads to intra- and extracellular hypoxia Signup and view all the answers

What is the recommended treatment for carboxyhaemoglobin intoxication?

100% oxygen Signup and view all the answers

What is the indication for ventilation in a major burn patient?

pH < 7.2 Signup and view all the answers

How should IV access be established in a major burn patient?

With 2 large bore cannulas, preferably through unburnt skin Signup and view all the answers

What is the primary cause of hypotension in a major burn patient?

All of the above Signup and view all the answers

What is the significance of a deep dermal or full thickness burn to the chest?

It can limit chest excursion and prevent adequate ventilation Signup and view all the answers

What is the primary goal of the primary survey in a major burn patient?

To identify any life-threatening injuries Signup and view all the answers

Study Notes

Initial Assessment of Burn Patients

Primary survey is similar to any trauma patient, with emphasis on airway and breathing assessment
Modified ATLS primary survey performed to avoid missing serious associated injuries
Airway assessment:
- Compromised or at risk of compromise
- Signs of inhalational injury:
  - History of flame burns or burns in an enclosed space
  - Deep dermal or full thickness burns to face, neck, or upper torso
  - Singed nasal hair
  - Carbonaceous sputum or carbon particles in oropharynx
Indications for intubation:
- Erythema or swelling of oropharynx on direct visualization
- Change in voice, with hoarseness or harsh cough
- Stridor, tachypnoea, or dyspnoea

Breathing Assessment

All burn patients receive humidified oxygen via a non-rebreathing mask
Compromise can occur via:
- Mechanical restriction of breathing
- Deep dermal or full-thickness circumferential burns of the chest
- Blast lung can complicate ventilation
- Lung contusions and alveolar trauma can lead to ARDS
- Penetrating injuries can cause pneumothoraces
Smoke inhalation:
- Products of combustion act as direct irritants
- Resultant bronchospasm, inflammation, bronchorrhoea, and impaired ciliary action

Circulation Assessment

Establish IV access with 2 large-bore cannulas, preferably through unburnt skin
Hypovolaemia is not the normal initial response to a burn
Hypotension may be due to delayed presentation, cardiogenic dysfxn, or occult blood loss (chest, abdo, pelvis)

Neurological Disability

Assess GCS
Confusion?

Assessment of Burn Area

3 commonly used methods:
- Palmar surface method
- Wallace rule of nines
- Lund and Browder chart
Important to expose and assess all burn wounds

Resuscitation

Fluid resuscitation using guidelines
Urinary catheter mandatory in burns >20% TBSA
Analgesia: IV morphine dose titrated against pain and respiratory depression

Transfer Criteria

Adults:
- >10% FT
- >20% deep partial
- Flexors
- Perineum
- Inhalation
- Head and neck
Children:
- >5% FT
- >10% deep partial
- Rest as for adults

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Description

Learn about the initial assessment and management of burn patients, including controlling environmental factors, fluid resuscitation, and analgesia. This quiz covers key steps in treating burns and preventing complications.