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Questions and Answers
What is the primary reason for keeping the environment warm during assessment?
What is the percentage of deep partial thickness burns that indicates futile care?
Which of the following patient groups does NOT require extra fluid requirements?
What is the primary goal of in-hospital care for burn patients?
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What is the primary determinant of mortality rate in burn patients?
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What is the maximum percentage of total body surface area that can be covered in a single sitting with autologous split skin grafts?
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What is the starting point for fluid resuscitation calculation?
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What is the primary purpose of the Parkland's formula?
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Who is involved in the rehabilitation team for burn patients?
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What is the primary goal of early enteral feeding in burn patients?
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What is the recommended course of action for pigmented skin during assessment?
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What is the purpose of post-graft splinting in burn patients?
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What is the primary reason for keeping a burn patient warm during the initial assessment?
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What is the primary purpose of the secondary survey in burn patient assessment?
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What is the most accurate method of estimating burn area in adults?
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Why should erythema not be included when calculating burn area?
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What is the primary advantage of the Lund and Browder Chart in assessing burn area?
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What is the primary reason for using a urinary catheter in burn patients with >20% TBSA burns?
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What is the recommended dose of IV morphine for burn patients?
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What is the primary advantage of the palmar surface method in assessing burn area?
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What is the primary goal of the initial assessment of a major burn patient?
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What is the indication for intubation in a burn patient?
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What is the effect of carbon monoxide on the body?
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What is the treatment for carbon monoxide intoxication?
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What is the indication for ventilation in a burn patient?
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What is the primary focus of the 'C' part of the primary survey in a burn patient?
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What is a complication of electrical burns?
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What is the purpose of escharotomies?
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What is a sign of inhalational injury?
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What is the goal of the primary survey in a burn patient?
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Study Notes
Management of Burns
- Burns can be caused by thermal energy, electrical energy, and chemical energy (acid or alkaline)
- Initial assessment of a major burn involves a modified ATLS primary survey, with emphasis on airway and breathing assessment
- Burn injury must not distract from sequential assessment, as serious associated injuries may be missed
Initial Assessment of a Major Burn
- Primary survey:
- A: Airway with C Spine Control
- Assess for compromised or at-risk airway
- Signs of inhalational injury: history of flame burns, deep dermal or full-thickness burns to face, neck, or upper torso, singed nasal hair, or carbonaceous sputum
- Indications for intubation: erythema or swelling of oropharynx, change in voice, stridor, tachypnoea, or dyspnoea
- A: Airway with C Spine Control
- Breathing:
- All burn patients should receive humidified oxygen via a non-rebreathing mask
- Compromise can occur via mechanical restriction, blast injury, or smoke inhalation
- Carboxyhaemoglobin:
- CO binds preferentially to Hb and intracellular proteins, leading to intra- and extracellular hypoxia
- Signs of CO intoxication vary with COHb levels
- Rx with 100% oxygen, and ventilate patients with COHb levels > 25-30%
Initial Assessment (Continued)
- Circulation:
- Establish IV access with 2 large-bore cannulas, preferably through unburnt skin
- Hypovolaemia is not a normal initial response to a burn
- D - Neurological Disability:
- Assess GCS
- Confusion may be due to hypoxia or hypovolaemia
- E - Exposure with Environmental Control:
- Fully assess burn area and depth
- Check for concomitant injuries
- Keep warm to prevent hypothermia
- F - Fluid Resuscitation:
- Use guidelines
- Urinary catheter mandatory in burns > 20% TBSA
- Analgesia: IV morphine titrated against pain and respiratory depression
Assessment of Burn Area
- 3 commonly used methods: palmar surface, Wallace rules of nines, and Lund and Browder chart
- Erythema should not be included in burn area calculation
- Palmar surface: surface area of pt's palm is roughly 1% TBSA, but less accurate for medium-sized burns
- Wallace rules of nines: quick way to estimate large burns in adults, but not accurate in children
- Lund and Browder chart: most accurate method, compensates for variation in body shape with age, and gives accurate assessment in children
Assessment and Resuscitation
- Minor burn: TBSA < 15% in adults and < 10% in children warrant formal resuscitation
- Parkland's formula: pure crystalloid formula, easy to calculate, and rate is titrated against urine output
- Fluid resuscitation regimens: guidelines for probable amount of fluid required, continuously adjust according to urine output, pulse, BP, and RR
- Regular investigations: plasma sodium, base excess, lactate, and packed cell volume
Transfer and Care
- Who to transfer: adults with > 10% FT, > 20% deep partial, flexors, perineum, inhalation, head and neck, and children with > 5% FT, > 10% deep partial
- When is care "futile": > 60% FT with inhalation, > 70% FT without inhalation, > 80% DP
- Transfer wound coverage: Burnshield, Cling-wrap
In-hospital Care
- Prevent sepsis
- Cover with silver-containing cream
- Debride blisters
- Resuscitate
- Early enteral feeding
- Early excision and biological wound coverage
Skin Cover Options
- Autologous split skin grafts
- Living related donors
- Cadaver skin
- Synthetic analogues
- Xenografts (pig and frog)
- 20% BSA per sitting
- Tissue biopsy for MCS
Rehabilitation
- Early chest physio
- Early mobilisation
- Post-graft splinting
- ADL adaptation
- Compression garments and dynamic hand splints
- Social worker, psychologist, dietician, pastor/Imam/rabbi, family, and community involvement
- Reconstructive (plastic) surgeon
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Description
Learn about the management of burns, including assessment, resuscitation, and rehabilitation. This quiz covers the causes of burns, initial assessment, and primary survey of a major burn.
