Burn Management: Assessment, Resuscitation, and Rehabilitation

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Questions and Answers

What is a key consideration when assessing the burn area?

The weight of the patient

The surface area involved (correct)

The age of the patient

The medical history of the patient

Why may it be necessary to remove loose epidermal layers when assessing pigmented skin?

To calculate burn size (correct)

To assess the patient's age

To determine the patient's medical history

To calculate burn depth

What is the percentage of TBSA that warrants formal resuscitation in children?

More than 10% (correct)

15% or less

10% or less

20% or more

What is the starting point for calculating fluid resuscitation using the Parkland's formula?

Time of injury Signup and view all the answers

Which of the following patient groups require extra fluid requirements?

Children, inhalational injury, electrical injury, delayed resuscitation, and dehydrated or intoxicated patients Signup and view all the answers

What is the purpose of continuously adjusting fluid resuscitation regimens?

To monitor the patient's response to treatment Signup and view all the answers

What is the primary goal of in-hospital care for burn patients?

Prevent sepsis Signup and view all the answers

Which of the following is not an option for skin cover in burn patients?

Living unrelated donors Signup and view all the answers

When is care considered 'futile' for burn patients?

>60% FT with inhalation Signup and view all the answers

What is the primary role of a social worker in burn patient rehabilitation?

Supporting the patient's family and community Signup and view all the answers

What is the recommended wound coverage for burn patients during transfer?

Cling-wrap Signup and view all the answers

What is the primary goal of early mobilization in burn patient rehabilitation?

Enhancing respiratory function Signup and view all the answers

What is a critical aspect of exposure in the primary survey of a burn patient?

Keeping the patient warm to prevent hypothermia Signup and view all the answers

What percentage of Total Body Surface Area (TBSA) burn requires a urinary catheter?

20% Signup and view all the answers

When calculating burn area, what should be excluded?

Erythema Signup and view all the answers

What is the surface area of a patient's palm, including fingers, roughly equivalent to?

1% TBSA Signup and view all the answers

What method of estimating burn area is quick and suitable for large burns in adults?

Wallace rules of nines Signup and view all the answers

What is the most accurate method of assessing burn area, if used correctly?

Lund and Browder Chart Signup and view all the answers

What is important to do when assessing the burn area?

Touch the wounds to assess the burn area Signup and view all the answers

What is a critical aspect of analgesia in burn patients?

Titrating IV morphine against pain and respiratory depression Signup and view all the answers

What type of energy can cause burns?

Thermal energy Signup and view all the answers

What is the primary focus of the initial assessment of a major burn?

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

What is a sign of inhalational injury?

Singed nasal hair Signup and view all the answers

When should intubation be considered in a burn patient?

When the patient has a Change in voice, with hoarseness or harsh cough Signup and view all the answers

What is a complication of mechanical restriction of breathing in burn patients?

Escharotomies Signup and view all the answers

What is the effect of carboxyhaemoglobin on the body?

Intra- and extracellular hypoxia Signup and view all the answers

When should a burn patient be ventilated?

When the patient has a COHb level greater than 25 – 30% Signup and view all the answers

What is a indication for ventilation in a burn patient?

CXR shows an “ARDS-like” picture Signup and view all the answers

What is the primary focus of the 'C' component of the primary survey in a burn patient?

Establishing IV access Signup and view all the answers

What should be administered to all burn patients?

Humidified oxygen Signup and view all the answers

Study Notes

Management of a Burn – Assessment, Resuscitation & Rehabilitation

Causes of Burns

Thermal energy
Electrical energy
Chemical (acid or alkaline)

Initial Assessment of a Major Burn

Primary Survey

Modified ATLS primary survey
Emphasis on airway and breathing assessment
Serious associated injuries may be missed if not followed sequentially

Airway with C Spine Control

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 visualisation
Change in voice, with hoarseness or harsh cough
Stridor, tachypnoea, or dyspnoea

Breathing

All burn patients should 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 injury (blast lung, lung contusions, alveolar trauma, and pneumothoraces)
Smoke inhalation (products of combustion act as direct irritants, leading to bronchospasm, inflammation, bronchorrhoea, and impaired ciliary action)

Circulation

Establish IV access with 2 large bore cannulas, preferably through unburnt skin
Profound hypovolaemia is not the normal initial response to a burn

Neurological Disability

Assess GCS
Confusion ?Hypoxia or hypovolaemia

Exposure with Environmental Control

Fully assess burn area and depth
Check for concomitant injuries
Keep warm – burn patients easily become hypothermic, leading to hypoperfusion and deepening of burn wounds

Fluid Resuscitation

Using guidelines
Urinary catheter mandatory in burns >20% TBSA

Analgesia

All patients with large burns should receive IV morphine, titrated against pain and respiratory depression

Assessment of Burn Area

Methods of Estimating Burn Area

Palmar surface (roughly 1% TBSA)
Wallace's rule of nines (quick way of estimating large burns in adults)
Lund and Browder chart (most accurate method, compensates for variation in body shape with age)

Important Considerations

Erythema should not be included when calculating burn area
Use a warm environment and sequentially expose small segments of skin to reduce heat loss
Pigmented skin can be difficult to assess; may need to remove loose epidermal layers to calculate burn size

Resuscitation

Fluid Resuscitation Regimens

The Parkland formula is commonly used
The starting point is the time of injury, not time of admission
Certain patient groups require extra fluid requirements (children, inhalational injury, electrical injury, delayed resuscitation, and dehydration or intoxicated patients)

Transfer and Care

Who to Transfer

Adults: >10% full thickness, >20% deep partial, flexors, perineum, inhalation, head and neck
Children: >5% full thickness, >10% deep partial (Red Cross Hospital)

When Care is "Futile"

>60% full thickness with inhalation
>70% full thickness without inhalation
>80% deep partial
What to do:
Secure airway (don't ventilate)
Adequate analgesia (IV)
Catheter
Counsel family and call spiritual leader

In-Hospital Care

Prevention of 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 (expensive)
Xenografts (pig and frog)
20% BSA per sitting
Tissue biopsy for MCS

Rehabilitation: A Team Effort

Early Phase

Chest physio
Early mobilisation
Post-graft splinting
ADL adaptation
Compression garments and dynamic hand splints (OT later phase)

Multidisciplinary Team

Social Worker
Psychologist
Dietician
Pastor / Imam / Rabbi
Family and community
Reconstructive (plastic) surgeon

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Description

This quiz covers the assessment, resuscitation, and rehabilitation of burns, including causes, primary survey, and initial management. It's designed for medical professionals and students.