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Questions and Answers
What is the recommended fluid resuscitation strategy for a 70 kg patient with a 30% burn over 24 hours?
What is the recommended fluid resuscitation strategy for a 70 kg patient with a 30% burn over 24 hours?
What factor increases the mortality risk in burn patients?
What factor increases the mortality risk in burn patients?
Which age group is considered to have a higher mortality risk due to burns?
Which age group is considered to have a higher mortality risk due to burns?
Which of the following correctly defines a deep thickness burn?
Which of the following correctly defines a deep thickness burn?
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Which body part's burn is approximately represented as 18% in the rule of nines?
Which body part's burn is approximately represented as 18% in the rule of nines?
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What defines a full thickness burn?
What defines a full thickness burn?
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Which of the following best describes a thermal burn?
Which of the following best describes a thermal burn?
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According to the rule of nines, what percentage does each adult arm represent?
According to the rule of nines, what percentage does each adult arm represent?
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What symptom is commonly associated with partial thickness burns?
What symptom is commonly associated with partial thickness burns?
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At what percentage of burn area should hospitalization be required for adults?
At what percentage of burn area should hospitalization be required for adults?
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Which type of burn is produced by exposure to acids and alkalis?
Which type of burn is produced by exposure to acids and alkalis?
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What management technique is recommended for smoke inhalation injuries?
What management technique is recommended for smoke inhalation injuries?
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What is a characteristic of full thickness burns in terms of healing?
What is a characteristic of full thickness burns in terms of healing?
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What is the correct formula for calculating fluid replacement within the first 24 hours after a burn?
What is the correct formula for calculating fluid replacement within the first 24 hours after a burn?
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When performing fluid resuscitation, what is the recommended rate of fluid administration in the first 24 hours?
When performing fluid resuscitation, what is the recommended rate of fluid administration in the first 24 hours?
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What type of fluid is indicated as the crystalloid of choice for fluid replacement in the first 24 hours after a burn?
What type of fluid is indicated as the crystalloid of choice for fluid replacement in the first 24 hours after a burn?
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Which of the following antibiotics is NOT indicated for systemic administration in treating burn infections?
Which of the following antibiotics is NOT indicated for systemic administration in treating burn infections?
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What is the main purpose of using Omeprazole in burn patients?
What is the main purpose of using Omeprazole in burn patients?
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What is the correct indication for administering colloid infusion in burn patients?
What is the correct indication for administering colloid infusion in burn patients?
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Which factor is NOT monitored during the clinical assessment of burn patients?
Which factor is NOT monitored during the clinical assessment of burn patients?
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What is the recommended action for a bedridden patient with severe burns to prevent pulmonary embolism?
What is the recommended action for a bedridden patient with severe burns to prevent pulmonary embolism?
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Study Notes
Burn Management
- Intravenous Opiates: Morphine is used for pain relief in burn patients.
- Hypovolemic Shock: Occurs due to fluid loss from damaged capillaries and tissues, primarily within the first 24 hours post-burn. Fluid loss is proportional to the burn size, not its depth.
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Fluid Replacement:
- First 24 hours: 4 x weight (kg) x burn area (%) mL. This excludes daily maintenance fluids (3 liters for adults).
- Rate: Half the volume is given in the first 8 hours, the other half over the next 16 hours.
- Type: Lactated Ringer's solution is the preferred crystalloid for the first 24 hours. Shock patients receive colloid infusions like Haemaccel, albumin, or fresh frozen plasma.
- Anemia: Treated with blood transfusions due to red blood cell destruction.
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Observation:
- Monitor: Pulse rate, blood pressure, central venous pressure, body temperature, hematocrit, and hourly urinary output.
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Sepsis:
- Common causative organisms: Streptococcus pyogenes and Pseudomonas aeruginosa.
- Treatment: Systemic broad-spectrum antibiotics (e.g., Amoxicillin, gentamycin, metronidazole).
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Nutrition:
- Maintain nutrition, especially with extensive burns.
- Parenteral feeding should be initiated early if enteral nutrition is not possible, to prevent catabolism.
- Muscle Exercises: Prevent pulmonary embolism from prolonged immobility in bedridden patients.
- Anti-Ulcer Treatment: Omeprazole is used to prevent Curling's ulcer (stress peptic ulcer).
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Local Treatment of Burn:
- Dressing: Non-adherent dressings with topical antibiotics like silver sulfadiazine cream are applied daily.
- Wound Excision: Necrotic tissue is removed surgically to prevent infection.
- Skin Grafts: Used for large burn areas, keloid formation, and contractures.
Causes of Burns
- Thermal Burn: Direct contact with flames, hot objects, or indirect exposure to heat (e.g., sunburn).
- Chemical Burn: Caused by acids or alkali.
- Electrical Burn: Severity depends on current strength and duration of contact.
- Radiation Burn: Localized erythema can occur following radiotherapy.
Severity of Burn
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Depth:
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Partial Thickness (Superficial):
- Germinal epithelium is partially intact.
- Dermis and appendages are preserved.
- Capillary dilation and plasma transudation cause erythema and blistering.
- Sensation is present.
- Healing is complete.
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Full Thickness (Deep):
- Germinal epithelium, dermis, and appendages are destroyed.
- Sensation is absent.
- Healing is slower, incomplete, and associated with scarring and contractures.
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Partial Thickness (Superficial):
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Size:
- Estimated using Rule of Nines: Body is divided into zones of nine and its multiplications, accounting for age differences.
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Rule of Nines:
- Head and neck: 9%
- Each arm: 9%
- Each leg : 18%
- Front of the trunk: 18%
- Back of the trunk: 18%
- Perineum: 1%
- The patient's hand is roughly 1% of the body surface area.
Management
- Hospitalization: Required for burns over 15% in adults or 10% in children. Minor burns managed in outpatient settings.
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Airway Control and Ventilation: Smoke inhalation can cause respiratory tract injury.
- Laryngeal edema: Respiratory obstruction.
- Alveolar damage: Acute lung injury (ARDS).
- Management: Intubation or tracheostomy.
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Escharotomy: Circumferential full-thickness burns on the chest or limbs can restrict breathing and blood flow.
- Longitudinal incisions are made to relieve pressure and restore circulation.
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Prognosis:
- Early death: Hypovolemic shock.
- Late death (after 1 week): Septicemia.
- Influencing factors:
- Depth of burn (deeper burns higher mortality)
- Size of burn (larger area higher mortality)
- Age of patient (infants and elderly higher mortality)
- Infection (infected burns higher mortality)
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Description
This quiz covers essential topics in burn management, including the use of intravenous opiates for pain relief, the impact of hypovolemic shock, and fluid replacement strategies. It also highlights the important observations necessary for monitoring burn patients during treatment.