Burn Management Fundamentals

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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?

75% of the fluid should be administered in the first 8 hours.

100% of the fluid should be given within the first 24 hours.

50% of the fluid should be given in the first 12 hours.

25% of the fluid should be given in the first 8 hours and the remaining 75% over the next 16 hours. (correct)

What factor increases the mortality risk in burn patients?

Young adulthood.

Infection of the burn area. (correct)

Superficial burns.

Minor burn percentage.

Which age group is considered to have a higher mortality risk due to burns?

Teenagers.

Middle-aged individuals.

Young infants and the elderly. (correct)

Young adults.

Which of the following correctly defines a deep thickness burn?

Pain sensation is absent. Signup and view all the answers

Which body part's burn is approximately represented as 18% in the rule of nines?

Each leg. Signup and view all the answers

What defines a full thickness burn?

The dermis and its appendages are destroyed. Signup and view all the answers

Which of the following best describes a thermal burn?

Occur due to direct contact with flames or hot objects. Signup and view all the answers

According to the rule of nines, what percentage does each adult arm represent?

9% Signup and view all the answers

What symptom is commonly associated with partial thickness burns?

Presence of capillary dilation and blistering. Signup and view all the answers

At what percentage of burn area should hospitalization be required for adults?

Over 15% Signup and view all the answers

Which type of burn is produced by exposure to acids and alkalis?

Chemical burn Signup and view all the answers

What management technique is recommended for smoke inhalation injuries?

Intubation or tracheostomy Signup and view all the answers

What is a characteristic of full thickness burns in terms of healing?

Healing is slower and incomplete with scarring. Signup and view all the answers

What is the correct formula for calculating fluid replacement within the first 24 hours after a burn?

4 × weight (kg) × burn area (%) Signup and view all the answers

When performing fluid resuscitation, what is the recommended rate of fluid administration in the first 24 hours?

Half the volume in the first 8 hours, remainder over 16 hours Signup and view all the answers

What type of fluid is indicated as the crystalloid of choice for fluid replacement in the first 24 hours after a burn?

Lactated Ringer’s (Hartmann’s) solution Signup and view all the answers

Which of the following antibiotics is NOT indicated for systemic administration in treating burn infections?

Ciprofloxacin Signup and view all the answers

What is the main purpose of using Omeprazole in burn patients?

To prevent Curling’s ulcer Signup and view all the answers

What is the correct indication for administering colloid infusion in burn patients?

To treat anemia from red cell destruction Signup and view all the answers

Which factor is NOT monitored during the clinical assessment of burn patients?

Muscle mass Signup and view all the answers

What is the recommended action for a bedridden patient with severe burns to prevent pulmonary embolism?

Implement muscle exercises Signup and view all the answers

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.
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.
Observation:
- Monitor: Pulse rate, blood pressure, central venous pressure, body temperature, hematocrit, and hourly urinary output.
Sepsis:
- Common causative organisms: Streptococcus pyogenes and Pseudomonas aeruginosa.
- Treatment: Systemic broad-spectrum antibiotics (e.g., Amoxicillin, gentamycin, metronidazole).
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).
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

Depth:
- 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.
- Full Thickness (Deep):
  - Germinal epithelium, dermis, and appendages are destroyed.
  - Sensation is absent.
  - Healing is slower, incomplete, and associated with scarring and contractures.
Size:
- Estimated using Rule of Nines: Body is divided into zones of nine and its multiplications, accounting for age differences.
- 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.
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.
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.
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.