Podcast
Questions and Answers
What is the most common organ affected by burn injuries?
What is the most common organ affected by burn injuries?
- Heart
- Kidneys
- Lungs
- Skin (correct)
Which of the following can lead to coagulation and necrosis of tissue?
Which of the following can lead to coagulation and necrosis of tissue?
- Scalds
- Cold exposure (correct)
- Electrical injuries
- Chemical burns
What is a potential complication affecting the gastrointestinal tract due to burn injury?
What is a potential complication affecting the gastrointestinal tract due to burn injury?
- Ileus (correct)
- Cirrhosis
- Enteritis
- Cholecystitis
What type of burn injury is most commonly associated with flammable liquids and matches?
What type of burn injury is most commonly associated with flammable liquids and matches?
What is a likely consequence of edema resulting from endothelial damage in burn injuries?
What is a likely consequence of edema resulting from endothelial damage in burn injuries?
What is the primary zone of injury in a burn characterized by irreversible tissue loss?
What is the primary zone of injury in a burn characterized by irreversible tissue loss?
Which function of the skin helps maintain hydration and balance electrolytes?
Which function of the skin helps maintain hydration and balance electrolytes?
In which zone does tissue perfusion decrease but is potentially salvageable if managed properly?
In which zone does tissue perfusion decrease but is potentially salvageable if managed properly?
What is the average weight of the skin, the largest organ in the body?
What is the average weight of the skin, the largest organ in the body?
What consequence does prolonged hypotension have on the zone of stasis in burn management?
What consequence does prolonged hypotension have on the zone of stasis in burn management?
Which type of cell is NOT found in the epidermis?
Which type of cell is NOT found in the epidermis?
What is the outermost zone of a burn where tissue perfusion is increased?
What is the outermost zone of a burn where tissue perfusion is increased?
What is a common primary function of the skin in addition to its protective role?
What is a common primary function of the skin in addition to its protective role?
What is the primary effect of carbon monoxide (CO) on hemoglobin?
What is the primary effect of carbon monoxide (CO) on hemoglobin?
At what percentage of carbon monoxide saturation can symptoms such as headache and confusion occur?
At what percentage of carbon monoxide saturation can symptoms such as headache and confusion occur?
Which of the following is the most appropriate fluid for burn resuscitation?
Which of the following is the most appropriate fluid for burn resuscitation?
What is the half-life of carbon monoxide in the bloodstream while breathing 100% oxygen?
What is the half-life of carbon monoxide in the bloodstream while breathing 100% oxygen?
Which statement regarding the assessment of burn size is true?
Which statement regarding the assessment of burn size is true?
What is the main concern when managing a patient with potentially high compliance during chest/escharotomy?
What is the main concern when managing a patient with potentially high compliance during chest/escharotomy?
What should be done immediately after discovering a patient is experiencing carbon monoxide intoxication?
What should be done immediately after discovering a patient is experiencing carbon monoxide intoxication?
Which condition is most likely to occur with a carbon monoxide saturation greater than 60%?
Which condition is most likely to occur with a carbon monoxide saturation greater than 60%?
Which of the following is NOT a recommended topical antimicrobial for infection control in burns?
Which of the following is NOT a recommended topical antimicrobial for infection control in burns?
What is a key requirement for an early enteral feeding approach in burn patients?
What is a key requirement for an early enteral feeding approach in burn patients?
Which of the following criteria indicates a major burn injury?
Which of the following criteria indicates a major burn injury?
Which sign or symptom is NOT indicative of sepsis diagnosis?
Which sign or symptom is NOT indicative of sepsis diagnosis?
What is a consequence of electrical burns that requires careful monitoring?
What is a consequence of electrical burns that requires careful monitoring?
Which method is NOT typically used to assess burn depth?
Which method is NOT typically used to assess burn depth?
In the Lund and Browder chart, how is the entire trunk estimated regarding burn surface area?
In the Lund and Browder chart, how is the entire trunk estimated regarding burn surface area?
Which of the following statements is true regarding superficial burns?
Which of the following statements is true regarding superficial burns?
What is the appropriate referral percentage for a child before referring to a Regional Burn Unit?
What is the appropriate referral percentage for a child before referring to a Regional Burn Unit?
Which fluid resuscitation formula requires 4 ml/kg/% burn over 24 hours?
Which fluid resuscitation formula requires 4 ml/kg/% burn over 24 hours?
What characterizes full-thickness burns?
What characterizes full-thickness burns?
What aspect of burn injury management has NOT contributed to decreased mortality rates?
What aspect of burn injury management has NOT contributed to decreased mortality rates?
What percentage is assigned for the groin area in the Rule of Nines?
What percentage is assigned for the groin area in the Rule of Nines?
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Study Notes
Structure and Function of the Skin
- Largest organ, averaging 4 kg and covering approximately 2 m²
- Composed of two main layers: Epidermis (four cell types: Basal, Prickle, Granular, Horny) and Dermis (two parts: papillary and reticular)
- Protective barrier against microbes, chemicals, and water loss; also regulates temperature, provides sensation, and synthesizes Vitamin D
Zones of Thermal Injury
- Zone of Coagulation: Closest to heat source; irreversible tissue loss due to protein coagulation.
- Zone of Stasis: Reduced perfusion; potentially salvageable tissue, may progress to coagulation without proper management.
- Zone of Hyperemia: Increased blood flow, typically recovers unless severe systemic issues arise.
Aetiology of Burns
- Common causes include: scalds (children), flammable liquids (adolescents), flame burns (adults), electrical injuries, chemical burns, and rare causes such as cold or radiation.
- Drug reactions and immunological responses (e.g., Toxic Epidermal Necrolysis) also contribute.
Pathophysiology of Burn Injury
- Primarily affects the skin but can impact airways, lungs, and gastrointestinal tract.
- Risk factors include inflammation, metabolic issues, and circulatory changes (e.g., capillary leak syndrome).
- Potential for gastric complications, such as Curling ulcers from hypoperfusion.
Carbon Monoxide Intoxication
- Symptoms range from headache (15-20% CO) to death (>60% CO).
- High affinity of CO for hemoglobin reduces oxygen delivery and can cause anoxia.
Emergency Department Protocol
- Breathing: Administer 100% oxygen; assess for chest trauma.
- Circulation: Identify shock causes, initiate fluid resuscitation with Ringer's lactate; start two 14g cannulae.
- Disability: Monitor GCS; investigate neurological status.
- Exposure: Control environment, cover burns, and estimate size using the Rule of Nines.
Burn Assessment
- Use the patient’s whole hand (1% TBSA) and the Rule of Nines for initial assessment.
- Lund-Browder chart is preferred for children due to body proportion variations.
- Determine burn depth through clinical examination; utilize pinprick tests or laser Doppler.
Fluid Resuscitation
- Use formulas such as Parkland (4 ml/kg/% burn, with specific timing) for calculating fluid requirements and managing metabolic acidosis.
Nutrition and Recovery
- Increased protein requirement; early enteral feeding helps prevent complications such as ileus and bacterial translocation.
Infection Control
- Focus on hand hygiene, isolation precautions, topical antimicrobials (e.g., silver sulfadiazine), and wound cleaning techniques.
Major Thermal Injury Criteria
- Classified as greater than 30% TBSA; special care for burns on hands, face, genitalia, or those exceeding 10% in adults and 5% in children.
- Inhalation injuries and electrical burns require specialized management due to increased risks.
Simplified Referral Criteria
- Patients exhibiting significant burns, suspected inhalation injuries, or existing health challenges (e.g., elderly or children) should be urgently referred for comprehensive care.
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