BURNS

PROF PHANI KUMAR

WOUND CAUSED BY EXOGENOUS
AGENT LEADING TO COAGULATIVE
NECROSIS OF THE TISSUE
CAUSES
• DRY
THERMAL • WET

• ACID
CHEMICAL • ALKALI

ELECTRICAL

COLD

RADIATION
THERMAL BURNS – PROTEIN DENATURATION

T0

t
 Resuscitation and proper wound care in burns helps in salvaging

a) Zone of stasis
b) Zone of coagulation
c) Zone of hyperemia
d) None
LOCAL EFFECT – JACKSON’S ZONES

Necrosis Vascular damage

Vasodilatation
 In burns heat loss is due to

a) Dilatation of veins
b) Shock
c) Exposed area by evaporation
d) None
 Fever in burnt patient is caused by

a) Septicemia
b) Hypermetabolism
c) Decresed sweating
d) Release of pyrogens from dead product
e) Dehydration
 All are true about Curling’s ulcer except

a) Acute gastric erosions

b) Ischemia of gastric mucosa
c) Hypersecretion of HCl
d) Occur with burns
 SYSTEMIC
>30% TBSA
SODIUM ENTERS CELLS
EDEMA
HYPOTENSION
INFECTIONS HYPOVOLEMIA IN
FIRST 12 HOURS
FLUID SHIFT TO INTERSTIAL

PROTEIN LOSS
CURLING’S
ULCER
 Metabolic derangements in severe burns are all except

a) Increased corticosteroids
b) Increased insulin
c) Increased glucose
d) Increased PTH
 INCREASE  DECREASE
 CORTISOL  HCL
 CATECHOLAMINES  PTH
 GLUCAGON  OSTEOCALCIN
 INSULIN
 GLUCOSE
 HEMATOCRIT
 METABOLIC RATE
 CORE BODY TEMPERATURE
DEPTH TBSA

LOCATION
 True regarding superficial second degree burn

a) Epidermis
b) Reticular dermis
c) Papillary dermis
d) Subcutaneous
PAPILLARY DERMIS

RETICULAR DERMIS
 True regarding 1st degree burn except

a) Anesthesia at burn site

b) Dry
c) Painful
d) Heal spontaneously
 Blisters are seen in which type of burns

a) 1 degree
b) 2 degree
c) 3 degree
d) 4 degree
 True regarding 2nd degree burn

a) Blanch on pressure
b) Dry white colour
c) Painless
d) Heals with scarring
TYPE LAYER APPEARANCE TEXTURE SENSATION HEALING TIME PROGNOSIS

SUPERFICIAL EPIDERMIS RED DRY PAINFUL 5-10 DAYS HEALS WELL

FIRST DEGREE

SUPERFICIAL PAPILLARY RED WITH MOIST VERY PAINFUL 2-3 WEEKS LOCAL
PARTIAL DERMIS BLISTERS. INFECTION. NO
SECOND BLANCHES WITH SCARRING
DEGREE PRESSURE

DEEP PARTIAL RETICULAR YELLOW OR DRY PRESSURE 3-8 WEEKS SCARRING

SECOND DERMIS WHITE. LESS DISCOMFORT CONTRACTURES
DEGREE BLANCHING SKIN GRAFTING

FULL THICKNESS SUBCUTANEOUS WHITE/BROWN. LEATHERY PAINLESS MONTHS SCARRING

THIRD DEGREE NO ESCHAR INCOMPLETE CONTRACTURES
BLANCHING. ESCHAROTOMY
STIFF

FOURTH DEGREE MUSCLE BONE BLACK. DRY PAINLESS REQUIRES AMPUTATION

CHARRED WITH EXCISION
ESCHAR
 A third degree circumferential burn in arm . Which is most important for
monitoring

a) Blood gases
b) Carboxy Hb levels
c) Myoglobinuria
d) Peripheral pulse and circulation
CIRCUMFERENTIAL BURNS

THIRD DEGREE BURNS

AROUND LIMBS, THORAX, NECK
COMPARTMENT SYNDROME
CAPILLARY PRESSURE 30 mmHg
 PULSE , SpO2 MONITORING
ESCHAROTOMY – LONGITUDINAL
 Best method to assess the burn percentage in 5 years old child caused by
boiling water is

a) Palm method
b) Rule of 9
c) Lund & Browder chart
d) Rule of 1
 According to the rule of nines, difference in burns percentage between
adult and child is

a) Perineum
b) Trunk
c) Head
d) Lower limbs
e) Upper limbs
 A 5 year old presents to emergency with burns. The burn area
corresponding to the size of his palm is

a) 1%
b) 2%
c) 5%
d) 10%
WALLACE RULE OF NINES
 6 year old child with burns involving whole of head and trunk is

a) 37%
b) 42%
c) 55%
d) 58%
 A 1 year child has circumferential burns of both of the thighs and buttocks ,
face and scalp. Calculate the percentage of burns.

a) 24%
b) 27%
c) 35%
d) 45%
 Percentage of body surface area involved in burns of scalp and face in
adult using Berkow formula

a) 7%
b) 8%
c) 9%
d) 10%
BERKOW
FORMULA
 All require hospitalization except

a) 5% burns in children
b) Inhalational burns
c) Electrocution
d) 10% scalds in children
e) 15% burns in adults
f) 3% full thickness burns
AIRWAY OBSTRUCTION

 24 – 48 HRS LATER
 BURNED IN CONFINED SPACE
 FACIAL BURN
 CARBON PARTICLES IN OROPHARYNX
 CARBONACEOUS SPUTUM
 CIRCUMFERENTIAL BURNS OF TRUNK
 CARBOXYHEMOGLOBIN > 10%
 ELECTIVE INTUBATION
 NEVER TRACHEOSTOMY
 A woman was brought to the casuality 8 hours after sustaining burns on the
abdomen, both limbs, and back. What will be the best formula to calculate
amount of fluid to be replenished.

a) 2ml/kg x % TBSA
b) 4ml/kg x % TBSA
c) 8ml/kg x % TBSA
d) Oral hydration
 In a 50 kg adult how much fluid should be given in first 8 hours in burns of
40%

a) 2L
b) 4L
c) 6L
d) 8L
 In burns management the following is the fluid of choice

a) Dextrose 5%
b) Ringer lactate
c) Normal saline
d) Isolyte M
 The best guide to adequate tissue perfusion in the fluid management of a
patient with burns is to ensure minimum hourly urine output of

a) 10-20ml
b) 20-30ml
c) 30-50ml
d) 70-100ml
 True statement about burn resuscitation except

a) Colloid preferred in patients with burns > 70%

b) Colloids preferred in all after 24 hours
c) Oral fluids must contain salt
d) Albumin most preferred colloid
e) Enteral nutrition advised at earliest
FLUID RESUSCITATION
 > 20% TBSA (15% CHILDREN ). OTHERWISE ORAL HYDRATION
 PARKLAND FORMULA
 4 X TBSA % X BODY WEIGHT ADULT
 3 X TBSA % X BODY WEIGHT CHILDREN
 HALF IN FIRST 8 HOURS
 HALF IN NEXT 16 HOURS
 RINGER LACTATE ****
 HYPERTONIC SALINE ( DECREASE EDEMA )
 UOP 30-50 ml / HOUR ADULTS, 1 ml / kg / hr CHILDREN
 COLLOIDS 20 – 60% OF PLASMA VOLUME IN NEXT 24 HRS – 5% ALBUMIN
 LOWER LIMB CANNULATION AVOIDED
 SAPHENOUS VEIN CUTDOWN RECOMMENDED
CARE OF WOUND - GENERAL

 COOLING BODY IMMEDIATELY (14-15 degrees )

 TO SALVAGE ZONE OF STASIS
 MOIST WOUND DRESSINGS - HYDROGEL
 ELEVATION OF LIMB
 EARLY EXCISION ( 7-10 DAYS BLOOD SUPPLY MAXIMUM )
 BLISTERS – SMALL LEFT, LARGE DEROOFED
 BODY HAIR WITHIN BURN & 2.5 cm AROUND SHAVED
 LARVA OF “LUCILIA SERICATA”
 A 2 year old child was brought to emergency with burns by hot water on
both hands . The lesion was pink, oozing , and painful to touch. Following is
the best management

a) Paraffin gauze and dressing

b) Collagen dressing
c) Excision and grafting
d) Apply 1% silver sulphadiazine and keep the wound open
SUPERFICIAL BURNS

 USUALLY NO DRESSING
 TOPICAL ANALGESICS
 MOISTURING CREAM
 HYDROCOLLOID CREAM
PARTIAL THICKNESS BURNS

 HYDROCOLLOID DRESSING
 VASELINE DRESSINGS
 POLYURETHANE FILMS (TRANSPARENT)
 ALGINATES (NATURAL)
 BIOSYNTHETIC DRESSINGS
 ANTIMICROBIAL DRESSINGS NOT USED
 Most common cause for infection in burns is

a) Staphylococcus
b) Streptococcus
c) Bacteroides
d) Pseudomonas
 Which of the following is effected against Pseudomonas and is used in
burns patients

a) Silver sulphadiazine
b) Silver sulphazine
c) Sulphamethoxazole
d) Sulphadoxine
 Exposure treatment is done for

a) Upper limbs
b) Thorax
c) Lower limbs
d) Head & neck
 FULL THICKNESS BURNS

 1% SILVER SULPHADIAZINE CREAM

 0.5% SILVER NITRATE SOLUTION
 MAFENIDE ACETATE CREAM
 SIVER SULPHADIAZINE & CERIUM NITRATE***(STERILE ESCHAR)
 TANGENTIAL DEBRIDEMENTS 1-3 DAYS
 EARLY SPLIT SKIN GRAFTING
 EXPOSURE METHOD  CLOSED METHOD

 NO DRESSINGS  PREFERRED
 APPLY THE AGENT 2-3 /DAY  TWICE
 FACE AND HEAD  ALL OTHER PARTS EXCEPT FACE, HEAD
 MORE PAIN, HEAT LOSS  LESS PAIN & HEAT LOSS
 CONTAMINATION  NO CONTAMINATION
 INCREASE IN BACTERIAL GROWTH IF
NOT CHANGED TWICE
 Most common cause of death  Most common cause of death
due to burns in early phase is due to burns in late phase is

a) Sepsis a) Sepsis
b) Hypovolemia b) Hypovolemia
c) Renal failure c) Renal failure
d) Respiratory distress d) Respiratory distress
GENERAL
 ENTERAL NUTRITION
 OPIOID ANALGESIA
 TETANUS TOXOID
 ANTIOXIDANTS – VITAMIN C
 BURN ITCH
 Z PLASTY
 MOST COMMON CAUSE OF DEATH IS SEPSIS
 NO ROLE FOR SYSTEMIC ANTIBIOTICS
 LONG TERM RISK OF SQUAMOUS CELL CARCINOMA
 True about Marjolin’s ulcer except

a) Squamous cell carcinoma following burns

b) Painless
c) Spreads by lymphatics
d) Treatmen by wide excision
 Domestic low voltage electric supply can cause all except

a) Contact wound
b) Cardiac arrest
c) Cardiac fibrillation
d) Deep subcutaneous tissue damage
 Myoglobinuria is seen with

a) Flame burn
b) Electric burn
c) Scald burn
d) Contact burn
 VASCULAR INJURY
 NEURAL INJURY - NEUROPATHY
 MUSCLE SPASM
 MYOGLOBINURIA
 HYPERKALEMIA
 ARRHYTHMIA
 CARDIAC ARREST
 CATARACT
 MANNITOL
 SODABICARBONATE
 LASIX