1) With respect to the clinical assessment of a patient presenting with a severe burn injury sustained in a house fire:
a) Outline how burns are classified.
b) List three methods for estimating the total body surface area affected by a burn injury.
c) Other than the burn type and extent, list the other important features of the physical examination that should be noted as part of the initial clinical assessment of the patient described above.
a) Outline how burns are classified.
Burns are classified by depth of injury.
Superficial (formerly first degree):
• Epidermis only
Partial Thickness (formerly second degree):
• Superficial
• Deep
Full Thickness (formerly third degree)
• All layers of dermis and may involve underlying tissue
b) List three methods for estimating the total body surface area affected by a burn injury.
• Lund-Browder Chart
• The Rule of Nines
• The Rule of Palm
c) Other than the burn type and extent, list the other important features of the physical examination that should be noted as part of the initial clinical assessment of the patient described above.
• Basic resuscitation status: Airway patency, Breathing, Circulatory status, Conscious level
• Adequacy of resuscitation to date: heart rate, blood pressure, urine output
• Evidence of associated trauma
• Evidence of airway burn and inhalational injury: stridor, burns around nose and mouth, carbonaceous sputum
• Presence of facial and/or corneal burns, perineal burns
• Presence of circumferential burns, evidence of extremity compartment syndrome, ventilator inadequacy
• Evidence of rhabdomyolysis
• Evidence of inhalation of toxic gases eg CO
• Temperature
• Adequacy of analgesia
• Potential problems with vascular access
• Evidence of drug / alcohol ingestion and/or co-morbid conditions eg epilepsy
a) Outline how burns are classified.
Little can be added to the college answer, as it is a fairly straightforward question. The table below comes from the Clinical Practice Guidelines of the Royal Children's Hospital in Melbourne.
|
Depth |
Cause |
Surface/colour |
Pain sensation |
|
Superficial |
Sun, flash, minor scald |
Dry, minor blisters, erythema, brisk capillary return |
Painful |
|
Partial thickness-superficial (superficial dermal) |
Scald |
Moist, reddened with broken blisters, brisk capillary return |
Painful |
|
Partial thickness- deep (deep dermal) |
Scald, minor flame contact |
Moist white slough, red mottled, sluggish capillary return |
Painless |
|
Full thickness |
Flame, severe scald or flame contact |
Dry, charred whitish. Absent capillary return |
Painless |
b) List three methods for estimating the total body surface area affected by a burn injury.
The college gives the following three methods:
c) Other than the burn type and extent, list the other important features of the physical examination that should be noted as part of the initial clinical assessment of the patient described above.
The assessment of a burns patient is covered in greater detail by the BMJ series.
The BMJ had published a series of 12 articles, titled "the ABC of burns". These are a valuable resource.
PRUITT Jr, BASIL A., DARYL R. ERICKSON, and ALAN MORRIS. "Progressive pulmonary insufficiency and other pulmonary complications of thermal injury."Journal of Trauma and Acute Care Surgery 15.5 (1975): 269-379.
Hettiaratchy, Shehan, and Remo Papini. "Initial management of a major burn: II—assessment and resuscitation." Bmj 329.7457 (2004): 101-103.
Hettiaratchy, Shehan, and Peter Dziewulski. "Pathophysiology and types of burns." Bmj 328.7453 (2004): 1427-1429.
Ansermino, Mark, and Carolyn Hemsley. "Intensive care management and control of infection." Bmj 329.7459 (2004): 220-223
