Basic Considerations - Burns and Sutures

What is the most common cause of burn injury requiring hospital admission?

Flame burn

Which burn injury classification carries the highest overall mortality rate?

Flame burn

What is the primary factor responsible for the high mortality rate in flame burns?

Association with structural fires and accompanying inhalational injury

What causes a flash burn?

Explosions of natural gas, propane, gasoline, and other flammable liquids

What defines the duration of heat exposure in a flash burn?

Intense heat for a very brief period of time

What voltage threshold defines a high voltage electrical burn?

>1000 volts

What voltage threshold defines a low voltage electrical burn?

<1000 volts

What cardiac complication is a primary concern in electrical burn injuries?

Cardiac arrhythmias

What musculoskeletal/vascular complication is a concern in electrical burn injuries?

Compartment syndrome with rhabdomyolysis

What is the most serious medical complication resulting from an electrical burn?

Renal failure

Why do scald burns from hot liquids, soups, and sauces cause prolonged skin contact?

They are thicker in consistency

How do acid burns behave when they contact skin tissue?

They tan the skin, creating an impermeable barrier that limits further penetration

Why are acid burns generally more self-limiting than alkali burns?

Because they create an impermeable tanned barrier on the skin

How do alkali burns interact with cutaneous lipids upon contact?

They combine with cutaneous lipids to create soap

Why do alkali burns continue to dissolve skin tissue progressively?

Because they continue to dissolve tissue until they are fully neutralized

What is the most important initial component of chemical burn therapy regarding the chemical agent?

Removal of the toxic substance

What is the recommended method and duration for irrigating a chemical burn injury?

Irrigation of the affected area with water for ~30 minutes

What causes a contact burn injury?

Hot metals, plastic, glass, or hot coils

What is the typical physical extent versus depth profile of a contact burn?

Usually limited in extent but very deep

What causes radiation burns?

Exposure from laboratory accidents, x-ray machines, nuclear power plant meltdowns, or nuclear device detonations

What respiratory threat can rapidly develop from direct thermal injury to the upper airway or smoke inhalation?

Rapid and severe airway edema

What physical signs indicate impending respiratory compromise in a burn patient?

Hoarse voice, wheezing, or stridor

How should burn patients initially be evaluated in emergency management before addressing burn wounds?

They should first be considered trauma patients and undergo a primary survey

When should urgent non-skeletal radiology studies like CXR be performed in burn trauma management?

In the emergency room during initial evaluation

Why should non-urgent skeletal radiology evaluations (extremity X-rays) be delayed in severe burn cases?

To avoid hypothermia and delays in burn resuscitation

What is the timeframe for the Resuscitative Period in burn injury management?

First 48 hours

What are the primary clinical tasks during the Resuscitative Period (First 48 hours)?

Assessment of burn injury, classification, criteria for admission, initial ER management (fluid resuscitation, wound dressing), and monitoring

What is the timeframe for the Definitive Period in burn injury management?

>48 hours

What are the primary clinical tasks during the Definitive Period (>48 hours)?

Excision and grafting, control of infection, nutrition, rehabilitation, and complications

What percentage of TBSA for partial thickness burns warrants referral to a Burn Center?

>10% TBSA

Which specific anatomical locations with burns mandate referral to a Burn Center?

Face, hands, feet, genitalia, perineum, and major joints

What burn depth grade in any age group requires referral to a Burn Center?

Third-degree burns

What specific injury mechanisms warrant referral to a Burn Center?

Electrical and chemical burns

Does the presence of an inhalation injury mandate referral to a Burn Center?

Yes

Do burn injuries combined with pre-existing comorbidities require Burn Center referral?

Yes

Do burn injuries combined with concomitant physical trauma require Burn Center referral?

Yes

Which burn depth classifications are counted when calculating % Total Body Surface Area (%TBSA)?

Only partial thickness (second degree) and full thickness (third degree) burns

Are superficial (first degree) burns included when calculating %TBSA?

No, superficial (first degree) burns SHOULD NOT be included

What prerequisite step is mandatory before calculating burn size to avoid confusing soot with burns?

Thorough cleaning of soot and debris

What is the common name for the Rule of Wallace?

Rule of Nines

Why is the Rule of Nines considered inaccurate in pediatric populations?

Because children have different body proportions relative to age

In the Rule of Nines, what %BSA is assigned to the Head?

9%

In the Rule of Nines, what %BSA is assigned to the Chest?

9%

In the Rule of Nines, what %BSA is assigned to the Abdomen?

9%

In the Rule of Nines, what %BSA is assigned to the Upper Back?

9%

In the Rule of Nines, what %BSA is assigned to the Lower Back or Buttocks?

9%

In the Rule of Nines, what %BSA is assigned to the Right Arm?

9%

In the Rule of Nines, what %BSA is assigned to the Left Arm?

9%

In the Rule of Nines, what %BSA is assigned to the Right Thigh and Leg?

18%

In the Rule of Nines, what %BSA is assigned to the Left Thigh and Leg?

18%

In the Rule of Nines, what %BSA is assigned to the Genitalia or Perineum?

1%

What percentage of TBSA is represented by the patient's open hand (palm and extended fingers)?

Approximately 1% TBSA

Which burn size assessment tool is most accurate for children because it considers variation in body shape with age?

Lund and Browder chart

Which precise burn assessment diagram reflects percentage of TBSA by anatomic parts across various age groups?

Berkow diagram

What are the causes of a 1st Degree Burn?

Flash flame, ultraviolet (sunburn)

What is the surface appearance of a 1st Degree Burn?

Dry, no blisters, or minimal edema

What is the characteristic color of a 1st Degree Burn?

Erythematous

What is the pain sensation in a 1st Degree Burn?

Painful

What is the healing time for a 1st Degree Burn?

3 to 6 days

What are the causes of a 2nd Degree Burn?

Contact with hot liquids or solids, flash flame to clothing, direct flame, chemical, ultraviolet

What is the surface appearance of a 2nd Degree Burn?

Moist blebs, blisters

What is the characteristic color of a 2nd Degree Burn?

Mottled white to pink, cherry red

What is the pain sensation in a 2nd Degree Burn?

Very painful

What is the healing time for a 2nd Degree Burn?

10 to 21 days

What are the causes of a 3rd Degree Burn?

Contact with hot liquids or solids, flame, chemical, electrical

What is the surface appearance of a 3rd Degree Burn?

Dry with leathery eschar until debridement, charred vessels visible under eschar

What are the possible colors of a 3rd Degree Burn?

Mixed white, waxy, pearly, dark, khaki, mahogany, charred

What is the status of pinprick sensation in a 3rd Degree Burn?

Decreased pinprick sensation

Is deep-pressure sensation preserved in a 3rd Degree Burn?

Yes, intact deep-pressure sensation

What is the healing time for a 3rd Degree Burn?

More than 21 days

What causes a 4th Degree Burn?

Prolonged contact with flame, electrical

What is the surface appearance of a 4th Degree Burn?

Same as third degree, possibly with exposed bone, muscle, or tendon

What is the pain sensation in a 4th Degree Burn?

Little or no pain

What definitive management is required for a 4th Degree Burn?

Grafting required

What are the clinical features of 1st Degree (Superficial) burns?

Painful, no blisters, blanching

What are the clinical features of 2nd Degree Superficial (papillary) burns?

Extremely painful, blister formation, blanching

What are the clinical features of 2nd Degree Deep (reticular) burns?

Less painful, white or pale

What are the clinical features of 3rd Degree (Full-thickness) burns?

Painless, leathery, non-blanching

What tissue is affected in 4th Degree burns?

Affects underlying soft tissue

What tissue layer do 5th Degree burns reach?

Goes through muscle to bone

What characterizes 6th Degree burns?

Charring bone is present

Which zone of a burn injury occupies the central area?

Zone of coagulation

Which burn zone represents the area of most severe burn injury?

Zone of coagulation

What is the state of capillary blood flow in the zone of coagulation?

No capillary blood flow

What intervention does the zone of coagulation require?

Needs excision and grafting

Which burn zone surrounds the zone of coagulation?

Zone of stasis

What degree of injury characterizes the zone of stasis?

Area of moderate degree of injury

What is the status of capillary blood flow in the zone of stasis?

Sluggish capillary blood flow

What vascular mechanisms cause tissue ischemia in the zone of stasis?

Variable degrees of vasoconstriction and resultant ischemia

Can the zone of stasis be saved with medical management?

Salvageable by appropriate resuscitation

What is the outermost burn zone surrounding the zone of stasis?

Zone of hyperemia

What causes the physical findings in the zone of hyperemia?

Related to vasodilation from inflammation surrounding the burn wound

What type of tissues are contained within the zone of hyperemia?

Contains viable tissues from which the healing process begins

How does the zone of hyperemia heal?

Heals with minimal or no scarring

What is the standard Parkland (Baxter) Formula for fluid requirements in the first 24 hours post-burn?

3 to 4 ml plain LR/kg/%TBSA

What is the adult fluid resuscitation formula under Revised Parkland's (Baxter) Formula?

2 ml PLR/kg/%TBSA

What is the pediatric fluid resuscitation formula under Revised Parkland's (Baxter) Formula?

3 ml D5% LR/kg/%TBSA

What is the fluid resuscitation formula for electrical burns under Revised Parkland's (Baxter) Formula?

4 ml PLR/kg/%TBSA

How much of the calculated fluid requirement is given in the first 8 hours post-burn?

First 1/2 given in the first 8 hours

How much of the calculated fluid requirement is given in the next 16 hours post-burn?

Next 1/2 given for the next 16 hours