Burns

 Questions are important,  asked in almost all exams!!

Q1. Which of the following is not an indication for admission in a case of burns
a) Full thickness burns more than 5% of total body surface area (TBSA)
b) Partial thickness burns more than 10% in adults
c) Partial thickness burns more than 10% in children

d) Inhalationsl burns


 
Q2. Which is the site for escharotomies in extremities for deep burns?
a) Anterior aspect
b) Posterior Aspect of the limb
c) Medial or lateral aspect of limb

d) It can be anywhere


 
Q3. Which of the following is not true about carbon monoxide poisoning?
a)  It shift the oxygen hemoglobin dissociation curve to left
b) Kills cytochrome
c) It increases displacemnet of oxygen from hemoglobin

d) Direct action occurs on central nervous system


 
Q4. Which is not  true regarding infectious complications in a burn patient?
a) The incidence of serious infections increase in proportion to the total body surface area (BSA)
b) Flame, Chemical, Inhalational burn injury and full thickness burns are more prone for infection
c) Catheter related sepsis is more common than local wound sepsis

d) Burn wound septicemia has 80% mortality in children


 

Q5 . Most common cause of fire in operation theatre
a) Electro Surgical units
b) LASER
c) Anesthesia Chemicals

d) Fiber optic  instruments


 

Q6) A 45 year old male sustains 30% burns on both legs and anterior abdominal wall.  There was  mild inhalation  injury associated with it. He initially responded well to treatment with IV fluids, Inj Tramadol and enteral feeding. Three days after the treatment he is having slight tachypnea (30/min) pulse 110/min and BP 98/60

His temp is 97degree F and some areas of partial thickness have converted into full thickness. He is currently on Inj Magnamycin. His platelets are 70ooo, TLC is 17000 and sugar is 200 mg%. What is the next step in management?

a) Continue same management

b) Upgrade the antibiotic and send a fresh culture from skin

c) Treat it as carbon monoxide poisoning

d) Manage in lines of Acute Tubular Necrosis

Answers
 
1.b
Indications of admission for a burn patient are generally
- Partial thickness burn more than 10% in age less than 10 and more than 50 years
- Partial thickness burn more than 20% in adults
- Partial thickness burn of face, hand, feet, perineum
- Full thickness burn more than 5% TBSA
- Chemical burns, Inhalational burns, Electric burns
- Burns with other medical illness
- Burns with other trauma, like bony fractures
 

Note- scalds are the most common burns in civilian practise


 
2 c
The escharotomy should be away from the main arterial and venous blood supply. Mid medial or mid lateral aspect of extremity is chosen for escharotomy.
the incision is taken  deep to the eschar through to the dermis  into the subcutaneous fat.
 
Notes
1st degree burns-- Involve the epidermis, Do not blister, erythematous
 
2nd degree superficial partial thickness involves upper dermis. It is very sensitive and forms blister
2nd degree deep partial thickness burn involves Reticular dermis
 
3rd degree burn all layers of dermis with contractures
 

4th degree burn involves the subcutaneous tissue as well.


 
3. c
Poisoning with carbon monoxide poisoning leads to formation of carboxyhemoglobin which has 200 times more affinity for hemoglobin.

Carboxyhemoglobin prevents reversible displacement of oxygen. It shifts the oxygen hemoglobin dissociation curve to the left , kills the cytochrome, direct action on CNS and direct toxicity to cardiac and skeletal muscles.


 
4. c
Burn victims are susceptible to a wide variety of infections associated with relative immunosuppression (which occurs with burns of 30% TBSA or more) and complications of intensive care. Virtually any organ can become the target of an infection in such patients. The most common infections in burned children are those related to the burn wound and catheter-associated septicemia

5. a

Causes of fire in OT 
1. Electrosurgical units 68% 
2. lasers 13% 
3. Fiberoptic light source and cables
4. Sparks from drills
5. Defibrillators

 

 6) b
Hypothermia with tachypnea and tachycardia in a patient of more than 20% burns is a sign of septicemia.
Other signs of septicemia in this patient are conversion of partial thickness  burn into complete.
Thrombocytopenia and high TLC also point in the direction of sepsis.

Next step would be to immediately upgrade the antibiotics, desloughing and send a fresh culture


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