S1 INTEGUMENT /
DERMATOLOGY
includes: common disorders of skin, dermatology, subcutaneous tissues;
burns, wounds and wound healing, plastic and reconstructive surgery.
, 018 Burns
(See also # 113C Burn Injuries)
Overview
Burns range from minor cutaneous wounds to massive life-threatening traumas, and
remain a frequent cause of accidental death, and of gross burn morbidity. Many
domestic and industrial accidents are preventable. Public education concerning risks
and their avoidance is of major importance.
Causes
1) Scalds (hot water spills are commonly partial thickness, molten
metal spills cause full thickness localised burns)
2) Flame burns (commonly full thickness)
3) Burns from radiant heat and hot objects
4) Electrical burns (high amperage and voltage electrical burns
add risks of electrocution)
5) Chemical burns (cause additional damage by continuing
contact)
j 6) Requiring special care
a) Partial thickness (second degree) and full thickness (third degree)
greater than 10% body surface area (BSA) in patients aged less than
10 and more than 50 years or greater than 20% any age
b) Second and third degree greater than 15% BSA require Intravenous
(IV) replacement; greater than 20% BSA require urinary catheter
c) Second and third degree on face, hands, feet, genitalia, perineum,
major joints
d) Third degree greater than 5% BSA
e) Electrical burns (including lightning) and chemical burns
f) Circumferential burns
g) Burns plus other serious Illness
110
,Key Objectives
• Perform assessment and initial treatment of burn patients according to
emergency management of severe trauma (EMST) protocol: primary
survey, secondary survey, etc.
• Diagnose burns according to:
Percentage BSA involved ('rule of nines', modified in children).
Depth of skin injury.
Partial thickness burns (first and second degree) - erythema, blistering,
moist exudates, soft, painful to pinprick, circulation present.
Full thickness burns (third and fourth degree) -dull white, opaque,
brown and charred, visible thrombosed veins, dry, firm , painless to
pinprick, no capillary response.
• Outline effective management plans for:
The burned patient.
The burn wound.
General/Specific Objectives
• Through efficient, focused data gathering:
Determine the BSA affected first, since depth is difficult to determine
initially.
After 24 hours, determine depth of skin injury (first degree to fourth
degree).
Determine whether there are other associated clinical problems or other
trauma.
Determine patient's tetanus immunisation status.
Determine whether inhalation injury has caused respiratory distress.
Superficial scald burns
111
, • Interpret critical clinical and laboratory findings which were key in the
processes of exclusion, differentiation and diagnosis:
Determine whether carbon monoxide poisoning has occurred by
measuring carboxyhaemoglobin.
• Conduct an effective plan of management for a patient with severe burns:
Outline initial management in a burn patient who will require referral
including stopping further burn injury, covering of burn area, and
resuscitation with oxygen, IV fluids, and physiologic monitoring.
Outline initial topical antibacterial treatment.
Discuss mechanism of injury of electrical burns and need for cardiac
and renal monitoring.
Select patients in need of specialised care.
• Outline an appropriate initial plan of IV fluid replacement
(e.g. %BSA x kg weight x 2 ml fluid in first 24 hours- one-third first 4 hours,
one-third next 8 hours, one-third next 12 hours).
Full thickness bums - legs
Superficial bums - face
112
DERMATOLOGY
includes: common disorders of skin, dermatology, subcutaneous tissues;
burns, wounds and wound healing, plastic and reconstructive surgery.
, 018 Burns
(See also # 113C Burn Injuries)
Overview
Burns range from minor cutaneous wounds to massive life-threatening traumas, and
remain a frequent cause of accidental death, and of gross burn morbidity. Many
domestic and industrial accidents are preventable. Public education concerning risks
and their avoidance is of major importance.
Causes
1) Scalds (hot water spills are commonly partial thickness, molten
metal spills cause full thickness localised burns)
2) Flame burns (commonly full thickness)
3) Burns from radiant heat and hot objects
4) Electrical burns (high amperage and voltage electrical burns
add risks of electrocution)
5) Chemical burns (cause additional damage by continuing
contact)
j 6) Requiring special care
a) Partial thickness (second degree) and full thickness (third degree)
greater than 10% body surface area (BSA) in patients aged less than
10 and more than 50 years or greater than 20% any age
b) Second and third degree greater than 15% BSA require Intravenous
(IV) replacement; greater than 20% BSA require urinary catheter
c) Second and third degree on face, hands, feet, genitalia, perineum,
major joints
d) Third degree greater than 5% BSA
e) Electrical burns (including lightning) and chemical burns
f) Circumferential burns
g) Burns plus other serious Illness
110
,Key Objectives
• Perform assessment and initial treatment of burn patients according to
emergency management of severe trauma (EMST) protocol: primary
survey, secondary survey, etc.
• Diagnose burns according to:
Percentage BSA involved ('rule of nines', modified in children).
Depth of skin injury.
Partial thickness burns (first and second degree) - erythema, blistering,
moist exudates, soft, painful to pinprick, circulation present.
Full thickness burns (third and fourth degree) -dull white, opaque,
brown and charred, visible thrombosed veins, dry, firm , painless to
pinprick, no capillary response.
• Outline effective management plans for:
The burned patient.
The burn wound.
General/Specific Objectives
• Through efficient, focused data gathering:
Determine the BSA affected first, since depth is difficult to determine
initially.
After 24 hours, determine depth of skin injury (first degree to fourth
degree).
Determine whether there are other associated clinical problems or other
trauma.
Determine patient's tetanus immunisation status.
Determine whether inhalation injury has caused respiratory distress.
Superficial scald burns
111
, • Interpret critical clinical and laboratory findings which were key in the
processes of exclusion, differentiation and diagnosis:
Determine whether carbon monoxide poisoning has occurred by
measuring carboxyhaemoglobin.
• Conduct an effective plan of management for a patient with severe burns:
Outline initial management in a burn patient who will require referral
including stopping further burn injury, covering of burn area, and
resuscitation with oxygen, IV fluids, and physiologic monitoring.
Outline initial topical antibacterial treatment.
Discuss mechanism of injury of electrical burns and need for cardiac
and renal monitoring.
Select patients in need of specialised care.
• Outline an appropriate initial plan of IV fluid replacement
(e.g. %BSA x kg weight x 2 ml fluid in first 24 hours- one-third first 4 hours,
one-third next 8 hours, one-third next 12 hours).
Full thickness bums - legs
Superficial bums - face
112
