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1. What are the four main types of burns?
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Correct answer:
- Thermal burn: the commonest cause of a burn, due either to direct contact with a hot object or flames or to hot vapour such as steam.
- Chemical burn: such as from caustic material. The chemical may penetrate deep into the skin and be difficult to remove.
- Radiation burn: due to exposure by radiation, as in the local erythema that may follow superficial radiotherapy.
- Electrical burn: severity depends on strength of current and the duration of contact.
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2. What is the most common cause of a burn?
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Correct answer:
Thermal burn.
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3. How are burns classified?
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Correct answer:
Burns may be classified into partial thickness and full thickness, depending on whether or not the germinal epithelial layer of the skin is intact or destroyed.
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4. What are the characteristics of a partial thickness burn?
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Correct answer:
Partial thickness burns vary in appearance and severity:
- Erythema: a superficial burn with erythema due to capillary dilatation and with or without areas of blistering produced by exudation of plasma beneath coagulated epidermis. The underlying germinal layer is intact, and complete healing takes place within a few days.
- Superficial partial thickness: burn extends down through the epidermis to involve the germinal layer, but the dermal appendages such as sweat glands and hair follicles remain largely preserved. There is intense blistering followed by the formation of a slough. This separates after about 10 days, leaving healthy, newly formed, pink epithelium beneath.
- Deep partial thickness: burn extends to the germinal layer and destroys a significant proportion of hair follicles, sebaceous glands and dermis. Healing is much slower and is associated with significant scarring.
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5. What are the characteristics of a full thickness burn?
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Correct answer:
Full thickness burns completely destroy the skin. There may be initial blistering but this is soon replaced by a coagulum or slough; more often this is present from the onset in an intense deep burn. Unlike the more superficial burns, this slough separates only slowly over 3-4 weeks, leaving an underlying surface or granulation tissue. Very small deep burns may heal from an ingrowth of epithelium from adjacent healthy skin; more extensive burns, unless grafted, heal by dense scar tissue with consequent contracture and deformity.
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6. What are the clinical features of burns?
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Correct answer:
Stress reaction; hypovolaemic shock; airway; toxaemia; pain; anaemia; plasma loss.
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7. How does the thickness of a burn relate to the severity of pain?
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Correct answer:
Pain is due to stimulation of numerous nerve endings in the damaged skin. It is more severe in superficial and, indeed, deep burns may be relatively painless, owing to extensive destruction of nerve endings.
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8. What characteristic of a burn is most related to the severity of plasma loss?
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Correct answer:
The loss of plasma is proportional to the area of the burn, not the depth.
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9. How long following a burn is the most plasma lost?
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Correct answer:
During the first 24 hours.
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10. Why do people get hypovolaemic shock following burns?
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Correct answer:
Shock is a direct result of plasma loss. The intravascular volume is rapidly depleted as plasma is lost from the surface of the burn.
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11. Why might a patient become anaemic following a burn?
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Correct answer:
This results partly from destruction of red cells within involved skin capillaries and partly from toxic inhibition of bone marrow if infection of the burnt area occurs.
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12. What is the effect of burn on the airway?
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Correct answer:
Smoke inhalation or thermal injury of the respiratory tract may rapidly result in respiratory obstruction from pharyngeal or laryngeal oedema and is a common cause of death.
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13. What is the stress reaction following a burn?
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Correct answer:
The adrenocortical response of sodium and water retention, potassium loss and protein catabolism occurs as in any severe injury. Peptic ulceration (Curling’s ulcers) may occur as a reaction to stress.
