Burns


All are true of carbon monoxide poisoning except


A. Death occurs with carboxyhemoglobin concentrations around 25%
B. Intentional carbon monoxide poisoning with motor vehicles is a common method of suicide
C. Smokers have 5 times more carboxyhemoglobin in their blood
D. pregnant women require more aggressive treatment with hyperbaric therapy



Evaluation of carboxyhemoglobin toxicity includes all except


A. An arterial sample is not required for analysis
B. CO-oximeter should not be used unless blood gasses are unavailable.
C. Elevated lactate is seen and directly correlate with severity
D. Neuron-specific enolase (NSE) can indicate neurological damage



Not true in management of large area burns


A. The Lund and Browder chart is useful in assessing the area of a burn
B. Escharotomy helps in relieving the mechanical block to breathing
C. Chest radiograph showing patchy consolidation indicates smoke inhalation
D. Coagulation necrosis indicates alkaline chemicals injury



Rules for fluid resuscitation in burn patients includes all except

A. If oral fluids are to be used, salt must be added
B. If urine output falls below 0.5 mL/kg body weight per hour., the infusion rate should be increased by 50%.
C. Muir and Barclay formula is used to calculate fluid volume to be given
D. Ringer’s lactate is the most commonly used crystalloid fluid



The best dressing for burn wounds infected with methicillin-resistant Staphylococcus aureus is

A. Silver nitrate solution (0.5%)
B. Silver sulfadiazine cream (1%)
C. Cerium nitrate cream (1%)
D. Mafenide acetate cream (5%)



Not true of burn wound dressing is

A. Heavily contaminated wounds should be cleaned under a general anesthetic
B. Vaseline-impregnated gauze is used to avoid the problems of the wound adhering to the sheets and clothes.
C. Fenestrated silicone sheet reduces the stiffness of the dry eschar
D. Hydrocolloid dressings is good for epithelialization but needs to change daily



In short


  • Circumferential full-thickness burns to the limbs require emergency surgery to prevent the tourniquet effect of this injury. Escharotomy is done by incising the whole length of full-thickness burns.
  • In children with burns over 10% TBSA and adults with burns over 15% TBSA, consider the need for intravenous fluid resuscitation.
  • A nasogastric tube should be used in all patients with burns over 15% of TBSA
  • All but the smallest full-thickness burns need surgery. Deep dermal burns need tangential shaving and split-skin grafting. Eyelids must be treated before exposure keratitis arises.
  • Z-plasty is useful where there is a single band and a transposition flap is useful in wider bands of scarring.

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