Burns: Scenario 1

00:01 You know, the reason why we spend a little bit of time in burns is just because, it's in the syllabus.

00:10 And there is not big difference between with level for Part B and part A because burns is more of a theory in your exam.

00:17 So in your Part A you pretty much need to know, more or less what is needed for Part B apart from a slightly higher level.

00:25 And you always get at least one or two questions in burns and that will be related to plastic surgery, in terms of, is it plasty or skin graft.

00:33 So if I cover this, we will be able to discuss those four or five questions.

00:39 Okay, the easiest way to cover it is to give you a scenario and then we'll just go look at the aspects in that.

00:46 So here, you have a inpatient 55% burn, full thickness, reduced GCS, circumferential.

00:56 These are the important aspects, okay? Okay, what are the main concerns at this point? What are you really worried about in this patient? One, Dehydration.

01:10 Airway inhalation injury, compartment syndrome, well, circumferential burn, you will, okay fine.

01:20 Yes, but one more concern GCS, reduce GCS.

01:23 Okay head injury, reduce GCS.

01:25 Okay.

01:26 Fluid management.

01:29 How much fluid do you want and what fluid? Very good.

01:42 It's Hartmann's, it is Hartmann's.

01:43 In the UK, it's always Hartmann's.

01:45 The resuscitation fluid in the UK is Hartmann's, 3 to 4 ml per kilogram, per percentage burn, half of this given in the first eight hours and the rest of it given the next 16 hours.

01:59 Okay.

01:59 So in this patient, Hartmann's, 55 x (the body weight) So I know, (percentage burn) x (body weight) x 4, definitely 20 liters.

02:11 Half of this is given in the first 8 hours.

02:15 Okay.

02:17 What are the investigations relevant in this patient? Yes, before the fabric on your electrolytes.

02:28 And couple more specific things for burns.

02:32 ABG, high carboxyhemoglobin level.

02:35 Okay, and then you can mention trauma series, skull x-ray or pelvis, just depending on where you think the other trauma is.

02:45 Okay.

02:46 So for the record you utilize glucose carboxyhemoglobin, ABG and trauma series.

02:53 Okay.

02:53 Why do you have to do trauma series in a burn patient? Okay, fair enough, house fire? Yeah, just jumping out.

03:03 Yeah.

03:04 Okay, so that's why you're always suspecting associated injury in a patient with a burn who's got a low GCS.

03:14 Okay.