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.