Burns

1. Types and Depth of Burns

● Key Points:
○ Superficial Burns: Affect only the epidermis, causing redness and pain but no
blistering. Generally heals without scarring.
○ Partial-Thickness Burns: Involves the epidermis and part of the dermis. Presents
with blisters, pain, and redness. Often managed conservatively unless deep.
○ Full-Thickness Burns: Extends through all layers of the skin, appearing charred or
leathery, often painless due to nerve damage. Requires grafting for healing.
● 2025 Prediction: Expect more scenario-based questions on distinguishing between burn
types, especially on indications for grafting and conservative management techniques.
● Example MCQ:
○ Question: A 40-year-old male presents with burns showing blisters and redness but
complains of intense pain. Which type of burn is most likely?
■ A) Superficial Burn
■ B) Partial-Thickness Burn
■ C) Full-Thickness Burn
■ Answer: B) Partial-Thickness Burn
● Suggested Reading:
○ UpToDate: "Classification of Burn Depth and Management"
○ Bailey & Love Surgery: "Burns: Management of Different Types"

2. Fluid Resuscitation in Burn Patients

● Key Points:
○ Parkland Formula: 4 mL x body weight (kg) x % BSA burned, with half administered
in the first 8 hours.
○ Types of Fluids: Hartmann’s solution or Lactated Ringer's is commonly used in initial
resuscitation.
○ Monitoring: Urine output is the best indicator of adequate resuscitation, aiming for
0.5–1 mL/kg/hr in adults.
● 2025 Prediction: Questions on fluid resuscitation calculations and specific indications for fluid
choice are likely. Focus may also shift to monitoring parameters, especially urine output.
● Example MCQ:
○ Question: A 30-year-old with a 40% TBSA burn weighing 70 kg requires how much
fluid in the first 24 hours?
■ Answer: 11,200 mL (4 x 70 x 40)
● Suggested Reading:
○ UpToDate: "Fluid Resuscitation in Burn Injuries"
○ Royal College of Surgeons: "Burn Management: Fluid Therapy and Resuscitation"
3. Airway Management in Burns

● Key Points:
○ Signs of Airway Compromise: Hoarseness, stridor, facial burns, soot in the
mouth/nose.
○ Management: Immediate endotracheal intubation in cases of suspected inhalation
injury. Early intubation is critical as edema progresses.
○ Special Cases: Smoke inhalation often requires high-flow oxygen.
● 2025 Prediction: Look for clinical scenarios emphasizing airway evaluation and management
decisions. Intubation vs tracheostomy will be a key decision point.
● Suggested Reading:
○ UpToDate: “Airway Management in Burn Patients”
○ British Journal of Surgery: "Airway Complications in Burn Patients"

4. Topical Agents and Burn Wound Care

● Key Points:
○ Silver Sulfadiazine: Avoid on facial burns due to scarring risk; better suited for other
body areas.
○ Alternative Agents: Mafenide acetate for deeper burns and areas with cartilage
involvement; honey-based dressings or specialized antimicrobial films.
○ Escharotomy: Indicated in circumferential burns to relieve compartment pressure.
● 2025 Prediction: Expect questions comparing topical treatments based on burn location and
depth, and indications for surgical interventions like escharotomy.
● Suggested Reading:
○ UpToDate: "Topical Burn Treatments"
○ Bailey & Love Surgery: "Burns: Wound Care and Surgical Management"

5. Inhalation Injury and Smoke Inhalation

● Key Points:
○ Clinical Indicators: Stridor, soot in nasal passages, singed facial hair.
○ Management: 100% oxygen therapy, intubation in severe cases, and bronchoscopy
for evaluation.
○ Complications: Respiratory failure, ARDS, carbon monoxide, and cyanide toxicity.
● 2025 Prediction: Likely to see questions on managing inhalation injury with an emphasis on
oxygen therapy and the role of bronchoscopy.
● Suggested Reading:
○ UpToDate: "Management of Inhalation Injury in Burn Patients"
○ British Journal of Surgery: "Smoke Inhalation Injury and Airway Management"
6. Chemical Burns

● Key Points:
○ Immediate Lavage: Begin irrigation immediately with water for at least 20-30
minutes. Avoid neutralizing agents.
○ Acid vs. Alkali Burns: Alkali burns penetrate deeper and often require more
extensive irrigation.
○ Special Cases: Hydrofluoric acid burns require calcium gluconate gel for treatment.
● 2025 Prediction: Questions may focus on the initial management of chemical burns and the
differences in treating acidic vs. alkaline exposures.
● Suggested Reading:
○ UpToDate: "Management of Chemical Burns"
○ Bailey & Love Surgery: "Chemical Burns and Emergency Management"

7. Burn Classification and Lund-Browder Chart

● Key Points:
○ Lund-Browder Chart: Preferred in children due to more accurate TBSA estimation.
The Rule of Nines is commonly used in adults.
○ Calculation Importance: Guides fluid resuscitation and surgical planning.
● 2025 Prediction: Scenario-based questions requiring TBSA calculation using the
Lund-Browder chart, particularly in pediatric patients.
● Suggested Reading:
○ UpToDate: "Assessment of Burn Surface Area"
○ Bailey & Love Surgery: "Burn Classification and Surface Area Estimation"

8. Complications of Burns

● Key Points:
○ Infections: Common in severe burns; requires broad-spectrum antibiotics.
○ Respiratory Complications: Inhalation injuries can lead to ARDS.
○ Long-Term Complications: Scarring, contractures, psychological effects, and
chronic pain.
● 2025 Prediction: Expect questions on infection prevention, recognizing respiratory
complications, and management of contractures.
● Suggested Reading:
○ UpToDate: "Complications in Burn Patients"
○ British Journal of Surgery: "Long-Term Complications After Burn Injury"

MCQs from the 2024 Paper and Predictions for 2025

1. Burn Depth and Management: Partial-thickness burns may heal without grafting;
full-thickness burns generally require grafting.
2. Fluid Resuscitation: A 30% TBSA burn in a 50 kg patient requires 6,000 mL fluid over 24
hours, half in the first 8 hours.
3. Airway Management: Intubate immediately in cases of facial burns with stridor.
 4. Chemical Burns: Irrigation with water as first-line treatment.

2025 Prediction Highlights:

● Scenarios focusing on the Parkland formula, airway management, and early treatment in
chemical burns.
● Key contraindications for silver sulfadiazine on facial burns.
● Questions on infection control and long-term complications like contractures.

Suggested Reading for 2025:

● UpToDate: “Fluid Resuscitation in Burn Injuries”

● Royal College of Surgeons: “Burn Complications and Their Management”
● Bailey & Love Surgery: “Comprehensive Burn Management”