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42 - Examination of burns

from Section 10 - Plastic surgery

Published online by Cambridge University Press:  05 July 2015

Yezen Sheena
Affiliation:
Health Education East of England, Cambridge, UK
Edmund Fitzgerald
Affiliation:
St Andrew's Centre
Petrut Gogalniceanu
Affiliation:
London Postgraduate School of Surgery
Henk Giele
Affiliation:
Oxford University
Petrut Gogalniceanu
Affiliation:
Specialist Registrar, General and Vascular Surgery, London Deanery
James Pegrum
Affiliation:
Orthopaedic Registrar, Oxford Deanery
William Lynn
Affiliation:
Specialist Registrar, General Surgery, North East Thames
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Summary

Acute burns

Checklist

WIPER

Physiological parameters

General

• Resuscitate patient.

• ITU support: airway, hydration, analgesia and antibiotics.

• Comment on dressings already applied.

Look

• Site of the burn

• Airway compromise risk factors: singed nasal hairs, perioral burns, blistered palate, swelling of tongue or naso-oral mucosa, hoarse voice due to laryngooedema, swollen uvula

• Percentage of total body surface area (TBSA) burnt

• Circumferential burns to chest or limbs

• Depth of burn:

• superficial (epidermal)

• superficial partial-thickness (superficial dermal)

• deep partial-thickness (deep dermal)

• full-thickness

• Assess any structure(s) involved at the base of the burn.

Feel

• Sensation/tenderness

• Capillary refill time in burn, peripheral and centrally

• Moist or dry burn

• Assess peripheral pulses

• Assess chest movements if any circumferential burns

• Identify compartment syndrome in circumferential limb burns

Move

• Movement of underlying joints

Old burns

Checklist

WIPER

Physiological parameters

General

• Tracheostomy scar

• Fitted pressure garments/splints

Look

• Site affected by the burn

• Extent of burn

• Burn and donor sites: graft/flap healing status, colour, contour, contracture, cosmetic result

Feel

• Burn and donor sites for healing result: thickness scars, texture, sensation, tenderness, pliability

Move

• Assess contraction of scars around joints, testing ROM.

• Assess functional impairment of local structures.

To complete the examination

• Assess neurovascular status of loco-regional tissue involved.

Examination notes

What is a burn?

A burn is the coagulative necrosis of tissue due to a thermal, chemical, electrical, friction or radiation insult.

What are the guidelines for the management of burns?

  1. Advanced Trauma Life Support (ATLS)

  2. Emergency Management of Severe Burns (EMSB) principles

One must accurately assess the burn size and depth, as this will determine further specialist management.

Type
Chapter
Information
Physical Examination for Surgeons
An Aid to the MRCS OSCE
, pp. 367 - 370
Publisher: Cambridge University Press
Print publication year: 2015

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