Internal Medicine
Dermatology
Burns

Burns

Introduction

Burns are a critical topic for the MCCQE1 exam and an essential area of knowledge for Canadian medical practitioners. This comprehensive guide covers the key aspects of burn management, tailored specifically for Canadian healthcare practices and the MCCQE1 exam.

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Understanding burn management is crucial for success in the MCCQE1 exam and for providing effective care in Canadian healthcare settings.

Classification of Burns

Burns are classified based on their depth and extent. Knowing these classifications is vital for MCCQE1 preparation and clinical practice in Canada.

  1. Superficial (1st degree)
  2. Partial thickness (2nd degree)
  3. Full thickness (3rd degree)
  4. Fourth degree (involves underlying structures)

Depth Classification in Detail

Superficial (1st degree)

  • Affects epidermis only
  • Erythema, pain, no blisters
  • Heals within 3-7 days

Partial thickness (2nd degree)

  • Affects epidermis and part of dermis
  • Blisters, severe pain, moist appearance
  • Heals within 2-3 weeks

Full thickness (3rd degree)

  • Destroys epidermis and full thickness of dermis
  • Leathery, painless, dry appearance
  • Requires skin grafting

Fourth degree

  • Extends beyond skin into subcutaneous tissue, muscle, or bone
  • May require amputation

Burn Assessment

Accurate burn assessment is crucial for appropriate management and is a key focus area for the MCCQE1 exam.

Rule of Nines

The Rule of Nines is a quick method to estimate the percentage of Total Body Surface Area (TBSA) affected by burns. It's essential knowledge for MCCQE1 preparation.

Body PartAdultChild
Head and Neck9%18%
Each Arm9%9%
Anterior Trunk18%18%
Posterior Trunk18%18%
Each Leg18%13.5%
Perineum1%1%
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Canadian burn centers often use the Lund and Browder chart for more accurate TBSA estimation, especially in pediatric cases.

Initial Management

Proper initial management of burns is critical and is frequently tested in the MCCQE1 exam.

  1. Stop the burning process

    • Remove clothing and jewelry
    • Cool the burn with room temperature water for 20 minutes

  2. Assess Airway, Breathing, Circulation (ABC)

    • Look for signs of inhalation injury
    • Monitor oxygen saturation

  3. Fluid Resuscitation

    • Use the Parkland Formula for burns >20% TBSA
    • Formula: 4 mL × kg body weight × % TBSA burned

  4. Pain Management

    • Use appropriate analgesics as per Canadian pain management guidelines

  5. Wound Care

    • Clean wounds with mild soap and water
    • Apply appropriate dressings
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Remember the "C's" of burn assessment: Color, Consistency, Capillary refill, and Charring.

Canadian Guidelines for Burn Management

The following guidelines are specific to Canadian healthcare practices and are important for MCCQE1 preparation:

  1. Referral Criteria to Burn Centers

    • Partial thickness burns >10% TBSA
    • Burns involving face, hands, feet, genitalia, perineum, or major joints
    • Full thickness burns in any age group
    • Electrical burns, including lightning injury
    • Chemical burns
    • Inhalation injury
    • Burn injury in patients with pre-existing medical disorders
    • Burns with concomitant trauma

  2. Tetanus Prophylaxis

    • Administer tetanus toxoid if last booster was >5 years ago
    • For contaminated wounds, give tetanus immune globulin if vaccination history is unknown or incomplete

  3. Nutritional Support

    • Early enteral feeding within 24-48 hours of injury
    • High protein, high calorie diet

Complications of Burns

Understanding burn complications is crucial for MCCQE1 success and effective patient care in Canadian healthcare settings.

  • Infection
  • Hypovolemic shock
  • Compartment syndrome
  • Acute respiratory distress syndrome (ARDS)
  • Acute kidney injury
  • Contractures and scarring

Key Points to Remember for MCCQE1

  • 🔑 Know the burn classification system and how to accurately assess TBSA
  • 🔑 Understand the initial management steps, including fluid resuscitation using the Parkland Formula
  • 🔑 Be familiar with Canadian referral criteria to burn centers
  • 🔑 Recognize signs of inhalation injury and its management
  • 🔑 Understand the principles of pain management and wound care in burn patients
  • 🔑 Be aware of potential complications and their management

Sample Question

A 35-year-old man presents to the emergency department with burns on his anterior trunk and right arm after a kitchen accident involving boiling water. The burns appear red, painful, and have some blistering. Which of the following is the most accurate estimate of the Total Body Surface Area (TBSA) affected?

  • A. 18%
  • B. 27%
  • C. 36%
  • D. 45%
  • E. 54%

Explanation

The correct answer is:

  • B. 27%

Using the Rule of Nines for adults:

  • Anterior trunk: 18% TBSA
  • One arm: 9% TBSA

Total: 18% + 9% = 27% TBSA

This question tests your ability to apply the Rule of Nines, a crucial skill for burn assessment in the MCCQE1 exam and clinical practice in Canada.

References

  1. American Burn Association. (2022). Burn Incidence and Treatment in Canada. https://ameriburn.org/canada-burn-statistics/ (opens in a new tab)

  2. Canadian Association of Emergency Physicians. (2021). Position Statement on the Management of Burns. https://caep.ca/burn-management/ (opens in a new tab)

  3. Jeschke, M. G., et al. (2020). Guidelines for Burn Care Under Austere Conditions: Special Care Topics. Journal of Burn Care & Research, 41(4), 882-891.

  4. Pham, T. N., et al. (2018). American Burn Association Practice Guidelines Burn Shock Resuscitation. Journal of Burn Care & Research, 39(6), 967-974.

  5. Canadian Agency for Drugs and Technologies in Health. (2019). Burn Wound Management: Guidelines. https://www.cadth.ca/burn-wound-management-guidelines (opens in a new tab)

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