ANZCA Final Exam Resources
Day 2

Burns

Read Stapelberg 2020 review article

Who to Transfer to Burns Unit

Burns > 10% BSA or > 5% full thickness
Burns to face, hands, feet, perineum
Electrical/chemical burns
Inhalational injuries
Circumferential full-thickness burns
Extremes of age
Significant comorbidities or associated trauma

Burns Surgery

Biobrane for intermediate/deep dermal burns - amazing results
Full thickness burns need to be debrided
BTM (biodegradable temporising matrix) has revolutionised large burn management
Temporary skin coverage
New vessels grow through foam matrix
Skin is grafted onto BTM
BTM degrades over the next 18 months

Anaesthesia for Burns

Grossly swollen airway
Inhalational injury
Septic, inotropic support, renal failure
Coagulopathic
Awkward positioning - prone, lateral
Burnt fingers, toes, ears, trunk
SpO2 in cheek, no NIBP, no ECG dots, difficult IV access
Massive blood loss and transfusion
Unable to warm - warm theatres instead, hot/humid/smelly environment
Severe pain
ETT may be tied to teeth rather than tied externally (can strangle patient with oedema)
Tumescent prep is now commonly used for burns debridements to limit blood loss
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