OET Reading Part A - Management of BURNS
OET Reading Part A
Management of Burns
Text A
Burn depth
Burn injuries are classified according to how much tissue damage is present.
1. Superficial partial thickness burns (also known as first and second degree)
Present in most burn wounds. Injuries do not extend through all layers of skin.
2. Full thickness burns (also known as third degree)
* Burn extends into the subcutaneous tissue.
* Underlying tissue may appear pale or blackened
* Remaining skin may be dry and white, brown or black with no blisters
* Healing associated with considerable contraction and scarring
3. Mixed burns
Burns are frequently of mixed depth. The clinician should estimate the average depth by the appearance and the presence of sensation.
Resuscitation should be based on the total of second and third degree burns, and local treatment should be based on the burn thickness at any specific site.
Text B
Fluid resuscitation
If the burn is over 15% of the TBSA (Total Body Surface Area) in or 10% in children, intravenous fluids should be started as soon as possible on scene, although transfer should not be delayed by more than two cannulation attempts. For physiological reasons, the threshold is closer to 10% in the elderly (more than 60 years).
Suggested regimen for fluid resuscitation
Adults
Resuscitation fluid alone (first 24 hours)
* Give 3-4 ml Hartmann's solution (3ml in superficial and partial thickness burns/ 4ml in full thickness burns or those with associate inhalation injury) per kg body weight /% TBSA burned. Half of this volume is given in the first 8 hours after injury and the remaining in the second 16-hour period.
Children
Resuscitation fluid as above plus maintenance (0.45% saline with 5% dextrose)
* Give 100 ml/kg body weight plus 50ml/kg for the next 10kg body weight plus 20ml/kg for each extra kg.
Text C
Management of burns
1. Assess the patient status: airway, breathing, circulation, IV access.
2. Assess the burn depth and extent. A sheet can be placed on burns during this time.
3. Cooling: Remove jewellery or hot clothing. Limit inflammation and pain by using cool water, cool saline soaked gauze or a large sheet in the case of a large wound. Cool the wound not the patient taking care not to cause hypothermia.
4. Pain control: Acetaminophen usually helpful but may need to use opiates such as codeine.
5. Check immunization status and update tetanus if necessary.
6. If possible begin fluid resuscitation.
7. Debridement of blisters - there are are some differences of opinion regarding breaking of blisters.
a. Some suggest leaving blisters in tact because act as a barrier to infection and others debride all blisters.
b. Most agree that necrotic skin should be removed following blister raptures.
8. Application of antibiotics in the form of ointment. Should always be used to prevent infection in any non-superficial burns.
9. Apply suitable dressing to the wound area
Text D
Adult Analgesic Guidelines
The following table provides recommended short term (less than 72 hours) oral analgesia guidelines for the management. Aim for pain scores 4 or less at rest. Analgesia should be reviewed after 72 hours and adjusted according to pain scores. Patient management should be guided by individual case and clinical judgment.
Pain score elicited from patient (scale 1-10)
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Mild pain- Moderate pain- Severe pain-
Pain score 1-3 Pain score 4-6 Pain score 7-10
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Recommended- Recommended- Recommended-
analgesia analgesia + col 1 Analgesia + 1=2
Paracetamol Tramadol 50-100 Strong opioids
1gm 4x daily 4x daily Oxycontin SR 100
And if needed: If above unsuccessful Endone, 2 -4 hourly
Naproxen 250 Endone 5 -10 mg (2-4 as needed
2xdaily. hourly
Review in 72 hours Review in 72 hours.
If pain can't be controlled, consider admission.
Paediatric Analgesia Guidelines
* Paracetamol (15 mg/kg orally or per rectum (PR)
* Non-steroidal Anti-inflammatory Drugs
* naproxen 5-10 mg (max 500 mg) 12-hourly orally or PR
* ibuprofen 2.5 -10 mg (max 600mg) 6-8 hourly orally
* Opioids ( Codeine 0.5- 1mg/kg orally)
Answers
For each question, 1-5, decide which text (A, B, C, or D) the information come from. Write the letter A,B,C or D in the space provided. You may use any letter more than once.
In which text can you find information about
1. age-related considerations for initial treatment of burns injuries?
Ans: B (Re: Topic sentence of Text B says, "if the burn area is over 15% of the TBSA in adults or 10% in children....")
2. the risk involved in certain treatments?
Ans: C (Re: "risk" implies "risk management", which is discussed in C)
3. when to start thinking about specialist treatment options?
Ans: D ("specialist treatment" implies 'Guidelines')
4. treatment informed by patient self-assessment?
Ans: D ("self-assessment" implies 'score elicited' discussed in text D, the heading of the table)
5. how to categorise the severity of a burn?
Ans: A ( Re: Topic sentence of Text A, "burn injuries are classified......" 'classified' = 'categorised'
How to Answer Questions 6-22.
Text A
Burn depth
Burn injuries are classified according to how much tissue damage is present. ( Topic sentence)
1. Superficial partial thickness burns (also known as first and second degree)
Present in most burn wounds. Injuries do not extend through all layers of skin.
2. Full thickness burns (also known as third degree)
* Burn extends into the subcutaneous tissue.
* Underlying tissue may appear pale or blackened
* Remaining skin may be dry and white, brown or black with no blisters
* Healing associated with considerable contraction and scarring
3. Mixed burns
Burns are frequently of mixed depth. The clinician should estimate the average depth by the appearance and the presence of sensation.
Resuscitation should be based on the total of second and third degree burns, and local treatment should be based on the burn thickness at any specific site.
Text B
Fluid resuscitation
If the burn is over 15% of the TBSA (Total Body Surface Area) in or 10% in children, intravenous fluids should be started as soon as possible on scene, although transfer should not be delayed by more than two cannulation attempts. For physiological reasons, the threshold is closer to 10% in the elderly (more than 60 years).
Suggested regimen for fluid resuscitation
Adults
Resuscitation fluid alone (first 24 hours)
* Give 3-4 ml Hartmann's solution (3ml in superficial and partial thickness burns/ 4ml in full thickness burns or those with associate inhalation injury) per kg body weight /% TBSA burned. Half of this volume is given in the first 8 hours after injury and the remaining in the second 16-hour period.
Children
Resuscitation fluid as above plus maintenance (0.45% saline with 5% dextrose)
* Give 100 ml/kg body weight plus 50ml/kg for the next 10kg body weight plus 20ml/kg for each extra kg.
Text C
Management of burns
1. Assess the patient status: airway, breathing, circulation, IV access.
2. Assess the burn depth and extent. A sheet can be placed on burns during this time.
3. Cooling: Remove jewellery or hot clothing. Limit inflammation and pain by using cool water, cool saline soaked gauze or a large sheet in the case of a large wound. Cool the wound not the patient taking care not to cause hypothermia.
4. Pain control: Acetaminophen usually helpful but may need to use opiates such as codeine.
5. Check immunization status and update tetanus if necessary.
6. If possible begin fluid resuscitation.
7. Debridement of blisters - there are are some differences of opinion regarding breaking of blisters.
a. Some suggest leaving blisters in tact because act as a barrier to infection and others debride all blisters.
b. Most agree that necrotic skin should be removed following blister raptures.
8. Application of antibiotics in the form of ointment. Should always be used to prevent infection in any non-superficial burns.
9. Apply suitable dressing to the wound area
Text D
Adult Analgesic Guidelines
The following table provides recommended short term (less than 72 hours) oral analgesia guidelines for the management. Aim for pain scores 4 or less at rest. Analgesia should be reviewed after 72 hours and adjusted according to pain scores. Patient management should be guided by individual case and clinical judgment.
Question 6 - 13
Complete each of the questions, 6 -13, with a word or a short phrase from the texts. Each answer may include words, numbers or both.
[1. Identify which text the question refers to.
2. Go to the text and look for the answers using synomymous language.]
6. Classification (Text A) of burn injuries depends on the amount of ................... caused. Ans: tissue damage.
[Explanation. Text A .Text A. Topic sentence. "Burn injuries are classified according to (= depends) how much (amount of) tissue damage is present (caused)."
7. Patients recovering from third degree burns (Text A) are likely to experience a great deal of shrinkage and ................... of their skin.
Ans: scarring.
[ Explanation.: Text A. Refer 'third degree burns'. " * Healing (= 'recovering') associated with considerable (='a great deal of') contraction ('shrinkage') and scarring". ]
8. When evaluating mixed depth burns, (Text A) you should take into account how the burn looks and whether there is .................. in the affected area. Ans: sensation.
[Explanation: refer 'mixed depth burns'. "The clinician (= you) should estimate (=evaluating) the average depth by the appearance (looks) and the presence of (= there is) sensation"
9. You should cool burn injuries (Text C) by taking off any ................. or jewelry that the patient is wearing. Ans: hot clothing
Explanation. Cooling: Remove (taking off any) jewellery or hot clothing.
10. When cooling the wound, (Text C)make sure that you don't put the patient at risk of ................... Ans: hypothermia
Explanation: Cool the wound (cooling the wound), not the patient, taking care (make sure) not to cause (at risk of) hypothermia.
11. The patient may require a ................... booster, depending on when they were last immunized. Ans: tetanus
Explanation: " require a .... booster" shows that it refers to Text C.
"Check immunisation status (= the patient may require a booster and update) tetanus"
12. You should consider leaving ............ undisturbed, as these may prevent infection. Ans: blisters
13. You should apply ointments containing to all deeper burns.
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