General learning Objectives:
A generalist physician must be able to explain the biological foundation and basis in the clinical management of a BURN patient.
Enabling Objectives:
A generalist physician must be able to answer the questions and accomplish the tasks listed below:
1. What is a BURN injury? How does it differ from a cold injury?
2a. What are the different kinds of BURN injury based on the causes?
2b. What are the 2 more common causes of BURN injury in the community?
2c. Identify the causes of BURN that have legal implications and then describe the legal implications.
3a. What type(s) of patients (based on age group, behavior, and other factors) are at a higher risk for accidental BURN injury?
3b. What type(s) of occupations and physical environment are at a higher risk for BURN injury?
3c. Suggest ways to prevent BURNS in the various types of persons at risk.
4. Identify behaviors of individual persons or family, folk beliefs, and cultural practices that may contribute to higher risk for BURNS and then suggest change strategies.
5. What anatomical structures (organs and tissues) are usually primarily involved in a BURN injury?
Organs/Tissues
Sunburns
Thermal burns
Flame
Scald
Electrical burns
Inhalational burns
Chemical burns
6. Draw the surface anatomy of the whole human body. Then, mark the areas which can be affected by a flame BURN injury.
7. Draw the gross and microscopic anatomy of a section of the skin, subcutaneous
tissues, and muscles which can be affected by a BURN injury. Place the
appropriate labels.
8. Illustrate the different microscopic layers of the epidermis of the skin that may be affected by a BURN injury.
9. What are the usual functions of the skin?
10. How does the skin protect the body against external noxious agents? Describe the pain sensors and withdrawal reaction mechanisms. Use diagrams and illustrations as necessary.
11. How does the skin protect the body against fluid loss? Use diagrams and illustrations as necessary.
12. How does the skin protect the body against infection? Use diagrams and illustrations as necessary.
13. What are the three types of tissue destruction (or three zones of tissue changes) in a BURN injury? Describe each zone and identify its clinical importance. Use diagrams and illustrations as necessary.
14. What is the relationship between length of exposure to the heat agent and severity of a BURN injury? Identify the clinical importance of knowing this relationship.
15. What is the relationship between intensity of the heat and severity of a BURN injury? Identify the clinical importance of knowing this relationship.
16. What characteristics of the human body tissues will affect the severity of a BURN injury if the duration and intensity of heat application are made constant and fixed? Identify the clinical importance of knowing this factor (characteristics of human body tissues).
17. What are the characteristic differences between thermal and chemical BURNS with respect to local tissue and whole body injury?
18. What are the characteristic differences between thermal and electrical BURNS with respect to local tissue and whole body injury?
19. What are the endocrine and metabolic responses to BURN injury? Relate the responses to clinical management. Use diagrams as necessary.
20. What is the pathophysiology of pain in BURNS? Explain the anatomical and physiological (including biochemical) bases of somatic pain.
21. What is the pathophysiology of hypovolemic shock in BURN? Describe using diagrams the anatomy of body fluid compartment and explain the body fluid physiology and biochemistry.
22. What is the pathophysiology of septic shock in BURNS or what is commonly known as BURN sepsis? Explain the microbiological bases of BURN wound infections and septicemia.
23. What is the pathophysiology of acute respiratory distress syndrome (ARDS) in BURN patients? Explain the anatomical, physiological, biochemical, and pathological bases of ARDS.
24. How do BURN wounds heal? Explain using diagrams the anatomical, physiological, and biochemical bases of wound healing.
25a. What is the pathophysiology of hypertrophic scars and contractures in BURNS?
25b. What are the preventive measures against hypertrophic scars and contractures in BURN patients?
26a. What are the usual causes of death in BURN patients?
26b. What preventive measures should a physician do to avoid death in BURN patients?
26c. What are the legal implications when a BURN patient dies under the care of a
physician? Identify conditions that may make the physician liable for the
patient’s death.
27. What are the two classifications of depth of surface BURNS? Relate the two classifications. Describe how these depths of surface BURNS can be recognized clinically. Explain why it is important to know the depth of the surface BURNS in clinical management.
28. Why is it important to determine the extent of surface BURNS in clinical management? What is the Rule of Nines and in what situations can it be used? What is the Lund-Browder Chart and in what situations can it be used? What is the palmar estimate method and in what situations can it be used?
29. When is inhalational BURN injury suspected? What are the general guidelines in the treatment of inhalational BURN injuries?
30. Name one indication for each of the following procedures in a BURN patient and briefly describe how the procedures are being done and results being interpreted:
Chest x-ray
Electrocardiogram
Arterial blood gases
Nasogastric tube insertion
Foley catheter insertion
Carboxyhemoglobin blood level
31. What are ways to stop the burning process in patients with
Flame burns?
Scald burns?
Electrical burns?
Chemical burns?
Inhalational burns?
32. Describe a fluid and electrolyte management approach/protocol in a BURN patient – the indications, the type of intravenous solutions to use, the regimen, and monitoring guidelines.
33. Describe a pain control and management approach/protocol in a BURN patient – the indications for analgesics, the drugs, their pharmacodynamics, pharmacokinetics, and pharmacotherapeutic usages.
34. Describe a BURN infection control and management approach/protocol in a BURN patient – the indications for antimicrobials (topical and systemic), the drugs, their pharmacodynamics, pharmacokinetics, and pharmacotherapeutic usages.
35. Describe a tetanus prophylaxis approach/protocol in a BURN patient – the indications, the drugs, their pharmacodynamics, pharmacokinetics, and pharmacotherapeutic usages.
36a. Describe a local BURN wound treatment approach/protocol including the rationale.
36b. Explain the following terms and give an indication for each:
Cleansing
Debridement
Removal of blister
Escharotomy
Escharectomy
Fasciotomy
Tangential excision
Primary excision of BURN wound
Skin grafting
Amnion dressing
Biological dressing
Artificial skin
37. Name at least 2 topical antimicrobial creams that can be used in a BURN patient. Identify which ones are usually used in the Philippines. Using a table, compare the various creams in terms of effectiveness (benefits), side-effects (risks), and cost.
38. Make a clinical management algorithm for patients with electrical injury. Start with essential clues in the clinical diagnosis, then paraclinical diagnostic procedures (indications, recommended procedures and interpretations) and lastly, recommended treatment procedures.
39. Make a clinical management algorithm for patients with chemical BURNS. Start with essential clues in the clinical diagnosis, then paraclinical diagnostic procedures (indications, recommended procedures, and interpretations) and lastly, recommended treatment procedures.
40. Describe an approach/protocol in the prevention and management of sunburns.
41. Describe an approach/protocol in the outpatient management of BURNS.
42. Describe an approach/protocol in the nutritional therapy in a BURN patient.
43. Describe an approach/protocol in the rehabilitation therapy (physical and
psychosocial) in a BURN patient.
44. Enumerate the general guidelines for hospitalization of a BURN patient.
45. Enumerate the general indications for referral to a BURN specialist.
ROJ@17oct29
ROJOSON's Blog on Medical Education 