Inhalation Injury & Burn Critical Care

Chapter 25 of Volume 3, Skin, Burns & Surgical Principles. Revision notes and examiner-style viva questions with model answers for the FRCS (Plast).

39 viva questions in this chapter

1. A 42-year-old man is pulled from a house fire. What is inhalation injury?
   Model answer for subscribers
2. Does inhalation injury change the outcome, or does it just mean the patient goes to ITU?
   Model answer for subscribers
3. How do you diagnose it? Is there a gold standard?
   Model answer for subscribers
4. You mention bronchoscopy. Grade it for me.
   Model answer for subscribers
5. This man has facial burns and soot in his mouth. Are you going to intubate him?
   Model answer for subscribers
6. You have decided to intubate. Talk me through the tube.
   Model answer for subscribers
7. When would you do a tracheostomy in a burn patient?
   Model answer for subscribers
8. He is now on the burns ICU, ventilated. How would you ventilate him?
   Model answer for subscribers
9. He develops bilateral infiltrates and a P:F ratio of 130. Define ARDS.
   Model answer for subscribers
10. His P:F is now 90 on 80% oxygen. What next?
    Model answer for subscribers
11. What about neuromuscular blockade?
    Model answer for subscribers
12. What about high-frequency percussive ventilation? Your unit has a VDR.
    Model answer for subscribers
13. He is failing everything. Would you refer him for ECMO?
    Model answer for subscribers
14. What else are you doing for the lungs, apart from the ventilator?
    Model answer for subscribers
15. He was found unconscious in a closed room. His saturations are 99% on air. Are you reassured?
    Model answer for subscribers
16. Would you send him for hyperbaric oxygen?
    Model answer for subscribers
17. His lactate is 14 and he is collapsing despite fluid. What are you thinking?
    Model answer for subscribers
18. Give me the antidote and the dose.
    Model answer for subscribers
19. Day 8. Temperature 39, heart rate 130, white cell count 22. Is he septic?
    Model answer for subscribers
20. You mention a 2023 guideline. Tell me about it.
    Model answer for subscribers
21. You said you would look at the wound. Talk me through source control.
    Model answer for subscribers
22. Would procalcitonin help?
    Model answer for subscribers
23. What is your approach to antibiotics on a burns unit?
    Model answer for subscribers
24. What organisms are you worried about on your burns unit?
    Model answer for subscribers
25. Tell me about the hypermetabolic response to burn injury.
    Model answer for subscribers
26. How do you modulate it?
    Model answer for subscribers
27. Propranolol. Dose, evidence, and what it actually does.
    Model answer for subscribers
28. What about oxandrolone?
    Model answer for subscribers
29. And growth hormone?
    Model answer for subscribers
30. Should you suppress the cortisol response?
    Model answer for subscribers
31. How do you feed this patient?
    Model answer for subscribers
32. What micronutrients?
    Model answer for subscribers
33. What about glutamine?
    Model answer for subscribers
34. And high-dose vitamin C?
    Model answer for subscribers
35. What glucose target?
    Model answer for subscribers
36. His haemoglobin is 7.4 the morning after a 25% excision. Do you transfuse?
    Model answer for subscribers
37. Thromboprophylaxis?
    Model answer for subscribers
38. Stress ulcer prophylaxis?
    Model answer for subscribers
39. Take me on your ward round. How do you review a ventilated burn patient?
    Model answer for subscribers