The 2027 Plastic Surgery ST3 Interview Revision Platform: Question Bank, Live Practice and Mocks with Other Candidates

This is a life-threatening injury, so I'd manage him with the MDT along Advanced Trauma Life Support and Emergency Management of Severe Burns principles, and I would not let the burn distract me from more urgent life threats in the primary survey. Airway with c-spine control: high-flow oxygen, and a careful look for inhalation injury. Breathing: assess the chest and look for a circumferential torso burn. Circulation: IV access, bloods with a crossmatch and an ABG, fluid resuscitation guided by the Parkland formula, and a urinary catheter for fluid balance. Disability: conscious level and glucose. Exposure: remove all clothing and jewellery, log roll, and keep him warm to avoid hypothermia. I'd give IV morphine for analgesia, arrange trauma imaging as indicated, and place an NG tube.

There are a few methods: Wallace's Rule of Nines, a Lund and Browder chart, or using the patient's palm as roughly 1%. I'd use the Rule of Nines for a quick estimate to guide fluid requirements. In an adult the body divides into nines: head and neck 9%, each arm 9%, the anterior trunk 18%, the posterior trunk 18%, each leg 18%, and the perineum 1%. In children the proportions are adjusted for age.

I'd cover the event and mechanism: was it an enclosed space, was there an explosion, was he found unconscious, and what first aid was given at the scene. Then the risk factors for complications such as diabetes, immunosuppression and smoking, along with anticoagulant use, other comorbidities and tetanus status.

The modified Parkland formula estimates fluid in the first 24 hours: 3ml of Hartmann's per kg per percent TBSA, with half given in the first 8 hours from the time of the burn and the rest over the following 16 hours. It's used to start resuscitation, and the rate is then titrated to a urine output of around 0.5ml per kg per hour in adults and 1ml per kg per hour in children. Formal resuscitation is indicated for burns of 20% TBSA or more in adults, and 10% or more in children.

On the torso, a circumferential full-thickness burn can restrict chest expansion and impair ventilation, and on a limb it can impair circulation and cause compartment syndrome. I'd consider an urgent escharotomy for circumferential burns to the limbs, neck or torso where circulation or ventilation is compromised, cutting from unburnt skin to unburnt skin.

He should be managed in a burns centre, the highest level of care in the UK system of centres, units and facilities. I'd refer to a specialised burn service in line with British Burns Association criteria, which include full-thickness or circumferential burns, burns over roughly 3% in adults or 2% in children, burns to the hands, face, feet, perineum or genitalia, chemical or electrical burns, any suspicion of non-accidental injury, and any suspicion of toxic shock syndrome. Definitive care is an MDT effort: surgical debridement and reconstruction, rehabilitation with physiotherapy, occupational therapy and dietetics, and psychological support.