Return to Scenario ListShow Learning Points most relevant to Phase 1:


Clinical Discipline(s)/Organ System(s)
Plastic Surgery, Emergency Medicine, Palliative Medicine
Progress Test Topic(s)
Seriously ill patient, Skin
An 87 year old Māori man is brought in by ambulance after a house fire. He has visible severe burns over the majority of his body. His family is in attendance and he is being managed in a side room. You are asked to take notes for the consultant who is going to review the patient.
Progress Test-Type Questions:   Question 1 | Question 2
Applied Science for Medicine 
   - Anatomy and function of the skin
   - Haemostasis of temperature control
   - Grades of burn (ANZBA 2004 Classification) and implications for prognosis and management
   - Pattern of burns caused by: electricity, acid, alkali and radiation
Clinical and Communication Skills 
   - Communication with a patient who is in pain and with distressed family members; breaking bad news
   - History from a patient with burns and/or a witness
   - Examination of a patient with burns; estimate surface area involved using "Rule of Nines" or Lund-Browder diagrams
   - Perform vital signs, blood cultures, skin swab
   - Injuries associated with burns
   - Indications for CT, MRI, ultrasound scanning
   - Interpret full blood count, electrolytes, renal function, skin swabs, blood cultures, chest X-ray, liver function tests, coagulation screen
   - Urgent management of extreme pain
   - Basic management of burns; immediate and long-term
   - Complications of burns
   - Prognosis of burns
   - Role of the anaesthetist, intensivist, dietitian
Personal and Professional Skills 
   - Self-care: coping with distressing presentations
   - Discuss disfiguring injuries with patients and families
   - Patient/family/whānau requests for treatment; futility of treatment; withdrawing treatment
   - Care and rights of an older patient; power and vulnerability
   - Death and dying; issues arising from end-of-life
   - Role of the police, coroner
   - Role of the Accident Compensation Corporation
Hauora Māori 
   - Caring for kaumatua and kuia
   - Housing issues for Māori
   - Ethnic disparities in fire-related injuries
   - Appropriate engagement and consultation with whānau
   - Understanding of inequities in access to health services and quality of medical care for Māori, and application of this to clinical decision making and management
   - Consideration of patient and whānau needs with regards to ‘breaking bad news
   - Consideration of access to cultural/spiritual support for patient and whānau
   - Ability to recognise own stereotypes and biases in relation to Māori patients and whānau
   - Awareness of disproportionate impact of socioeconomic deprivation on Māori, and appropriate response
   - Awareness of evidence that pain tends to be undertreated in disadvantaged populations
   - Differential ACC claims and rehabilitation for Māori vs non-Māori
Population Health 
   - Epidemiology of burns
   - Strategies for preventing burns in the home
   - Forensic medicine
Conditions to be considered relating to this scenario
epidermal burn, dermal burn (superficial, mid and deep), sunburn, scalding burns
Less common but 'important not to miss'
full thickness burn, electrical burns, radiation burns, frost-bite, chemical burns (acid and alkali)