Burns Injuries

Objectives

Estimate size of injury and determine associated injuries Demonstrate measures of initial stabilization and treatment Identify special problems and methods of treatment Specify criteria for transfer of burn patient

Burns / Cold Injuries

Management Principles

Establish / maintain
Airway Normal perfusion Fluid / electrolyte balance Normal body temperature

Inhalation Injury
Clinical Indications

Carbonaceous sputum Facial burns Hair singeing Carbon deposits Inflamed oropharynx History CO Hgb >10%

Life Saving Burn Treatment

Remove all Injurious material Clothing jewelry Prevent hypothermia Establish 2 large caliber IVS Initiate warmed Ringers lactate solution

Burn Assessment
History

Mechanism of injury Associated illnesses Allergies Tetanus status

Rule of Nines
surface of patients palm = 1% BSA

Second Degree Burn

Third Degree Burn

Burn Management
Airway

Assess for injury Establish and maintain patent airway early

Burns Management
Breathing

Assume CO exposure Inhalation of toxic fumes, carbon particles Direct thermal injury Oxygenate / ventilate Endotracheal intubation ABGs and CO levels

Burn Management
Circulation

Adequate venous access Monitor vital signs Hourly Urinary output Adult : 30-50 mL/hour Child : 1.0 ML/kg/hour

Burn Management
Circulation : Estimate Fluid Needs

2-4 ml warmed Ringers lactate solution/kg/% BSA in 1st 24 hours in first 8 hours in next 16 hours Based on time from injury Monitor heart rate and urinary output

Burn Management
Develop Treatment Plan

Estimate burn size / depth Identify associated injuries Weigh patient Baseline blood analyses and chest x-ray Document on flow sheet

Burn Management
Maintain peripheral Circulation
Remove All constricting devices Assess distal circulation Escharotomy : Surgical consult

Burn Management
Gastric Intubation

Nausea vomiting , distention Burns > 20% BSA

Medications
Narcotics : Minimal use, IV only Antibiotics : Not indicated early

Burn Management
Wound Care

Cover with clean linens Do not Break blisters Apply antiseptics Apply cold water

Burn Management
Chemical Burns

Duration, amount, and concentration Brush away dry chemicals Flush with copious amounts of water for 20-30 minutes Alkali Burn

Burn Management
Electrical Burn

Result in damage to fascia and muscle, and may spare the overlying skin Fasciotomy

Burn Management
Electrical Burn

ABCDES Myoglobinuria Fluids : 100 ml urine / hour Mannitol : 25 g IV Metabolic acidosis Maintain adequate perfusion Sodium bicarbonate

Burn Transfer Criteria

2nd and 3rd Degree burn

>10% BSA in ages <10 and > 50 years >20% BSA To : Face Hand Eyes Ears Feet Genitalia

Perineum
Major joints

Burn Transfer Criteria

3rd degree burn > 5% BSA Electrical and chemical burns Inhalation injury Preexisting illnesses,associated injuries Children Special situations

Burn Transfer Prosedure

Coordinate with burn center doctor Transfer with Documentation / information Laboratory results

Question

Summary
Burn Injury

Recognize and treat inhalation injury Fluid resuscitation Identify burns requiring transfer

Thank you