Burn Management

Types

Thermal Scald

Chemical Electrical Frostbite

 Case Study
Chief complaint:
22 / C / ♂ admitted for severe burn injuries @ his anterior chest,
abdomen, arms, hands and face.

H O P I:
• Accident occurred @ 10:00 am when he was burning brush in his
backyard and threw a can of gasoline in the fire which resulted in an
explosion. While yelling for help, he immediately dropped to the ground
and rolled in the dirt and grass.
• Upon arrival at ED on 11:00 am, he was found to have significant airway
edema and soot in his oropharynx. Nasal hair, eyelashes, and eyebrow
are singed.
What should
we do???
 Initial Mx
• ABC
A=airway- check for patency, soot around
nares, or signed nasal hair
B=breathing- check for adequacy of
ventilation, eschar encircling the chest
C=circulation- check for presence and
regularity of pulses, fluid replacement
D=disability- compartment syndrome
E=exposure- remove clothing, % TBSA of
burn
 % TBSA of Burn
• Rule of Nines = massive burns
• Patient’s Palm = patchy burns
• Lund-Browder Chart = pediatrics

Rule of 9’s -Lund

Browder

Adult 15 10 5 1 0 Age in years

3½ 4½ 5½ 6½ 8½ 9½ A-head (back or front)
4¾ 4½ 4¼ 4 3¼ 2¾ B-1 thigh (back or front)
3½ 3¼ 3 2¾ 2½ 2½ C-1 leg (back or front)
 Depth of Burns

1st Degree

Epidermal Burns
Erythematous
No blister
Relatively painful

Eg : Sunburn
 Depth of Burns

2nd Degree
Superficial Partial-
Thickness Burns
Blisters, pink & wet
Hypersensitive to
pain
Blanch with pressure
Spontaneously heal
<3 weeks

Eg : Scald burn
2nd Degree Deep Partial-Thickness
Burns
Blisters, mottled pink
& white
Capillary refill
slow/absent
<< sensitive to pain
Not blanch with
pressure
Heals in 3-9 weeks

Eg : Flash burns
 Depth of Burns

3rd Degree
Full-Thickness Burns
All layers of dermis
Leathery, dry white,
firm
Develop “ESCHAR”
Heal by contracture
or skin grafting

Eg : Electrical burn
Mixed Burn Injuries
 Dx Work-Up
• FBC
• RP
• RBS
• GXM if burn >20%
• ABG if inhalation/ burn >20%
• CXR

• CBD if burn >20%

• CVP if burn >30%
 Fluid Resuscitation
a) 1st 24H - Parkland (Baxter) Formula:
• HM only
• 4cc / kg / % BSA
• ½ over first 8H (from onset of burn not admission)
• The remaining ½ over 16H
b) 24 - 48H
• FFP (Colloid)  to maintain plasma vol
• or D5% + HM = ½ volume calculated the first 24H
c) After 48H
• Maintenance Fluids = 30-40cc/kg/day
 40 % TBSA, Wt 80kg,
Burn onset 10.00am, Admit 11.00am

a) 1st 24H - Parkland (Baxter) Formula:

• 4cc / kg / % BSA
• 4 cc x 80 x 40 = 12 800 cc in 1st 24 hrs

800cc/24H 12

over 1st 8H 50% remaining 16H 50%

cc to be completed 6400* cc/16H 6400*
over 7H 400cc/H*
914cc/H*
 Fluid Resuscitation
a) 1st 24H - Evan Formula – for children >15% :
• HM (1cc/kg/BSA) + Colloid (1cc/kg/BSA) + D5% at
2L/m2 over 24H

b) 24 - 48H
• ½ volume calculated in the first 24H
 Ancillary Mx
1. Analgesic (opioid) & sedation
2. A/b
3. Tetanus prophylaxis (IM Tetanus Toxoid
0.5ml stat)
 Burn Wound Care
• Salient Aspects:
– Debridement of necrotic tissue
– Daily dressing of burn wound
– Surgical :Escharotomy/Fasciotomy/
Skin Graft
• Topical Antimicrobials:
– Aqueous Silver Nitrate
– Silver Sulfadiazine
– Mafenide Acetate
– Povidone Iodine
Escharotomies
Criteria of Admission to Burn
Facility
• > 15% in adult
• > 10% in child
• Full thickness burn
• Burns of special regions
• Circumferential burns
• Inhalation injury
• Associated trauma or significant pre-burn
illness