Trauma Surgery [BURNS]

There should be some tight, knee-jerk reactions with each kind of

burn that should be known. Beyond that, it’s fluid management 1st Degree = Epidermis, Erythema, Ø Blister
and calculating area burned. 2nd Degree = Dermis, Erythema, + Blister
3rd Degree = Dermis or deeper, painless, white or charred,
1) Chemical Burns edges surrounded by 2nd degree burns
Alkaline are worse than acidic burns. It’s imperative to irrigate
like crazy. Attempts to neutralize will result in burns. There are Chemical Burns è Irrigation
some buffers; they shouldn’t be applied to the skin. Simply - SKIN
irrigate to get rid of the chemical. If ingested, do NOT induce + Never buffer
vomiting, but rather watch and wait, Operate if necessary.. + Irrigate a lot
- INGESTIONS
+ Never induce vomiting
+ Never NG
2) Respiratory Burns + Never Buffer
If there are burns or soot in or around the mouth or nose consider
inhalation injury (smoke, chemical, etc). The patient is usually Respiratory Burn è Intubate
trapped indoors near a fire. The major concern is the airway. - Bronchoscopy
Protect it now as it can close fast. Analyze the airway with - Endotracheal Intubation
bronchoscopy but secure it with intubation. If it needs to be
determined who needs an airway, use ABGs - but do it fast.

3) Electrical Burns
Caused by lightning strikes or contact with high-voltage lines
they yield both entrance and exit wounds. These take the path of Electrical Burns è U/A, Myoglobin, CK
least resistance (i.e. through the electrical conduction system of - Arrhythmias
the heart), causing arrhythmias. It also travels through bone, - Posterior Shoulder Dislocations
heating them, and cooking the muscle nearby. This yields - Demyelination
massive myoglobinuria (check a CK) as the muscle is destroyed.
But because the muscle is next to the bone, there may be no
external signs of injury. Hydrate and give mannitol to avoid
renal failure. Finally, muscle contractions can cause posterior
shoulder dislocations. Long-term sequelae are demyelination
syndromes and cataracts.

4) Circumferential Burns
Yeah that burn hurts, but the swelling and edema that forms under
a thick, leathery eschar will tamponade vessels (on the
extremity) or constrict breathing (on the thorax). Cut the eschar
to allow the tissue to expand. Because the burn killed the nerves,
it can just be cut out without anesthesia and at the bedside!

5) Fluids Rule-of-Nines / 50-50 in 8-16

Only 2nd and 3rd degree burns count. When using the rule of nines
we’re estimating the body service area burned in order to
determine severity and how much fluid is needed. With
significant burns, there’ll be massive fluid and electrolyte
shifts/loss. Use the Parkland Formula to decide how much fluid
to give. The first half is given in 8 hrs and the second half is
given in 16 hrs. Realistically, just start them off at a fluid rate and
adjust to a Uoutput that is adequate. From there, it’s about
supportive care: pain management, nutrition, electrolytes, and
rehab. Early grafting can be done on small areas of burns, but a
long painful rehab is ahead of the patient. Early movement is
critical to prevent scarring. Use silver sulfadiazine and mafenide
to prophylax against infection. In a pediatric patient take one of
the 9s and give it to the head.
(Kg x % BSA Burned X 4cc) of LR

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