ABC — dont be distracted by the burn

1. Secure the airway

A. Inspect and do a nger sweep
B. If hoarse they may have an airwar injury
C. If stridor : noisy breathing on inspiration: call anesthetics .. risk of total occlusion
D. Inability to ventilate (facial injury, drug overdose .. cant get the air in) — intubate!
E. Inability to oxygenate (inhalation injury) —intubate!
2. Breathing — 100% O2
3. Circulation
A. Gain IV access immediatley — give IV crystalloids
a. 500 cc/hr adults child over 5 yrs 250 cc/hr
B. Check for CENTRAL pulses .. vasoconstrict peripheries in a burn
C. Bloods for ABG, FBC, U and E, group and hold and Carboxyhemoglobin (check on ABG) —
CO poisoning (O2 stat can be deceitful) —- Smokers will have a higher level of
carboxyhemoglobin.. more than 10% will cause confusion
D. Treatment for carboxyhemoglobin —- hypobaric chamber and oxygen

How do you determine the depth of the burn?

• partial or full thickness : partial through the dermis — bleeds
• Full through the dermis - does not bleed
Mechamism often determines the depth
SCALD - partial thicknes (81C) — can heal without a skin graft — BIOBRANE or DUODERM dressing
keeps the dermis
FLAME - full thickness (4-500C) — Need a graft
Electric - full thickness
CHemical - variable
Duration of the contact is important
Flash burn (petrol ash) - often partial —-> will heal
Outdoor - little chance of inhalation injury
Inside - high temperatures, high chance inhalation injury
Loss consciousness - often airway injury

Inside of the eye lids ipped up — saves the eye

• children taken out of a burning building

• Lund and Browder Chart : rule of 9

◦Head and neck 9
◦Each arm is 9
◦19 on torso

Part time regime — used for recussitating burns

— 4ml/kg x % burn — Adult - dont need maintenance
— Child : needs maintenece udis (dextrose saline — pediatric liver has a small store of glycogen -
dont fast well - blood sugars drop fast) too and they need a higher urinary output : pediatric nephron
cant concentrate urine (children will always have light urine) — will become hypoglycemic

• weight in Kg
• Hourly HR, BP, temp, O2, and ins and outs

Early treatment
• Clean dressing covered with warm blanket - why?
 ◦Loose the ability to shiver and become VERY cold
• Why no IM morphine? Why
◦They are vasoconstricted … once you rehudrate them can cause respiratory depression
• No topical antibiotics
• Give IV uids
• Need DVT prophylaxis!!!

Surveys
• repeat primary and secondary survey

Escharotomies — 6 hours
— around the limbs and truck
— needs the tissue to be released = skin too tight
• otomy = open
• Eschar = thick burned tissue (necrotic)
• Open the burned full thickness burn
• DO it early — becuase when you put uid into them they SWELL and get systemic capillary leakage
• Need to do it right through the tissues in a straight line — the whole way with no gaps
◦They get necrosis of the tissues causing muscle death

Escharotomy — burned skin — squeezing from the outside in

Fasciotomy — deep layer below the skin = has nothing to do with the burn

COmpartment syndrome == need fasciotomy — sweezing from the inside out

• increasing pressure deep in muscle skin is normal
• Muscle is where the problem is