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ACS

Injuries due to
Burns and Cold

ACS

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

ACS

Burns / Cold Injuries

Management Principles

Establish / maintain

Airway
Normal perfusion
Fluid / electrolyte balance
Normal body temperature

ACS

Inhalation Injury
Clinical Indications

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

ACS

Life Saving Burn Treatment

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

ACS

Burn Assessment
History

Mechanism of injury
Associated illnesses
Allergies
Tetanus status

ACS

Rule of Nines
surface of patients
palm = 1% BSA

ACS

Second Degree Burn

ACS

Third Degree Burn

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ACS

Burn Management
Airway

Assess for injury

Establish and maintain patent airway
early

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ACS

Burns Management
Breathing

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

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ACS

Burn Management
Circulation

Adequate venous access

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

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ACS

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

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ACS

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

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ACS

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

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ACS

Burn Management
Gastric Intubation

Nausea vomiting , distention

Burns > 20% BSA

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

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ACS

Burn Management
Wound Care

Cover with clean linens

Do not
Break blisters
Apply antiseptics
Apply cold water

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ACS

Burn Management
Chemical Burns

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

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ACS

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

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ACS

Burn Management
Electrical Burn

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

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ACS

Burn Transfer Criteria

2nd and 3rd Degree burn

>10% BSA in ages

<10 and > 50 years
>20% BSA
To :
Face
Hand
Eyes

Feet

Ears

Genitalia

Perineum
Major joints

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ACS

Burn Transfer Criteria

3rd degree burn > 5% BSA

Electrical and chemical burns
Inhalation injury
Preexisting illnesses,associated injuries
Children
Special situations

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ACS

Burn Transfer Prosedure

Coordinate with burn center doctor

Transfer with
Documentation / information
Laboratory results

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ACS

Cold Injury Facture

Temperature
Duration of
exposure
Environmental
conditions

Immobilization
Moisture
Vascular disease
Open wounds

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ACS

Cold Injury : Local Tissue

Frostnip
Frostbite

Nonfreezing

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ACS

Cold Management

Do not delay
Remove clothing
Warmed blankets
Rewarm frozen
part

Preserve damaged
tissue
Prevent infection
Elevate exposed part
Analgesics, tetanus,
and antibiotics

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ACS

Hypothermia : Tc < 35 Degrees

Rapid / slow drop in core temperature

Elderly and Children at greater risk
Low-range thermometer required
Clinical findings
Depressed LOC
Gray, cyanotic, variable vital signs
Absence of cardiorespiratory activity

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ACS

Hypothermia
Management

ABCDES, IV access
Oxygenate and ventilate
Prevent heat loss and rewarm
Assess for associated disorders
Blood analyses

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ACS

Hypothermia
Management

Passive external rewarming : Warmed

environment, blankets, and IV fluids
Active core rewarming
Surgical rewarming techiniques
Do not delay transfer
Not dead until warm and dead

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ACS

Question

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ACS

Summary
Burn Injury

Recognize and treat inhalation injury

Fluid resuscitation
Identify burns requiring transfer

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ACS

Summary
Cold injury

Diagnose type
History
Clinical findings
Measure core temperature
Rewarming techniques
Monitor and support vital functions