Emergency

Management of Severe
Burns (EMSB)
Dr. Amrin Amir Lubis
A. Airway Maintenance with Cervical
Spine Control
 Check for a patent airway, easiest by speaking to the patient. If the airway is
not patent, clear the airway of foreign material and open the airway with
chin lift/jaw thrust.
 Control cervical spine (best with rigid collar). Injuries above the clavicle, such
as facial injuries or unconsciousness, are often associated with cervical
fractures.
B.Breathing and Ventilation

 Expose the chest and ensure that chest expansion is adequate and equal[2].
 Always provide supplemental oxygen –100% high flow(15 l/min) via a non-
rebreather mask[2, 9].
 Beware circumferential chest burns -is an escharotomy required?
C.Circulation with Haemorrhage
Control
 Check the central pulse –is it strong or weak?
 Check blood pressure
 Capillary refill (centrally and peripherally)–normal return is ≤2 seconds.
Longer indicates hypovolaemia or need for escharotomy on that limb; check
another limb.
 Insert 2 IV lines preferably through unburned tissue
 Take blood for FBC/U&E/LFT/Cross Match.
D.Disability

 Neurological Status
 Establish level of consciousness: AVPU
 A-Alert
 V-Response to Vocal stimuli
 P-Responds to Painful stimuli
 U-Unresponsive

Examine the pupil’s response to light  Be aware that hypoxaemia and shock
E.Exposure with Environmental Control

 Log roll the patient to visualise posterior surfaces

 Keep the patient warm [7, 9]
 Area burned is estimated by using the Rule of Nines or palmar (Rule of One’s)
methods
Fluids, Analgesia, Tests and Tubes

 Fluid Resuscitation

Modified Parkland formula [7, 11-19]:

3–4cc x weight (kg) x % burn TBSA + maintenance for children.
Crystalloids are the recommended fluid
½ total for 8 hours
½ total for 16 hours
Monitor adequacy of resuscitation with [3, 7, 11,14, 18, 20]:
-Urinary catheter with hourly output measured
-ECG, pulse, blood pressure, respiratory rate, pulse oximetry and arterial blood gas
analysis as appropriate.
Analgesia

 Burns hurt –give intravenous morphine 0.05–0.1mg/kg

Tests

 X-Ray
 -Lateral cervical spine
 -Chest
 -Pelvis
 -Other imaging as clinically indicated
Tubes

 Nasogastric tube
 Insertnasogastric tube for larger burns (>10% in children; >20% in adults).
Estimation of the Depth of the Burn
 Estimation of the Area of the Burn

Palmar (Rule of One’s) methods

“Rule Of Nines”
 Palmar (Rule of One’s) methods

For every year of life after 12 months 1% is taken from

the head and 0.5% is added to each leg
Once the child reaches 10 years oldtheir body is
proportional to an adult
DIGNOSIS OF THE BURN
TERIMAKASIH