Objectives

Estimate size of injury and determine

associated injuries
Discuss the principles of initial assessment
and treatment
Identify special problems and methods of
treatment
Specify criteria for transfer of burn patient
 Key Questions: Burn Injury

What should I do first?

How do I identify inhalation injury?
How do I estimate burn size and depth?
What is the rate and type of fluids
administered to a burn patient?
Who do I transfer to a burn center?
 What should I do first?

Asses the patients

And stop the burning process

 Burn Management Principles

Establish and Maintain

Airway and Breathing
Normal perfusion ( C and D )
Fluid and electrolyte balance ( C )
Normal body temperature (E)
 Identify inhalation injury?
CHO HGb > 10%
Carbon Carbonaceous
deposits sputum

Hair Inflamed
singeing Oropharynx
and
Face and neck burns hoarseness
 Manage airway / breathing?

Assume: Direct thermal or inhalation

injury
Establish and maintain patent airway
early and consider early ET intubation
Oxygenate and ventilate
Obtain ABGs and CO levels
 Adequate organ perfusion?

Adequate venous access

Monitor vital signs
Hourly urinary output
Adult: 0.5 1.0 mL /kg / hour
Child: 1.0 mL / kg / hour
Infant: 2.0 mL / kg / hour
Estimate burn size and depth?
Second-degree Burn
Third-degree Burn
 Rate and type of fluids?

4 mL warmed ringers lactate / kg / %

BSA in 1st 24 hpurs
Administer in 1st 8 hours
Administer in next 16 hours
Base on time from injury
Monitor heart rate and urinary output
 What history do I need?

AMPLE history
Tetanus status
 Other management?

Baseline blood analyses and chest x-ray

Gastric intubation
Narcotics
Antibiotics
Wound care
Flow sheet documentation
 Manage chemical burns?

Determine type, duration, amount, and

concentration
Brush away dry chemicals
Special consideration for specific
chemicals
Manage chemical burns?
 Manage electrical burns?

Fascia and muscle damage, may spare

overlying skin
Myoglobinuria: Fluids, mannitol
Maintain adequate perfusion
Sodium bicarbonate
Manage electrical burns?
 Whom do I transfer?

Second- and Third-degree Burns

> 10% BSA in ages < 10 and > 50 years
> 20% BSA (all ages)
To unique areas (any size burn)
Face Hand Perineum
Eyes Feet Major
Ears Genitalia joints
 Whom do I transfer?

Third-degree burns > 5% BSA (all ages)

Electrical and chemical burns
Inhalation injury
Preexisting illnesses, associated injuries
Children
Special situations
 Transfer procedures to use?

Coordinate with burn center doctor

Transfer with
Documentation / information
Laboratory results
 Key Questions: Cold Injury

How does cold cold affect my patient?

How do I recognize a cold injury?
How do I treat local cold injuries?
How do I treat a systemic cold injury?
 How does cold affect?

Cold Injury Factors

Temperature Immobilization
Duration of Moisture
exposure Vascular disease
Environmental Open wounds
conditions
 Recognize local cold injuries?

Frostnip
Frostbite
Nonfreezing
 Treat cold injuries?

Do not delay Preserve damaged

Remove clothing tissue
Warmed blankets Prevent infection
Rewarm frozen Elevated exposed
part part
Analgesics,
tetanus, and
antibiotics
 Recognize hypothermia?

Rapid or slow drop in core temperature

to < 35C
Elderly and children at greater risk
Low-range thermometer required
 Recognize hypothermia?

Clinical Findings
Tc < 35C
Depressed level of consciousness
Gray, cyanotic
Variable vital signs
Absence of cardiorespiratory activity
 Treat hypothermia?

ABCDEs
Rewarm
Assess for associated disorders
Blood analyses, including K+ and Ca++
 Treat hypothermia?

Passive, external rewarming: Warmed

environment, blankets, and IV fluids
Active core rewarming: Surgical
rewarming techniques
Do not delay transfer
Not dead until warm and dead
 : Burn Injury

Recognize and tread inhalation injury

Fluid resuscitation
Identify burn injuries requiring transfer
 : Cold Injury
Diagnose type
Measure core temperature
Rewarming techniques
Monitor and support vital functions