Investigation

FBC

U&E

Carboxyhaemoglobin

- Shift oxygen haemoglobin to the left

- Oxygen is there but cannot unbind the haemoglobin
- What will happen then?
o 10-20% - confusion
o 30% - sleep

Arterial blood sample

Acute management

Patient  immune suppression and opportunistic infection  burnt patient died of pneumonia

Resuscitate them quickly

- >5 years 250 ml /hr

- <5 years no IV – over resuscitate
o cerebral oedema

Bair hugger – Patient loss the ability to shiver

IV morphine

- Why not IM morphine ?

o Hypovolaemic, can get peripheral oedema, give IM doesn’t work – second dose
doesn work when patient is fully resuscitate and morphine is acting they get resp
depression from 3 dose of IM morphine

Take picture of the burn

Chart the fluid

Picture

- Burn injury is not about the burn

- Severe burn – evolving
o Full thickness
o 20%
o Partial thickness of scald burn is a SEVERE burn
- If you have partial impairment – severe burn
Respiratory complication

- high tech burn injury

Chemical cancause burn

- Acid
- Alkali
- Hydrochloric acid – crystal factory
o Absorb calcium quickly

Picture – left handed

- Why?
o Most important thing  keep intubated – arterial line, cathether, probe monitor ,
on trolley and warmer ideal management!

How to workup how many percent of burn?

- BSA % -
o Age specific
o Formula
o Why is the weight important
 Fluid based on the weight
 Percentage of the body burn
- Parkland Formula
o Kids – 90%
 on the head
 head is big
- Do BSA % once and then wrap them up all over again !!

Depth of the burn

- Superficial or deep
o What is the indicator
 Blanching and refills – the dermis is alive = artefacts?
o Best way
 Ask what happens?
 Temperature determine the depth of the burns
 High tech injury  to the bone
 Hydrochloric acid  concentration and duration of contact will determine
the depth
 Flash burn

Picture

- Splash in V shape pattern

Picture

- Wearing baseball cap

o drinking vodka and put his head into fire

Picture – comparison

- Tissue shrivelled –
- HE shows the inside of his eyelids
o FULL THICKNESS burn
 The skin shrink immediately and everything contracts straight away
o This is a flame burns

Picture

- Lady – Gonzales
o Fungal infection
o MASK like feature

Parkland ratio 4ml/kg/% of BSA

- Weigh the patient?

o you stand on the scale + and lift the patient ..
- Young child
o Why kids gets dextrose
 they have very little glycogen in their body so they can easily gets
hyoglycaemic
- Adults
o 0.5 ml/kg/h urine output
o
- Qs: 20 kg child – you don’t want 20 ml UO after resus why?
 A child cannot concentrate urine  they will be extremely dehydrated!
 You are in a serious trouble
o Kids in Mexico fell and get burn
 External traction

Apply clean and dry dressing

if partial thickness burn

Leave on for 3 weeks

Stop the dermis from drying out – Partial thickness burn

If put crazy dressing – you convert it from partial to full thickness – you dry them out

Full thickness – cut away the burn and GRAFT them.

Partial thickness  still get hair follicle and they can heal with keratinisation

Young child – put hand in a hot water for too long commonly burn themselves! VERY COMMON

- Hot water injury burn – right is the one!

What’s the problem in the picture?

- 60% burn whats going to happen now?

- Cathetherise and intubated whats going to happen to his chest
o cause sonstriction if we don’t release them what is going to happen? failure

Tight skin after burn needs to be released

Everybody with burn needs DVT prophylaxis

History is important  no topical antimicrobial !!

Compartment syndrome

- eschar – dead skin

o thightness
o Fascia escharotomy
- Compartment syndrome
o no burn skin is completely normal
o Deep in the muscle something goes wrong
 Swelling rapidly
 Compromise the blood supply
o Fasciotomy
o IVDU , after trauma,