Committee on Trauma

Presents

Therma
l
Injuries
Initial Assessment and
Management

Types of Thermal
Injuries
Burn Injuries

Cold
Injuries

Burn Injuries

Case Scenario
A 54-year-old is rescued from a smokefilled room in a burning house.
He fell asleep on a couch while smoking.
Patient is conscious, agitated, and
coughing carbonaceous sputum.
His upper body appears extensively
burnt.

What are your priorities in

managing this patient?

Objectives
Outline the principles of initial
assessment and treatment of
thermal injuries.
Discuss the importance of the size of
burn injury and associated injuries.
Identify special problems and
methods of treatment.
Specify criteria for transfer of
patients with burns.

Priorities
What is my first priority?

Assess the patients ABCs

AND
Stop the burning!

Priorities
Manage Airway and Breathing

Consider direct thermal or

inhalation injury.

Establish and maintain patent

airway early and consider early ET

intubation.

Oxygenate and ventilate.

Obtain ABGs and CO levels.

Assessment and
Management
How do I identify inhalation injury?

Assessment and
Management
How do I identify inhalation injury?

Carbonaceous
sputum

Carbon deposits
CoHb > 10%
Face and neck
burns

Hair singeing
Inflamed

oropharynx and

Assessment and
Management
Maintain Organ Perfusion

Adequate venous access

Monitor vital signs
Hourly urine output

Adult: 0.5 1.0 mL / kg / hour

Child: 1.0 mL / kg / hour
2.0 mL / kg / hour
Infant:

Assessment and
Management
How do I estimate burn size and
depth?

Assessment and
Management
How do I estimate burn size and
depth?

Assessment and
Management
Second-Degree Burn

Assessment and
Management
Third-Degree Burn

Assessment and
Management
What is the rate and type of fluids
administered to patients with
burns?

4 mL warmed balanced crystalloid

solution
/ kg / %BSA in first 24
hours (global only)

Administer in first 8 hours

Administer in next 16 hours
Base calculations on time from
injury
Monitor heart rate and urinary
output

Assessment and
Management
Other Information

AMPLE history
Tetanus status

Other Management

Baseline blood analyses and chest

x-ray
Gastric intubation
Narcotic analgesia
Antibiotics
Wound care
Flow sheet documentation

Assessment and
Management
Management of Chemical Burns
Flush with
copious amounts
of water for 20
30 minutes

Assessment and
Management
Management of Electrical Burns
Fascia and muscle
damage;
may spare
overlying skin

Myoglobinuria:
Increase
fluids,

administer mannitol

Maintain adequate
perfusion
Sodium bicarbonate

Transfer Criteria
Transfer Criteria for SecondDegree and Third-Degree Burns

> 10% BSA in ages < 10 and > 50

years

20% BSA (all ages)

(any size burn)
Unique
Face areas Hands
Perineu
m
Eyes
Ears

Feet
Genitali
a

Major
joints

Transfer Criteria
Transfer Criteria for SecondDegree and Third-Degree Burns

Third-degree burns > 5% BSA (all

ages)

Electrical and chemical burns

Inhalation injury
Preexisting illnesses, associated
injuries

Children
Special situations

Transfer Procedures

Coordinate with burn

center physician

Transfer with:
Documentation /

information

Laboratory results

Cold Injuries

Case Scenario
A 72-year-old female is found lying
in her garden outside her back door.
It is winter, and the outside
temperature is just above freezing.
The patients right leg is shortened
and externally rotated.
She appears confused.
What factors should you consider
in her early management?

Objectives
Outline the principles of initial
assessment and treatment of
localized and systemic cold injuries.
Identify special problems and
methods of treatment.
Discuss the importance of
hypothermia in the resuscitation of
the injured patient.

Local Tissue Effects

How does cold affect my patient?
Temperature
Duration of
exposure
Environmental
conditions

Immobilization
Moisture
Vascular disease
Open wound

Recognition
How do I recognize a local cold
injury?
Frostnip
Frostbite
Nonfreezing
injury

Treatment
How do I treat a local cold injury?
Do not delay
Remove clothing
Warmed blankets
Rewarm frozen
part
Preserve damaged
tissue

Prevent

infection

Elevate exposed
part

Analgesics,

tetanus, and
antibiotics

Recognition
How do I recognize hypothermia?
Rapid or slow drop in core
temperature to < 35C
Elderly and children at greater risk
Low-range thermometer required

Recognition
How do I recognize hypothermia?
What are the clinical findings
associated with hypothermia?

Recognition
How do I recognize hypothermia?
What are the clinical findings
associated with hypothermia?
Depressed level of consciousness
Gray, cyanotic
Variable vital signs
Absence of cardiorespiratory activity

Treatment
How do I treat a systemic cold
injury?
ABCDE
Rewarm
Assess for associated disorders
Blood analyses, including K+ and Ca+
+

Treatment
Treatment of 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

Summary
Burn Injuries

Recognize and treat inhalation

injury

Appropriate fluid resuscitation

Early identification of burn
injuries requiring transfer

Summary
Cold Injuries

Diagnose type of local injury

Measure core temperature
Treat hypothermia with
appropriate rewarming
techniques