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Medicine
Gabriella Handayani
405130103
Burn depth classification
Depth Appearance Surface Sensation Time to healing
1st degree Epidermis Pink or red Dry Painful Days
2nd degree
(partial-
thickness) Epidermis + pars Pink, clear Moist Painful 14-21 days
-Superficial papilare blister
http://emcrit.org/030-064/056-thermal.burn.htm
Rosen’s Emergency Medicine. 8th ed. 2016. Elsevier. p.811
Treatment
Pre Hospital
• Stop the burning process, remove smoldering
clothes/jewelry.
• Establish patent airway; frequent reassessment:
– Intubate early for signs of respiratory distress.
• Initiate early IV fluid therapy.
• Relieve pain.
• Protect the wound with clean sheets.
• Transport to burn center (for major burns) if transport
time shorter than 30 minutes.
• Immobilize spine if decreased sensorium or trauma.
A - Airway
B - Breathing
C - Circulation
D - Disability
E - Expose The Patient
http://www.uic.edu/labs/lightninginjury/treatment.html
Chemical Burns
• Chemical injury can result from exposure to acids, alkalies,
and petroleum products.
• Alkali burns are generally more serious than acid burns,
because the alkalies penetrate more deeply.
Etiology
• Acids
– Sulfuric acid
– Nitric acid
– Hydrofluoric acid ( not cause immediate burning or
pain on contact)
– Chloroacetic acids
• Monochloroacetic acid (highly corrosive)
• Dichloroacetic acid
• Trichloroacetic acid
– Phenol and cresols (substances are very irritating to
the skin and can be absorbed through the skin to
produce systemic toxicity.)
• Bases
– Sodium hydroxide and potassium hydroxide
– Calcium oxide
– Sodium and calcium hypochlorite
– Ammonia (cause severe skin burns as well as
pulmonary injury if inhaled)
– Phosphates
– Lithium hydride (produce thermal and alkaline
burns.)
Sign and symptoms
• Clinical signs and symptoms vary depending on
the route of exposure and the particular
substances involved.
• History:
– Offending agent, concentration, physical form, pH
– Route of exposure
– Time of exposure
– Volume of exposure
– Possibility of coexisting injury
– The timing and extent of irrigation
• If the exposure was by ingestion, the immediate concern is to
protect the patient's airway. If there is evidence of airway
compromise (eg, oropharyngeal edema, stridor, use of accessory
muscles), consider establishing a definitive airway.
• In dermal exposures, consider the following:
– Size
– Depth
– Location
– Circumferential burns
• In ocular exposures, consider the following:
– Visual acuity
• In the presence of periorbital dermal lesions, consider the
following:
– Scleral and corneal lesions (eg, ulcerations, fluorescein uptake)
– Leakage of vitreous humor
• For ingestions, consider the following:
– Presence of oral burns or edema, drooling
– Dysphagia, stridor, wheezing, dyspnea, tachypnea
– Abdominal tenderness, guarding, crepitus, subcutaneous air (Hamman
crunch)
Laboratory
• Laboratory studies depend on the burn • For ingestions of caustics, consider the
type and extent of exposure. following:
• For severe burns, consider the following: – Hemoglobin/hematocrit
– Electrolytes – Pulse-oximetry or ABG if respiratory symptoms
– Creatinine • For oxalic acid burns, check calcium.
– BUN • For chromic acid burns, consider the
– Glucose following:
– Urinalysis – BUN
– CBC count – Creatinine
– Creatine phosphokinase • For monofluoroacetic acid burns,
– Coagulation profile consider the following:
• For localized burns, usually no laboratory – Electrolytes
tests are required. – ABG
• For hydrofluoric acid burns, consider the • For phenol burns, consider the
following: following:
– Calcium – Electrolytes
– Magnesium – CBC count
– Potassium – Urinalysis
– Creatinine
– Liver function tests
• For ingestions, consider the following:
– Chest radiography if any respiratory symptoms
– Abdominal radiography (flat and upright) if signs
of peritonitis are present
Diagnose
• Endotracheal intubation is required for severe
respiratory symptoms. Direct visualization is
recommended to assess the degree of injury.
• Bullae resulting from chemical burns should
be decompressed and debrided
Treatment
• Pre-hospital
– Prevent contaminated irrigation solution from running
onto unaffected skin.
– Remove contaminated clothe
– Special situation:
• If contamination with metallic lithium, sodium, potassium, or
magnesium has occurredcovered with mineral oil and the
metallic pieces should be removed with forceps and placed in
mineral oil. If forceps are not available, soak the area with mineral
oil and cover it with gauze soaked in mineral oil.
• If contamination with white phosphorus has occurred. Keep the
area moist at all times. The area can also be covered with
petroleum jelly.
• If eye exposures have not been irrigated, then this should be
started immediately. Immediate removal of caustic substances in
the eye is critical
ED
• Using litmus paper to measure the pH of the affected area or the
irrigating solution
• Complete removal and neutralization of concentrated acids and
alkalis may require several hours of irrigation. Tap water is adequate
for irrigation.
• Hydrofluoric acid burns
– Fluoride can be neutralized by either calcium or magnesium.
– For small superficial burns, topical calcium or magnesium gels can be
applied.
– Deeper burns usually require subcutaneous injections of calcium
gluconate.
– Hand burns can be difficult to manage; these burns can be treated
with subcutaneous injections of calcium, intra-arterial calcium
infusions, or intravenous infusions of magnesium.
– Keeping the hand warm and adequately treating pain will help to
increase local circulation and the body's natural supply of calcium and
magnesium
• Caustic ingestions
– Gastric emptying is contraindicated.
– Activated charcoal is not useful and may interfere with
subsequent endoscopy.
– Dilution with milk or water is contraindicated if any degree
of airway compromise is present.
– Milk may interfere with subsequent endoscopy.
– Water is benign.
– Some substances, such as drain cleaners containing
sulfuric acid or sodium hydroxide, generate heat when
diluted with water.
– Local areas of heat generation can be minimized by
diluting with a moderate quantity of fluid (250-500 mL).
Head Injuries
• Head injuries are among the most common
types of trauma encountered in emergency
departments (EDs).
• A review of cranial anatomy includes
• Scalp
• Skull
• Meninges
• Brain
• Ventricular system
• Intracranial compartments
Classification
Skull Fractures
• Skull fractures may occur in the cranial vault or skull
base. They may be linear or stellate, and open or
closed.
• Basilar skull fractures usually require CT scanning
with bone-window settings for identification.
• The clinical signs of a basilar skull fracture include :
• periorbital ecchymosis (raccoon eyes)
• retroauricular ecchymosis (Battle’s sign)
• CSF leakage from the nose (rhinorrhea) or ear (otorrhea)
• N. VII and N.VIII dysfunction (facial paralysis and hearing
loss)
Skull Fractures
• Open or compound skull fractures can provide
a direct communication between the scalp
laceration and the cerebral surface, because
the dura may be torn.
• A linear vault fracture in conscious patients
increases the likelihood of an intracranial
hematoma by about 400 times.
Intracranial Lesions
• Intracranial lesions may be classified as diffuse
or focal, although these two forms frequently
coexist.
Diffuse Brain Injuries Focal Brain Injuries