Burns

Dr. Stella YiuEmergency Physician, TOH

LMCC objectivesDiagnose severity and extent

Manage complications

Institute initial management of burn trauma

1. SEVERITY & EXTENT

Partial thickness Full thicknessSuperficial Deep

Skin intact

Skin broken, moist

Skin intact

Skin broken, moist

Charred, dry

Skin intact

What body surface area?

Must know this!

Knowing surface area-> who needs special burn unit care-> how much fluids to give

WHO NEEDS SPECIAL CARE

Area

Agent

Vunerable population

Area: 10% second or third (deep partial or full)

Area:

Hands

Perineum

Face

2/3 Degree

Area: Circumferential = compartment syndrome

Agent: Chemical burn = penetrate tissue

Agent: Electricity

Vulnerable population: children

Vulnerable population: Children

2. MANAGE COMPLICATIONS

3 big complications of burnShock

Infection

High metabolic demands - DIC

Burn: Cellular levelLocal and systemic inflammatory

response

Capillaries permeable, fluids and proteins leak

Edema and hypovolemia

++ FluidsParkland Formula (1st 24 hrs)

4cc x %BSA x Wt (kg)

++ Fluids

1st half 8 hr from time 0

Time zero

Hospital arrival time

8 hours

++ Fluids

1st half 8 hr from time 0

Time zero

Hospital arrival time

8 hours

1st half of fluid to be given

Other associated injuriesChemical

Thermal burn

Other trauma

ChemicalCarbon Monoxide

Cyanide

Carbon Monoxide200x Affinity to Hb

Carbon Monoxide

Carbon Monoxide is chasedAtmos air T1/2 = 4 hours

Atmos 100% Oxygen = 1 hour

Hyperbaric oxygen = < 20 minutes

Cyanide Cyanide asphyxiates mitochondria

Lactic acidosis

AIRWAY THERMAL BURN

Thermal burn

Burn = Airway swelling

Minor burnsWashDebride open blistersCover wound with topical antibiotic ointment

Burn wound is tetanus prone!

3. MAJOR BURN RESUSCITATION

Airway: Intubate early

Intubate early if airway injury

- Singed nasal hairs- Facial or oral burns- Sooty sputum- Stridor- Grunting

Can also use fiberoptic bronchoscopy

++ FluidsParkland Formula (1st 24 hrs)

4cc x %BSA x Wt (kg)

1st half 8 hr from time 0

Treat pain

Escharotomy if third degree (full thickness)

InvestigationsCBC, lytes

CO level

Lactate, ABG

CXR

Burn unit

Electrical injury depends on entry and exit sites

Electrical burn• CVS: VF or asystole

• Neurologic: confusion, LOC, seizure

• MSK: compartment snd,

• Renal: Rhabdo, renal failure

• Trauma: thrown