Burns & Escharotomy

1. Burns & Escharotomy By Don Hudson, D.O. FACEP/ACOEP LifeFlight Medical Director

2. Burns • In the USA over 2.2 million/year • Major burns have a significant risk of morbidity & death. • The pre-hospital care is a major contributor to patients final out come.

3. Burns • The skin is the largest organ in the body • It provides Thermal regulation & prevention of fluid loss by evaporation. • Hermetic barrier to infection. • Contains sensory receptors that provide information about the environment.

4. Skin Anatomy • The skin is divided into 3 layers • Epidermis- outer layer of cornified epithelial cells. • Dermis- the middle layer, mostly connective tissue. Contains capillaries, nerve endings, & hair follicles. • Hypodermis- a layer of fat & connective tissue between skin & underlying tissue

5. Approach to Burn Patient • Age • History • Duration of exposure • Type of fire • Tetanus status • Consider Abuse in pediatrics • Determine depth, type & extent of injury

6. For Review

7. Consider Abuse

8. Important Points • A- Allergies • M- Medications even OTC • P- Past medical Hx/previous illness • L- Last meal or fluids consumed • E- Events leading up to injury/Hx present illness

9. Burn Patients • Burn patients need lots of medical skill • You must identify the amount of burn • You must define degree of burn • You must identify associated injuries • You must establish events preceding the injury • Establish basic care first

10. Airway, Fluids & Urine

11. Treatment • Airway- establish early • Fluids- Two (2) big bore IV’s • Consider Foley for fluid management • Protect from further injury • Consult • Notify dispatch of findings • Arrange appropriate referral &/or treatment

12. Studies Needed • CBS & Chemistry profile • ABG • CO level • Coagulation profile • UA • Type & screen • CPK & urine myoglobin (especially in electrical injuries) • CXR

13. Fluids • (4 ml crystalloid) X (% BSA burn) X (body wt in Kg) • Ex a man weighting 70 Kg with 30% BSA would require (30) X (4ml) X 70 = 8400 ml in 1st 24 hr. • Half of the fluid is given in the first 8 hr. with the balance given in the next 16 hr. • Maintain urine output at 1 ml/kg/hour

14. Escharotomy • Needed when there is a full thickness burn involving the extremities or chest. • The eschar acts like a tourniquet. • Edema forming in the middle layer pushes out ward & the eschar restricts further motion. • This compromises the vascular flow

15. Procedure • Perform along lateral aspect of extremity • Incision should go completely through the eschar. • Be prepared for the subq fat to bubble up through the incision • Once the incision is made some bleeding will occur.

16. Incision Lines

17. Procedure • Do not forget chest, it may also need a procedure • Don’t forget PAIN MEDS • Don’t forget, clean, bandage, Universal Precautions about blood products & potential for hypothermia

18. Visuals Your diagram Avoid Vessels Avoid Nerves

19. Review Where

21. Anatomy

23. Don't Forget Early Management

24. First Degree

25. Second Degree

26. Second & Third Degree

27. One Hour Difference

28. 30 Min After Procedure

29. Note: Chest Incisions

30. Fat Bulging

31. Chest

32. Foot

33. Leg

34. Be early Be aggressive in Tx Airway Control IV’s, adequate fluids Foley Consider other injuries Splints Escharotomy Temperature control REMEMBER

35. THE END