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Injuries Due to Burns and Cold. Objectives. Estimate size of injury and determine associated injuries Discuss the principles of initial assessment and treatment Identify special problems and methods of treatment Specify criteria for transfer of burn patient. Key Questions: Burn Injury.
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Injuries Due to Burns and Cold
Objectives • Estimate size of injury and determine associated injuries • Discuss the principles of initial assessment and treatment • Identify special problems and methods of treatment • Specify criteria for transfer of burn patient
Key Questions: Burn Injury • What should I do first? • How do I identify inhalation injury? • How do I estimate burn size and depth? • What is the rate and type of fluids administered to a burn patient? • Who do I transfer to a burn center?
A B C D E What should I do first? Assess the patient’s and stop the burning process
Burn Management Principles Establish and Maintain • Airway and Breathing • Normal perfusion (C and D) • Fluid and electrolyte balance (C) • Normal body temperature (E)
Carbon deposits Carbonaceous sputum Inflamed oropharynx and hoarseness Hair singeing Face and neck burns Identify inhalation injury? CO Hgb > 10%
Manage airway / breathing? • Assume: Direct thermal or inhalation injury • Establish and maintain patent airway early and consider early ET intubation • Oxygenate and ventilate • Obtain ABGs and CO levels
Adequate organ perfusion? • Adequate venous access • Monitor vital signs • Hourly urinary output • Adult: 0.5 – 1.0 mL / kg / hour • Child: 1.0 mL / kg / hour • Infant: 2.0 mL / kg / hour
4.5% 4.5% Rule of Nines 18% 18% 9% 9% 4.5% 4.5% Palm + fingers = approximately 1% BSA 1% 4.5% 4.5% 9 % 9% 9% 13% 18% 9% 2.5% 1% 7% 7% Adult Infant Estimate burn size and depth?
Rate and type of fluids? • 4 mL warmed Ringers lactate / kg / % BSA in 1st 24 hours • Administer ½ in 1st 8 hours • Administer ½ in next 16 hours • Base on time from injury • Monitor heart rate and urinary output
What history do I need? • AMPLE history • Tetanus status
Other management? • Baseline blood analyses and chest x-ray • Gastric intubation • Narcotics • Antibiotics • Wound care • Flow sheet documentation
Flush with copious amounts of water for 20 – 30 minutes Manage chemical burns? • Determine type, duration, amount, and concentration • Brush away dry chemicals • Special consideration for specific chemicals
Fasciotomy Manage electrical burns? • Fascia and muscle damage, may spare overlying skin • Myoglobinuria: Fluids, mannitol • Maintain adequate perfusion • Sodium bicarbonate
Whom do I transfer? Second- and Third-degree Burns • > 10% BSA in ages < 10 and > 50 years • > 20% BSA (all ages) • To unique areas (any size burn) • Face • Eyes • Ears • Hands • Feet • Genitalia • Perineum • Major joints
Whom do I transfer? • Third-degree burns > 5% BSA (all ages) • Electrical and chemical burns • Inhalation injury • Preexisting illnesses, associated injuries • Children • Special situations
Transfer procedures to use? • Coordinate with burn center doctor • Transfer with • Documentation / information • Laboratory results
Summary: Burn Injury • Recognize and treat inhalation injury • Fluid resuscitation • Identify burn injuries requiring transfer