Injuries Due to Burns and Cold

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?

Second-degree Burn

Third-degree Burn

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

Injuries Due to Burns and Cold