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Burns

Burns. Dr. Stella Yiu Emergency Physician, TOH. LMCC objectives. Determine severity and extent Diagnose Complications Institute initial management of burn trauma. By Sylvain Pedneault (Own work) [CC-BY-SA-3.0 (http:// creativecommons.org /licenses/by- sa /3.0)], via Wikimedia Commons.

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Burns

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  1. Burns Dr. Stella Yiu Emergency Physician, TOH

  2. LMCC objectives Determine severity and extent Diagnose Complications Institute initial management of burn trauma

  3. By Sylvain Pedneault (Own work) [CC-BY-SA-3.0 (http://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons

  4. 1. Severity & extent

  5. Skin layer Image credit: Simon Yiu Derived from work by Persian Poet Gal at en.wikipedia [GFDL (http://www.gnu.org/copyleft/fdl.html) or CC-BY-3.0 (http://creativecommons.org/licenses/by/3.0)], from Wikimedia Commons

  6. Image credit: Simon Yiu Derived from work by Persian Poet Gal at en.wikipedia [GFDL (http://www.gnu.org/copyleft/fdl.html) or CC-BY-3.0 (http://creativecommons.org/licenses/by/3.0)], from Wikimedia Commons

  7. 1st degree/Superficial Image credit: Simon Yiu Derived from work by Persian Poet Gal at en.wikipedia [GFDL (http://www.gnu.org/copyleft/fdl.html) or CC-BY-3.0 (http://creativecommons.org/licenses/by/3.0)], from Wikimedia Commons

  8. 2nd degree/Partial thickness Image credit: Simon Yiu Derived from work by Persian Poet Gal at en.wikipedia [GFDL (http://www.gnu.org/copyleft/fdl.html) or CC-BY-3.0 (http://creativecommons.org/licenses/by/3.0)], from Wikimedia Commons

  9. Superficial PT/2nd degree Image credit: Simon Yiu Derived from work by Persian Poet Gal at en.wikipedia [GFDL (http://www.gnu.org/copyleft/fdl.html) or CC-BY-3.0 (http://creativecommons.org/licenses/by/3.0)], from Wikimedia Commons By Cjr80 (Own work) [CC-BY-SA-3.0 (http://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons

  10. Deep PT/2nd degree Photo credit: www.vicburns.org.au The Victorian Adult Burns Service, Alfred Health, Melbourne, Australia Image credit: Simon Yiu Derived from work by Persian Poet Gal at en.wikipedia [GFDL (http://www.gnu.org/copyleft/fdl.html) or CC-BY-3.0 (http://creativecommons.org/licenses/by/3.0)], from Wikimedia Commons

  11. 3rd degree/Full thickness Image credit: Simon Yiu Derived from work by Persian Poet Gal at en.wikipedia [GFDL (http://www.gnu.org/copyleft/fdl.html) or CC-BY-3.0 (http://creativecommons.org/licenses/by/3.0)], from Wikimedia Commons Photo credit: www.vicburns.org.au The Victorian Adult Burns Service, Alfred Health, Melbourne, Australia

  12. What body surface area?

  13. Must know this!

  14. Scattered areas Image credit: Simon Yiu

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

  16. MCQ 1: Calculate his area of burn: Anterior torso + Whole left arm 18% 27% 31.5% 36% 45% Photo credit: www.vicburns.org.au The Victorian Adult Burns Service, Alfred Health, Melbourne, Australia

  17. 2. Diagnose Complications

  18. Burn: Cellular level Local and systemic inflammatory response Capillaries permeable, fluids and proteins leak Edema and hypovolemia

  19. ComplicationsFluid loss AirwayEdema Chemical

  20. Burn patients need ++ fluids

  21. ++ Fluids Parkland Formula (1st 24 hrs) 4cc x %BSA (2-3deg) x Wt (kg)

  22. ++ Fluids 1sthalf 8 hr from time 0 Time zero 8 hours Hospital arrival time

  23. ++ Fluids 1sthalf 8 hr from time 0 Time zero 8 hours 1st half to be given Hospital arrival time

  24. MCQ 2: 80kg, Ant + post torso, left arm. Presents 4 hr post. Rate of fluids/first 4 hour? • 1800cc /hr • 1500 cc/hr • 1000 cc/hr • 900 cc/hr • 700 cc/hr

  25. Image credit: Patrick J. Lynch, medical illustrator; C. Carl Jaffe, MD, cardiologist. http://creativecommons.org/licenses/by/2.5/, via Wikimedia commons

  26. Photo credit: www.vicburns.org.au The Victorian Adult Burns Service, Alfred Health, Melbourne, Australia

  27. Who is at risk for inhalation injury? • Face burn • Soot • Voice

  28. Photo credit: Dr. Mark Silverberg

  29. Face burn • Soot: Mouth, nose, sputum • Voice: Hoarse, change Intubate early even if no airway compromise

  30. Edema

  31. Tight skin + Edema  Compartment syndrome

  32. Escharotomy Photo credit: Drs. Mike Cadogan and Chris Nickson, lifeinthefastlane.com

  33. Chemicals

  34. Carbon Monoxide 200x Affinity to Hb

  35. Carbon Monoxide is chased Atmos air T1/2 = 4 hours Atmos 100% Oxygen = 1 hour Hyperbaric oxygen = < 20 minutes

  36. Cyanide chokes mitochondria

  37. 3. Initial management of burn patient

  38. Photo credit: www.vicburns.org.au The Victorian Adult Burns Service, Alfred Health, Melbourne, Australia

  39. CDMQ: Write your orders (6)

  40. Iv Fluids • Cardiac monitor (BP, HR, O2 sat) • Pain control • Tetanus • CBC, lytes, Cr, CO level, Lactate, Trop, CXR

  41. Who needs special care

  42. Area Agent Vulnerable population

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

  44. Area: Hands Perineum Face 2/3 Degree

  45. Circumferential

  46. Chemical burn

  47. Electricity

  48. Children

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