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Burns

Burns. Dr. Stella Yiu Emergency Physician, TOH. LMCC objectives. Diagnose severity and extent Manage complications Institute initial management of burn trauma. 1. Severity & extent . Partial thickness. Full thickness. Superficial. Deep. Skin intact. Skin intact. Skin broken, moist.

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Burns

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  1. Burns Dr. Stella Yiu Emergency Physician, TOH

  2. LMCC objectives Diagnose severity and extent Manage complications Institute initial management of burn trauma

  3. 1. Severity & extent

  4. Partial thickness Full thickness Superficial Deep

  5. Skin intact

  6. Skin intact Skin broken, moist

  7. Skin intact Skin broken, moist Charred, dry

  8. What body surface area?

  9. Must know this!

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

  11. Who needs special care

  12. Area Agent Vunerable population

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

  14. Area: Hands Perineum Face 2/3 Degree

  15. Area: Circumferential = compartment syndrome

  16. Agent: Chemical burn = penetrate tissue

  17. Agent: Electricity

  18. Vulnerable population: children

  19. Vulnerable population: Children

  20. 2. Manage complications

  21. 3 big complications of burn Shock Infection High metabolic demands - DIC

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

  23. ++ Fluids Parkland Formula (1st 24 hrs) 4cc x %BSA x Wt (kg)

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

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

  26. Other associated injuries Chemical Thermal burn Other trauma

  27. Chemical Carbon Monoxide Cyanide

  28. Carbon Monoxide 200x Affinity to Hb

  29. Carbon Monoxide

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

  31. Cyanide Cyanide asphyxiates mitochondria Lactic acidosis

  32. Airway Thermal burn

  33. Thermal burn Burn = Airway swelling

  34. Minor burns Wash Debride open blisters Cover wound with topical antibiotic ointment Burn wound is tetanus prone!

  35. 3. Major burn Resuscitation

  36. Airway: Intubate early

  37. Intubate early if airway injury • Singed nasal hairs • Facial or oral burns • Sooty sputum • Stridor • Grunting Can also use fiberoptic bronchoscopy

  38. ++ Fluids Parkland Formula (1st 24 hrs) 4cc x %BSA x Wt (kg) 1sthalf 8 hr from time 0 Treat pain

  39. Escharotomyif third degree (full thickness)

  40. Investigations CBC, lytes CO level Lactate, ABG CXR

  41. Burn unit

  42. Electrical injury depends on entry and exit sites

  43. Electrical burn • CVS: VF or asystole • Neurologic: confusion, LOC, seizure • MSK: compartment snd, • Renal: Rhabdo, renal failure • Trauma: thrown

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