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Burns

This guide provides emergency physicians with the essential objectives for evaluating and managing burn trauma. It covers the determination of burn severity and extent, diagnosis of complications, and implementation of initial management strategies. Key considerations include approaches to fluid resuscitation using the Parkland formula, recognition of patients at risk for complications like inhalation injury, and critical initial treatment protocols. Aimed at enhancing clinical decision-making in burn care, this resource supports effective outcomes for burn patients.

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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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