Injuries Due to Burns and Cold

ACS

Committee on Trauma Presents

Injuries Due

to Burns

and Cold

Injuries Due

to Burns

and Cold

ACS

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

ACS

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?

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What should I do first?

Assess the patient’s

A B C D E

and stop the burning process

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Burn Management Principles

Establish and Maintain Airway and Breathing

Normal perfusion (C and D)

Fluid and electrolyte balance (C)

Normal body temperature (E)

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Identify inhalation injury?

Carbonaceous sputum

Face and neck burns

Inflamed oropharynx

and hoarseness

Carbon deposits

Hair singeing

CO Hgb > 10%

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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

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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

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Estimate burn size and depth?

Palm + fingers = approximately

1% BSA

Rule of Nines

Infant

9%

13%2.5%

7%

4.5%

9%

4.5%

18%

1%7%

Adult

4.5%

18%

4.5%

18%

4.5% 4.5%

1%

9 %

9%

9% 9%

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Second-degree Burn

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Third-degree Burn

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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

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What history do I need?

AMPLE history

Tetanus status

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Other management?

Baseline blood analyses and chest x-ray

Gastric intubation

Narcotics

Antibiotics

Wound care

Flow sheet documentation

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Manage chemical burns?

Determine type, duration, amount, and concentration

Brush away dry chemicals

Special consideration for specific chemicals

Flush with copious amounts of water for 20 – 30 minutes

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Manage electrical burns?

Fascia and muscle damage, may spare overlying skin

Myoglobinuria: Fluids, mannitol

Maintain adequate perfusion

Sodium bicarbonate Fasciotomy

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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

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Whom do I transfer?

Third-degree burns > 5% BSA (all ages)

Electrical and chemical burns

Inhalation injury

Preexisting illnesses, associated injuries

Children

Special situations

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Transfer procedures to use?

Coordinate with burn center doctor

Transfer with Documentation / information Laboratory results

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Summary: Burn Injury

Recognize and treat inhalation injury

Fluid resuscitation

Identify burn injuries requiring transfer