Chapter 9

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

What should I do first? How do I identify inhalational 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?

Assess the patient’s

and stop the burning process.

Establish and maintain◦ Airway and Breathing◦ Normal perfusion (C and D)◦ Fluid and electrolyte balance (C)◦ Normal body temperature (E)

Be aware of inhalational injury◦ Face and neck burns, carbon deposits around

mouth, singed hair, hoarseness◦ Consider early ET intubation

Maintain adequate organ perfusion◦ Monitor urinary output and vital signs

AMPLE history Tetanus status Ringer’s lactate 4 mL/kg/% BSA in first 24

hours [half in first 8 hours] Monitor HR and urinary output Lab work GI tube Narcotics and antibiotics

Determine type, duration, amount and concentration of substance

Brush away dry chemicals Special consideration for specific chemicals

Fascia and muscle damage, may spare overlying skin

Myoglobinura Maintain adequate perfusion Consider sodium bicarbonate Possible fasciotomy

>10% burns in <10 and >50 years old >20% in all ages Burns to face, hands, genitals and joints Electrical and chemical burns Inhalation injury Comorbid diseases Young children

How does cold affect my patient? How do I recognize a cold injury? How do I treat local cold injuries? How do I treat a systemic cold injury?

Cold Injury Factors◦ Temperatures◦ Duration of exposure◦ Environmental conditions◦ Immobilization◦ Moisture◦ Vascular disease◦ Open wounds

Frostnip Frostbite Nonfreezing

Do not delay Replace cold or frozen clothing with warm

blankets Rewarm frozen part Preserve damaged tissue Prevent infection Elevate exposed part Analgesics, tetanus and antibiotics

Rapid or slow drop in core temperature to less than 35oC

Extremes of ages at highest risk Low-range thermometer required May have depressed LOC May be gray and cyanotic Variable vital signs May have absence of cardiac activity

Passive, external rewarming: warmed environment, blankets, and IV fluids

Active core rewarming: surgical rewarming technique

Do not delay transfer

Not dead until warm and dead!

Burn injury◦ Recognize and treat inhalational injury◦ Fluid resuscitation◦ Identify burn injuries requiring transfer

Cold injury◦ Diagnose type◦ Measure core temperature◦ Rewarming techniques◦ Monitor and support vital functions