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Injuries Due to Burns and Cold. 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. Key Questions: Burn Injury. - PowerPoint PPT Presentation
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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?
ACS
What should I do first?
Assess the patient’s
A B C D E
and stop the burning process
ACS
Burn Management Principles
Establish and Maintain Airway and Breathing
Normal perfusion (C and D)
Fluid and electrolyte balance (C)
Normal body temperature (E)
ACS
Identify inhalation injury?
Carbonaceous sputum
Face and neck burns
Inflamed oropharynx
and hoarseness
Carbon deposits
Hair singeing
CO Hgb > 10%
ACS
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
ACS
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
ACS
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%
ACS
Second-degree Burn
ACS
Third-degree Burn
ACS
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
ACS
What history do I need?
AMPLE history
Tetanus status
ACS
Other management?
Baseline blood analyses and chest x-ray
Gastric intubation
Narcotics
Antibiotics
Wound care
Flow sheet documentation
ACS
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
ACS
Manage electrical burns?
Fascia and muscle damage, may spare overlying skin
Myoglobinuria: Fluids, mannitol
Maintain adequate perfusion
Sodium bicarbonate Fasciotomy
ACS
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
ACS
Whom do I transfer?
Third-degree burns > 5% BSA (all ages)
Electrical and chemical burns
Inhalation injury
Preexisting illnesses, associated injuries
Children
Special situations
ACS
Transfer procedures to use?
Coordinate with burn center doctor
Transfer with Documentation / information Laboratory results
ACS
Summary: Burn Injury
Recognize and treat inhalation injury
Fluid resuscitation
Identify burn injuries requiring transfer