Burns

BURNS

Objectives  Estimate the burn size and determine the

presence of associated injuries  Demonstrate measures of initial stabilization and treatment of patients with burns  Identify special problems and methods of treatment patients with burns  Specify criteria for the admission of burn patients

Introduction  Burn constitute a major cause of morbidity    

and mortality High index of suspicion for airway compromise Maintenance of hemodynamic normality with volume replacement Prevention and treatment of rhabdomyolysis and cardiac arrhythmias in electric burns Temperature control

Immediate life-saving measures  Airway  Indications of inhalation injury  Facial burns  Singeing of the eyebrows and nasal vibrissae  Carbon deposits and acute inflammatory changes in the oropharenx  Carbonaceous sputum  History of impaired mentation and/or confinement in a burning environment  Explosion with burns to head torso

Immediate life-saving measures  Stop the burning process  Intravenous lines  20%

area of burn is indication of circulatory volume support.  Upper extremities are preferred to lower extremities  Start I/V ringer lactate.

ASSESSMENT OF BURN PATIENT  History  Body surface area  Rule of nine(palm represents 1% area)  Infants or young child’s head represents larger surface area.  Depth of burns   

First degree burns Second degree or partial thickness burns Full thickness or third degree burns

Rule of nine

Stabilizing the burn patient  Airway  Pharyngeal thermal injuries may produce marked laryngeal edema.Early airway maintenance is mandatory.  Clinical manifestation of laryngeal edema make take 24 hours to develop.  Breathing 

Following injuries may produce breathing injuries.   

Airway edema Chemical tracheobronchitis and pneumonia CO poisoning

Head & Neck Burns

Stabilizing the burn patient  Breathing (continued)  Patient

suspected of CO poisoning should receive high flow oxygen .  Arterial blood gases should be monitored.  Endotracheal tube may be needed.

Stabilizing the burn patient  Circulating blood volume  Urine output may be the only reliable measure to assess the the hydration status.  Foley’s catheter should be passed.  1 ml/kg body wt urine output should be maintained for children less than 30 kg.  30-50 ml /hr urine output for adults.  Burn patient may required 2-4ml/kg/% of burn area, of ringer lactate.  Formulae are only for estimation

Stabilizing the burn patient  Physical examination  Estimate extent and depth of burn  Assess for associated injuries  Weigh the patient  Flow sheet  Baseline determination of major burn patient  Blood  X ray chest

Stabilizing the burn patient  Circumferential extremity burns  Remove all jewelry  Asses the status of distal circulation  Escharotomy  Fasciotomy (rarely needed)  Gastric tube insertion  Narcotics, analgesics, and sedatives  Wound care  Antibiotics

Escharotomies for burns

Escharotomy

Special burn requirements  Chemical burns  Acids,

alkalis, petroleum products  Alkali burns are more serious  Irrigate the involved area with water shower for 20-30 minutes  Neutralizing agents should not be used  Eyes need continuous irrigation for first 8 hours

Acid burns - homicidal

Special burn requirements  Electric burns  Airway, breathing  I.V line  E.C.G.  Urinary catheter  If dark colored urine ,suspect myoglobinurea   

Increase fluids Mannitol Sodium bicarbonate

Criteria for admission  Partial-thickness and full-thickness burns

greater than 10% of body surface area (BSA) in patients under 10 years or over 50 years of age  Partial-thickness and full-thickness burns greater than 20% BSA in other age groups  Partial-thickness and full-thickness involving the face, eyes, ears, hands, feet, genitalia or perineum or those that involve skin overlying major joints

Criteria for admission  Inhalation injury  Full-thickness burns greater than 5%

BSA in any age group  Significant electrical burns including lightning injury  Significant chemical burns

Summary  Recognition of inhalation injury  Identifying the extent and depth of the burn  Establishing fluid guide lines according to   

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the weight of the patient Initiating a patient-care flow sheet Obtaining baseline X-ray studies Maintaining peripheral circulation in circumferential burns by performing escharotomy Identifying patients who need admission

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