BurnsDr. Stella YiuEmergency Physician, TOH

LMCC objectives

Determine severity and extent

Diagnose Complications

Institute initial management of burn trauma

By Sylvain Pedneault (Own work) [CC-BY-SA-3.0 (http://creativecommons.org/licenses/by-sa/3.0)],

via Wikimedia Commons

1. Severity & extent

Skin layer

Image credit: Simon YiuDerived 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

Image credit: Simon YiuDerived 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

1st degree/Superficial

Image credit: Simon YiuDerived 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

2nd degree/Partial thickness

Image credit: Simon YiuDerived 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

Superficial PT/2nd degree

By Cjr80 (Own work) [CC-BY-SA-3.0 (http://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia

Commons

Image credit: Simon YiuDerived 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

Deep PT/2nd degree

Image credit: Simon YiuDerived 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

3rd degree/Full thickness

Image credit: Simon YiuDerived 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

What body surface area?

Must know this!

Scattered areas

Image credit: Simon Yiu

Knowing surface area-> who needs special burn unit care-> how much fluids to give

Photo credit: www.vicburns.org.au The Victorian Adult Burns Service, Alfred Health, Melbourne, Australia

MCQ 1: Calculate his area of burn: Anterior torso + Whole left arm

A. 18%B. 27% C. 31.5%D. 36%E. 45%

2. Diagnose Complications

Burn: Cellular level

Local and systemic inflammatory response

Capillaries permeable, fluids and proteins leak

Edema and hypovolemia

Complications

Fluid loss AirwayEdema

Chemical

Burn patients need ++ fluids

++ Fluids

Parkland Formula (1st 24 hrs)

4cc x %BSA (2-3deg) x Wt (kg)

++ Fluids

1st half 8 hr from time 0

Time zero

Hospital arrival time

8 hours

++ Fluids

1st half 8 hr from time 0

Time zero

Hospital arrival time

8 hours

1st half to be given

MCQ 2: 80kg, Ant + post torso, left arm. Presents 4 hr post. Rate of fluids/first 4 hour?

A.1800cc /hrB.1500 cc/hrC.1000 cc/hr D.900 cc/hrE. 700 cc/hr

Image credit: Patrick J. Lynch, medical illustrator; C. Carl Jaffe, MD, cardiologist. http://creativecommons.org/licenses/by/2.5/, via Wikimedia commons

Photo credit: www.vicburns.org.au The Victorian Adult Burns Service, Alfred Health, Melbourne, Australia

Who is at risk for inhalation injury?Face burn

Soot

Voice

Photo credit: Dr. Mark Silverberg

Face burn

Soot: Mouth, nose, sputum

Voice: Hoarse, change

Intubate early even if no airway compromise

Edema

Tight skin + Edema Compartment syndrome

Escharotomy

Photo credit: Drs. Mike Cadogan and Chris Nickson, lifeinthefastlane.com

Chemicals

Carbon Monoxide200x Affinity to Hb

Carbon Monoxide is chasedAtmos air T1/2 = 4 hours

Atmos 100% Oxygen = 1 hour

Hyperbaric oxygen = < 20 minutes

Cyanide chokes mitochondria

3. Initial management of burn patient

Photo credit: www.vicburns.org.au The Victorian Adult Burns Service, Alfred Health, Melbourne, Australia

CDMQ: Write your orders (6)

Iv Fluids

Cardiac monitor (BP, HR, O2 sat)

Pain control

Tetanus

CBC, lytes, Cr, CO level, Lactate, Trop, CXR

Who needs special care

Area

Agent

Vulnerable population

Area: 10% second or third (deep partial or full)

Area:

Hands

Perineum

Face

2/3 Degree

Circumferential

Chemical burn

Electricity

Children

Burn unit

LMCC objectives

Determine severity and extent

Diagnose Complications

Institute initial management of burn trauma