PREPARED BY
MR. ARUN. S. ANGADI.
Emergency
Management of Burns
Pathophysiology
• Tissue damage occurs in two stages:
– Initial thermal injury
– Secondary injury from ongoing dermal
ischaemia or trauma
• Early management is aimed at
minimizing secondary damage
Jackson Burn Wound Model
Zone of Survival
Zone of Damage
Zone of Necrosis
Hyperaemia
Stasis
Coagulation
• Airway
• Breathing
• Circulation
• Disability
• Exposure
• Fluids
AIRWAY and BREATHING Early Symptoms: • Sore throat • Singing of nasal hairs/eyebrows/eyelashes • Hoarseness Late Symptoms: • Shortness of breath • Stridor • Indrawing
IF IN DOUBT INTUBATE
CIRCULATION
BURN SHOCK • Management focuses on fluid resuscitation,
pulmonary, cardiovascular and renal support.
Ends with mobilization of fluid and establishment
of cardiopulmonary and renal stability (lasts up
to 48 hours or several days)
• FLUID RESUSCITATION – Parklands Formula
DISABILITY
• Beware the Confused Patient
• Intoxicated Or Hypoxic?
• Electrolyte Imbalances
• Shock
EXPOSURE
• REMOVAL OF ALL JEWELLERY AND CLOTHING
WHILE KEEPING THE PATIENT WARM
• ASSESSMENT OF BURN SEVERITY AND EXTENT
• MANAGEMENT
Calculation of fluid
commences from the time of
burn
NOT
from the time of presentation
Limbs: Signs of Circulatory
Obstruction
• Loss of distal circulation
• pallor
• coolness
• absent pulse
• loss capillary refill
• decreased oxygen saturation
• Pain on passive extension
• Deep pain at rest
Escharotomy
After Consultation with Burns Unit:
• Chest: To allow respiratory movement
• Limb: To restore circulation in limb
with excess swelling under rigid eschar
THANK YOU….