Burn Patient

8/8/2019 Burn Patient

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The Burn PatientThe Burn Patient

E . James Radin , MDE . James Radin , MD


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ObjectivesObjectives

Describe the types of burnsDescribe the types of burns

Population at riskPopulation at risk

ABA guidelines for transport to burn centerABA guidelines for transport to burn center

Signs of inhalationSigns of inhalation Assessment of surface involvedAssessment of surface involved

Burn formulasBurn formulas

Evaluation and managementEvaluation and management


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EpidemiologyEpidemiology

2 million burns per year2 million burns per year

30 , 000 admissions a year30 , 000 admissions a year

all age groups at riskall age groups at risk

Mortality increases with ageMortality increases with age Males predominateMales predominate

Inhalation , Thermal , Chemical , ElectricalInhalation , Thermal , Chemical , Electrical

Scenes are not always safe for providersScenes are not always safe for providers


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Estimates of Involved SurfaceEstimates of Involved Surface

Rule of Nines . . . . . . . . .Rule of Nines . . . . . . . . .


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Degree of BurnDegree of Burn


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First DegreeFirst Degree


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Second DegreeSecond Degree


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Third DegreeThird Degree


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1111


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Facial BurnsFacial Burns

SurfaceSurface

OcularOcular

AirwayAirway

Singed Nasal HairsSinged Nasal Hairs Airway edemaAirway edema

Glossal SwellingGlossal Swelling

Epiglottic edemaEpiglottic edema Glottic edemaGlottic edema

Rapidly progressive deteriorationRapidly progressive deterioration


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Ocular BurnsOcular Burns

Often chemicalOften chemical Contact lenses need to be removedContact lenses need to be removed

Copious irrigationCopious irrigation

Sterile dressingsSterile dressings

Notify ED ASAP to arrangeNotify ED ASAP to arrange

Opthamology EvaluationOpthamology Evaluation


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Pulmonary BurnsPulmonary Burns

Closed spaceClosed space

Facial involvementFacial involvement

Carbonaceous sputumCarbonaceous sputum

Singed nasal hairsSinged nasal hairs

Lip edemaLip edema

ThermalThermal

ChemicalChemical Foreign debrisForeign debris

Rapidly progressive deteriorationRapidly progressive deterioration


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Pulmonary BurnsPulmonary Burns

ABCsABCs

Definitive control of the airwayDefinitive control of the airway

Humidified OxygenHumidified Oxygen

Prevent HypoxiaPrevent Hypoxia

Assist VentilationAssist Ventilation

NG / Oral Gastric tubesNG / Oral Gastric tubes

DoDo NotNot DelayDelay TransportTransport toto aa BurnBurn

CenterCenter forfor DiagnosticDiagnostic TestsTests


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Circumferencial BurnsCircumferencial Burns

Fluid replacement causes edemaFluid replacement causes edema

Capillary leaks / tighten the extremityCapillary leaks / tighten the extremity

Compartment pressures can go above arteriolarCompartment pressures can go above arteriolar

Monitor . . . . . . . .Monitor . . . . . . . .

PulsesPulses

Doppler flowDoppler flow Tightness / Compartment pressuresTightness / Compartment pressures


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Electrical BurnsElectrical Burns

CNS injuryCNS injury

Peripheral nerve injuryPeripheral nerve injury

Cardiac arrhythmiasCardiac arrhythmias

Occult injuryOccult injury

Low / high resistance tissuesLow / high resistance tissues

Low / high voltage < 1000 volts >Low / high voltage < 1000 volts >

Muscle injury / MyoglobinemiaMuscle injury / Myoglobinemia

Renal injury / direct electrical / myoglobinRenal injury / direct electrical / myoglobin

Entry and Exit woundsEntry and Exit wounds

AC / DCAC / DC


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2020

Electrical BurnsElectrical Burns

Arrhythmia when they occur usually at time ofArrhythmia when they occur usually at time of

injury , not delayedinjury , not delayed

Bone and skin are high resistance , occult injuryBone and skin are high resistance , occult injury

very commonvery common

Look for entry and exit wounds , all tissueLook for entry and exit wounds , all tissuebetween is at extreme surgical riskbetween is at extreme surgical risk

Myoglobinemia from muscle injury can shut downMyoglobinemia from muscle injury can shut down

kidneyskidneys

AC is more dangerous than DCAC is more dangerous than DC

Duration of shock determines extent of injuryDuration of shock determines extent of injury


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Burns can be by directcontact or by arcing


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Chemical BurnsChemical Burns

Treatment Specific . . . . . . . .Treatment Specific . . . . . . . .

Hydrofluoric : Irrigate , Calcium GluconateHydrofluoric : Irrigate , Calcium Gluconate

HCL / Sulfuric : Bicarbonate irrigationHCL / Sulfuric : Bicarbonate irrigation

Phenol : No irrigationPhenol : No irrigation

White Phosphorous : Ignites with irrigationWhite Phosphorous : Ignites with irrigation

Sample or container to hospital ! ! !Sample or container to hospital ! ! !

Treatment Kits at Industrial Sites ! ! !Treatment Kits at Industrial Sites ! ! !


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Fluid ResuscitationFluid Resuscitation

Rapid volume depletionRapid volume depletion

Diffuse capillary leaksDiffuse capillary leaks

> 15 % , Edema even where there is no> 15 % , Edema even where there is no

burnburn Aggressive fluids are not needed for shortAggressive fluids are not needed for short

triptrip

Do not waste scene time for IV if under 15Do not waste scene time for IV if under 15

minutes to the burn centerminutes to the burn center

Fluids critical for the long flight ! ! !Fluids critical for the long flight ! ! !


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Fluid ResuscitationFluid Resuscitation

Large bore IV (s)Large bore IV (s)

NonNon -- burn site if possibleburn site if possible

Best tool , Urine Output . . . .Best tool , Urine Output . . . .

0 . 5 cc / kg / hr adult0 . 5 cc / kg / hr adult

1 . 0 cc / kg / hr child [ < 30 kg ]1 . 0 cc / kg / hr child [ < 30 kg ]

Too much fluids can be just as bad as too little ! ! !Too much fluids can be just as bad as too little ! ! !


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Parkland FormulaParkland Formula

% BSA x Kg x 4 cc = 24 hour total% BSA x Kg x 4 cc = 24 hour total

needneed

1 / 2 over the first eight hours1 / 2 over the first eight hours

1 / 2 over the next sixteen hours1 / 2 over the next sixteen hours

Lactate Ringers is the fluid of choice !Lactate Ringers is the fluid of choice !


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Modified Brooke FormulaModified Brooke Formula

% BSA x Kg x 2 cc = 24 hour total% BSA x Kg x 2 cc = 24 hour total

needneed

1 / 2 over the first eight hours1 / 2 over the first eight hours

1 / 2 over the next sixteen hours1 / 2 over the next sixteen hours


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Wound CareWound Care

After the initial resuscitationAfter the initial resuscitation

Remove smoldering clothingRemove smoldering clothing Do not remove adherent clothingDo not remove adherent clothing

Compensate for loss of thermoregulationCompensate for loss of thermoregulation

Provide comfort and pain controlProvide comfort and pain control

Dry linen dressings , not gauzeDry linen dressings , not gauze

Do not cool wound , can advance theDo not cool wound , can advance thedegree of burndegree of burn

Regulate ambient temperatureRegulate ambient temperature


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Burn Center Transport GuidelinesBurn Center Transport Guidelines

Partial thickness over 15 %Partial thickness over 15 %

Full thickness over 5 %Full thickness over 5 %

Involvement of hands , perineum , face ,Involvement of hands , perineum , face ,

feetfeet InhalationInhalation

All high voltageAll high voltage

All chemicalAll chemical

Patients with significant prePatients with significant pre -- existingexisting

diseasedisease


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Burn Patient

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