Burns
last authored Aug 2009
Introduction
Causes and Risk Factors
Flame injuries are the most common in adults; splash injuries the most common in children.
Alkalais are worse than acids.
Acids
Electric burns are almost always deeper than appearances suggest.
Pathophysiology
First degree burns:
Second degree burns: extend into the dermis, with blistering
- superficial - sensation present; deeper - lack of pain
Third degree burns: full-thickness burn; leathery white, brown, black
Fourth degree burns: burn extends into organs or bone
Signs and Symptoms
- history
- physical exam
History
Mechanism of injury
- temperature an
Time
Treatment this far
query abuse in children, seniors, or other at-risk patients
Physical Exam
ABCs
- signs of airway invlovement include: peri-oral burns, oropharyngeal erythema/edema, singed nasal/facial hair
breathing: symmetrical chest expansion and sounds, oxygen saturation
circulation: pulse and blood pressure
Investigations
- lab investigations
- diagnostic imaging
Lab Investigations
CBC
electroytes
Diagnostic Imaging
Differential Diagnosis
Treatments
If airway compromise is present or threatened, intubate.
rule of 9's
applies to 2nd or 3rd degree burns
- arm - 9%
- head - 9%
- front torso - 18%
- back torso - 18%
- leg - 18%
- genitals - 1%
their palm = 1%
Oxygen and two large-bore IVs with crystalloid (Ringer's or normal saline)
Parkland Formula
Amount of fluid required in the first 24 hours since burn
4cc x total burned surface area up to 50 x body weight (kg)
- + 2L D5W because patient is NPO
Give 1/2 this amount in the first 8 hours, the second half over
the next 16 hours
Give half the above on day 2
Fluid needs are greater in electrical burns.
If you are under-resuscitating someone, increase their volume by 1/3
Keep patients warm, as the temperature control capacity of the skin becomes seriously compromised.
Foley catheter to measure urine output (aim for 1-2 ml/kg/hr).
Escharotomy is necessary in circumferential burns to prevent compartment syndrome.
Tetanus
Analgesia
Opioids such as fentanyl
Indications for transfer to a burn unit
Dressing
Saline soaks
Flamazine (sp) is one of the most appropriate dressings but is messy; avoid using it until the definitive providers are involved and have evaluated the burn.
Silver sulfadiazine is often used.
Surgery
Early excision and grafting should be carried out to save costs, minimize pain, and complications.
Consequences and Course
Clinical Vignette 1
A person takes this treatment for this reason due to concerns re: condition
This happens.
How do you respond?
Clinical Vignette 2
Additional Resources
Topic Development
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