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CHIANG W. H

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70% of burn injuries occur athome

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- Largest organ- Functions

!. "arrier

- #ee$s ui&s in - #ee$s bacteriaout

'. (ensor) organ

*. +em$eratureorgan

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,eate& to - tem$erature- &uration

"oiing /ater contact0.! sec su$ercia burn

! sec fu thic1ness burn

2ain 3 /ith&ra/a at 4*.5 &egree

+issue &amage at 46 &egree

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+raumatic

(uering2roonge& morbi&it)

Expensive

Prolonged rehabilitation &readaptation

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1. Thermal burn - (1in injur)

- Inhaation injur)

2. Chemical burn

- (1in injur)

- Inhaation injur)

- 8ucous membrane injur)

3. Electrical burn

- Lightning

4. Radiation burn

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Caused by :

Fames

Hot objects Fammabe 9a$or that

ignites

(team or hot i:ui&

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1. Superficial ( 10)

2. Partial thickness ( 20)

- Superficial partial thickness

- Deep partial thickness3. Full thickness (30)

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Aso 1no/n as !st &egree In9o9es the e$i&ermis Characteri;e& b)

,e&&ening

+en&erness an& 2ain Increase& /armth

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Aso 1no/n as 'n& &egree burn

amage e>ten&s through thee$i&ermis an& in9o9es the &ermis.

Not enough to interfere /ith

regeneration of the e$itheium 8oist= shin) a$$earance

(amon $in1 to re& coor

2ainfu oes not ha9e to bister to be 'n&

&egree

?sua) hea in @7-'! &a)s

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Also known as 3rd degreeAlso known as 3rd degree "oth e$i&ermis an& &ermis are &estro)e&

/ith burning into subcutaneous fat

+hic1= &r) a$$earance

early grayearly grayor charred black colorcharred black color

ainlessainless- ner9e en&ings are &estro)e&

2ain is &ue to intermi>ing of 'n& &egree

8a) be minor bee&ing Cannot hea an& re:uire grafting

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!urnClassi"cations

*r& egree "urnBFu +hic1ness burn

Dften it is not$ossibe to $re&ict thee>act &e$th of a burnin the acute $hase.

(ome 'n& &egreeburns /i con9ert to

*r& &egree /heninfection sets in.When in &oubt ca it*r& &egree.

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!ody #ur$ace AreaEstimation

,ue ofNines

AdultAdult

2am ,ue

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!ody #ur$ace AreaEstimation

,ue of Nines

ediatricsediatrics For each )r o9er !

)r= subtract !%from hea& an& a&&e:ua) to egs

2am ,ue

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!urn #e%erity

Factors to Consi&er

e$th or Cassication

"o&) (urface area burne&

Age A&ut 9s 2e&iatric

2ree>isting me&ica con&itions

Associate& +rauma

bast injur)

fa injur)

air/a) com$romise

chi& abuse

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A##E##&'( T)E !*R' AT&E'T:A##E##&'( T)E !*R' AT&E'T:

A+ )T,R-

Nature of injur)Associate& injuries

+ime of the burn injur)

2ast me&ica inessesEaergies

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!urn atient#e%erity

atient age Less than ' or greater than 55

Ha9e increase& inci&ence of com$ication

!urn con"guration

Circumferentia burns can cause totaoccusion of circuation to an area &ue toe&ema

,estrict 9entiation if encirce the chest "urns on joint area can cause &isabiit) &ue

to scar formation

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Critical Burn Criteria

3 / 10 !#A 2/ 30 !#A

/ 20 in ediatric

!urns with resiratory inury &nhalation&nury+

)ands $ace $eet or genitalia

!urns comlicated by other trauma

*nderlying health roblems

Electrical and dee chemical burns

5 d t !5oderate ! rn

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5oderate !urn5oderate !urn

CriteriaCriteria 32610 !#A

217630 !#A 1620 ediatric

E8cluding hands $ace $eet orgenitalia

9ithout comlicating $actors5inor !urn5inor !urn

CriteriaCriteria 3 20 !#A

2 170 !#A 10 ediatric

1 20 !#A

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Assessment ; 5anagement 6Thermal &nury

,A"C

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Airway and !reathingAirway and !reathing

Assess for $otentia air/a) in9o9ement

soot or singing in9o9ing mouth= nose= hair= face=facia hair

coughing= bac1 s$utum

encose& re en9ironment

Assist 9entiations as nee&e&

!00% o>)gen 9ia N," if

8o&erate or critica burn

2atient unconscious

(igns of $ossibe air/a) burn E inhaation injur)

Histor) of e>$osure to carbon mono>i&e or smo1e

NRB is nonrebreather. It refers to a type of oxygen mask.

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Airway andAirway and

!reathing!reathing Libera en&otrachea

intubation

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,ther,ther

Anagesia I 8or$hine (ufate

' - * mg re$eate& : !0 minutes titrate& toa&e:uate 9entiations an& boo& $ressure

0.! mgE1g for $e&iatric 8a) re:uire arge but toerabe tota &oses

A9oi& to$ica agents e>ce$t as &irecte& b)

burn unit e.g. si9a&ene

Fui& +hera$)

;

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?luid theray?luid theray

Dbjecti9e H, !!0 E minute

Norma sensorium Ba/a1e= aert= oriente&

?rine out$ut *0 - 50 mEhour Ba&ut 0.5 -! mE1gEhr B$ae&

,esuscitation formuas $ro9i&e estimates=a&just to in&i9i&ua $atient res$onses

(tart through burn if necessar)= u$$ere>tremities $referre&

8onitor for 2umonar)

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Consi&er Fui& +hera$) for J!0% "(A of *0

J!5% "(A of '0

J*0 - 50% "(A of !0/ith accom$an)ing '0

,inger Lactate using 2ar1an& Formua

K4 m Bbo&) /eight 1g % of burnM

!E' in rst 6 hours !E' o9er 'n& ! hours

+hese are ui& oss re$acement= notincu&e ui& maintenance

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atient 9eight @ kg

Estimated ercentage !ody !urned '0 %

?luid ReBuirements 1st 24 )ours 4.6 Liters

?luid ReBuirements 1st )ours 1D2 o$ total+ '.4 Liters

?luid ReBuirements 2nd

1@ )ours 1D2 o$total+

Rule o$ Fs $or Adults: 0 $or each arm 10 $or each leg 0

$or head10 $or $ront torso 10 $or back torso.

Rule o$ Fs $or Children: 0 $or each arm 140 $or each leg10 $or head 10 $or $ront torso 10 $or back torso.

Fluid Requirements = TBSA burned(%) x Wt (kg) x 4mLGive 1/2 of total requirements in 1st 8 hours, then give 2nd halfover next 16 hours.

http://www.mdcalc.com/parkland-formula-for-burns/

Calculates fluid requirements for burn patients ina 24-hour period.

A ; 5

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+reat "urn Woun&

Lo/ $riorit)Lo/ $riorit)- After A"Cs an& initiation of I o not ru$ture bisters

Co9er /ith sterie &ressings

8oist Contro9ersia= imit to sma areasB!0% or imit time of a$$ication B$re9enth)$othermia

r) ?se for arger areas &ue to concern forh)$othermia

Co9er /ith burn sheet

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&nhalation &nury

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&nhalation&nury

Antici$ate res$irator) $robemsAntici$ate res$irator) $robems Hea&= Face= Nec1 or Chest

Nasa or e)ebro/ hairs are singe&

Hoarseness= tach)$nea= &rooing $resent

Loss of consciousness in burne& area

NasaEDra mucosa re& or &r)

(oot in mouth or nose

Coughing u$ bac1 s$utum

In encose& burning area Be.g. smaa$artment

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#&('# ,? *ER A&R9A-!*R'#

"urns of the face (inge& e)ebro/s

or nasa hairs

"urns in the mouth

(oot) s$utum

Histor) of beingburne& /hie

conne& to anencose& s$ace

LI2 "?,N( 3 (DD+ IN8D?+H

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&nhalation &nury5anagement

Airway ,8ygenation and Gentilation Assess for air/a) e&ema ear) an& often

Consi&er ear) intubation= ,(I

When in &oubt o>)genate an& 9entiate High o/ o>)gen

"roncho&iators ma) be consi&ere& if

bronchos$asm $resent iuretics not a$$ro$riate for $umonar)

e&ema

RSI Rapid Sequence Induction

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CR&TER&A ?,R TRA'#?ER

A+A+ T-E# ,? !*R' &'H*R&E#T-E# ,? !*R' &'H*R&E#

artial ; ?ull Thickness !urns

J !0% in age !0 )ears or J 50 )ears.

J '0% in other age grou$s.

In9o9ing face= ears= e)es= han&s= feet=genitaia or $erineum.

?ull thickness burns

J 5% of "(A.

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CR&TER&A ?,R TRA'#?ER

!. ,T)ER T-E# ,? !*R' &'H*R&E# 2atient /ith $re-e>isting iness that cou&

com$icate management.

Chi&ren /ith burns seen in hos$itas

/ithout :uaie& $ersonne or e:ui$ment. 2atients /ho re:uire s$ecia socia=

emotiona or ong term rehabiitati9esu$$ort.

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CH

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?ACT,R# CA*#&'( T#*E

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TREAT5E'T ,? C)E5&CAIEJ,#*RE

22

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