burns
DESCRIPTION
Burns. Dr. Stella Yiu Emergency 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. - PowerPoint PPT PresentationTRANSCRIPT
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BurnsDr. Stella YiuEmergency Physician, TOH
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LMCC objectivesDetermine severity and extent
Diagnose Complications
Institute initial management of burn trauma
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By Sylvain Pedneault (Own work) [CC-BY-SA-3.0 (http://creativecommons.org/licenses/by-sa/3.0)],
via Wikimedia Commons
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1. Severity & extent
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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
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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
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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
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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
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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
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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
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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
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What body surface area?
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Must know this!
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Scattered areas
Image credit: Simon Yiu
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Knowing surface area-> who needs special burn unit care-> how much fluids to give
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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%
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2. Diagnose Complications
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Burn: Cellular levelLocal and systemic inflammatory
response
Capillaries permeable, fluids and proteins leak
Edema and hypovolemia
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Complications
Fluid loss AirwayEdema
Chemical
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Burn patients need ++ fluids
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++ FluidsParkland Formula (1st 24 hrs)
4cc x %BSA (2-3deg) x Wt (kg)
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++ Fluids
1st half 8 hr from time 0
Time zero
Hospital arrival time
8 hours
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++ Fluids
1st half 8 hr from time 0
Time zero
Hospital arrival time
8 hours
1st half to be given
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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
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Image credit: Patrick J. Lynch, medical illustrator; C. Carl Jaffe, MD, cardiologist. http://creativecommons.org/licenses/by/2.5/, via Wikimedia commons
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Photo credit: www.vicburns.org.au The Victorian Adult Burns Service, Alfred Health, Melbourne, Australia
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Who is at risk for inhalation injury?Face burn
Soot
Voice
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Photo credit: Dr. Mark Silverberg
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Face burn
Soot: Mouth, nose, sputum
Voice: Hoarse, change
Intubate early even if no airway compromise
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Edema
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Tight skin + Edema Compartment syndrome
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Escharotomy
Photo credit: Drs. Mike Cadogan and Chris Nickson, lifeinthefastlane.com
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Chemicals
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Carbon Monoxide200x Affinity to Hb
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Carbon Monoxide is chasedAtmos air T1/2 = 4 hours
Atmos 100% Oxygen = 1 hour
Hyperbaric oxygen = < 20 minutes
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Cyanide chokes mitochondria
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3. Initial management of burn patient
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Photo credit: www.vicburns.org.au The Victorian Adult Burns Service, Alfred Health, Melbourne, Australia
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CDMQ: Write your orders (6)
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Iv Fluids
Cardiac monitor (BP, HR, O2 sat)
Pain control
Tetanus
CBC, lytes, Cr, CO level, Lactate, Trop, CXR
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Who needs special care
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Area
Agent
Vulnerable population
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Area: 10% second or third (deep partial or full)
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Area:
Hands
Perineum
Face
2/3 Degree
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Circumferential
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Chemical burn
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Electricity
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Children
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Burn unit
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LMCC objectivesDetermine severity and extent
Diagnose Complications
Institute initial management of burn trauma