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 Flame burn: house fires, improper use of

flammable liquids, kerosene lamps, careless


Diagnosis and Management of Acute Burns
smoking, vehicular accidents, clothing ignited
Initial/Resuscitative Period from stove
 Assessment of burn injury  Flash burn: explosions of natural gas propane,
gasoline and other flammable liquids causing
 Classification of burn injury
intense heat for a very brief period of time.
 Criteria for admission
 Contact burn: results from hot metals, plastic,
 Initial ER management
glass or hot coals; usually limited in extent but
 Fluid resuscitation
very deep
 Monitoring
 Chemical burn: caused by strong alkali or acids;
these cause progressive damage until chemical is
Definitive Management Period
deactivated with reaction with tissue or reaction
 Excision and grafting
with water
 Control of infection
o Acid burns: more self limiting than alkali
 Nutrition burns; acid tend to tan the skin creating
 Rehabilitation an impermeable barrier limiting further
 Complications penetration of the acid
 Prevention o Alkali burns: combine with cutaneous
lipids to create soap and thereby
Initial/Resuscitative Period continue to dissolve the skin until they
are neutralized
Assessment Of Burn Injury
 Electrical burns: injury from electrical current
classified as high voltage or low voltage (high
1. Complete History
voltage 1000 V)
 Primary Survey
o Airway Estimate The Burn Size
o Breathing
o Circulation
 Expressed as %BSA; count only areas with partial
o Deficits/Disability
(2nd degree) or full thickness ( 3rd degree) burns
o Extremities/Exposure/Environment
 Rule of Nines obtains a rough estimate of the
 Initial evaluation includes 4 crucial assessments:
areas involved but not accurate in children due to
o Airway management
the large surface are of the child’s head and the
o Evaluation of other injuries
relatively smaller are of lower extremities. (See
o Burn size estimation
last page for image)
o Diagnosis of CO and Cyanide poisoning
o anterior and posterior trunk each
 Large-bore peripheral IV catheters + fluid account for 18%, each lower extremity is
resuscitation, concurrently with primary survey 18%, each upper extremity is 9%, and the
should be done to: head is 9%
o Burn >40% TBSA o 1st degree burn not included in
 Secondary survey must perform in ALL burn calculating TBSA
patients  Accurately done using the Lund and Browder
 Hypothermia - common prehospital complication charts
contributing to resuscitation failure  In electrical injuries, the %BSA does not
o Wrapped px during transport correspond to the extent of injuries of the
o Avoid cooling blankets to px with burn underlying soft tissues.
>20% TBSA
 No prophylactic antibiotic to acute burn px
 Administer tetanus booster
Classify As To Type Of Burn

 Scald burn: caused by hot liquids ( hot water,


soups, sauces) which are thicker in consistency,
remain in contact with the skin for a longer
period of time
Assess the Burn Depth

 Important in estimating burn size and fluid


requirement in determining the need for surgery
and in evaluating the progress of the patient

ABCD, EFGH Chenes, Doc 2 of 3


ABCD, EFGH Chenes, Doc 3 of 3

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