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