BURNS

Objectives

 Estimate the burn size and determine the

presence of associated injuries
 Demonstrate measures of initial stabilization
and treatment of patients with burns
 Identify special problems and methods of
treatment patients with burns
 Specify criteria for the admission of burn
patients
Introduction

 Burn constitute a major cause of morbidity

and mortality
 High index of suspicion for airway
compromise
 Maintenance of hemodynamic normality with
volume replacement
 Prevention and treatment of rhabdomyolysis
and cardiac arrhythmias in electric burns
 Temperature control
Immediate life-saving measures
 Airway
 Indications of inhalation injury
 Facial burns
 Singeing of the eyebrows and nasal vibrissae
 Carbon deposits and acute inflammatory changes
in the oropharenx
 Carbonaceous sputum
 History of impaired mentation and/or confinement
in a burning environment
 Explosion with burns to head torso
Immediate life-saving measures
 Stop the burning process
 Intravenous lines
 20% area of burn is indication of circulatory
volume support.
 Upper extremities are preferred to lower
extremities
 Start I/V ringer lactate.
ASSESSMENT OF BURN PATIENT

 History
 Body surface area
 Rule of nine(palm represents 1% area)
 Infants or young child’s head represents larger
surface area.
 Depth of burns
 First degree burns
 Second degree or partial thickness burns
 Full thickness or third degree burns
Rule of nine
Stabilizing the burn patient
 Airway
 Pharyngeal thermal injuries may produce marked
laryngeal edema.Early airway maintenance is
mandatory.
 Clinical manifestation of laryngeal edema make
take 24 hours to develop.
 Breathing
 Following injuries may produce breathing injuries.
 Airway edema
 Chemical tracheobronchitis and pneumonia
 CO poisoning
Head & Neck Burns
Stabilizing the burn patient
 Breathing (continued)
 Patient suspected of CO poisoning should
receive high flow oxygen .
 Arterial blood gases should be monitored.
 Endotracheal tube may be needed.
Stabilizing the burn patient
 Circulating blood volume
 Urine output may be the only reliable measure to
assess the the hydration status.
 Foley’s catheter should be passed.
 1 ml/kg body wt urine output should be maintained
for children less than 30 kg.
 30-50 ml /hr urine output for adults.
 Burn patient may required 2-4ml/kg/% of burn
area, of ringer lactate.
 Formulae are only for estimation
Stabilizing the burn patient
 Physical examination
 Estimate extent and depth of burn
 Assess for associated injuries
 Weigh the patient

 Flow sheet
 Baseline determination of major burn patient
 Blood
 X ray chest
Stabilizing the burn patient
 Circumferential extremity burns
 Remove all jewelry
 Asses the status of distal circulation
 Escharotomy
 Fasciotomy (rarely needed)
 Gastric tube insertion
 Narcotics, analgesics, and sedatives
 Wound care
 Antibiotics
Escharotomies for burns
Escharotomy
Special burn requirements

 Chemical burns
 Acids, alkalis, petroleum products
 Alkali burns are more serious
 Irrigate the involved area with water
shower for 20-30 minutes
 Neutralizing agents should not be used
 Eyes need continuous irrigation for first 8
hours
Acid burns - homicidal
Special burn requirements
 Electric burns
 Airway, breathing
 I.V line
 E.C.G.
 Urinary catheter
 If dark colored urine ,suspect myoglobinurea
 Increase fluids
 Mannitol
 Sodium bicarbonate
Criteria for admission
 Partial-thickness and full-thickness burns
greater than 10% of body surface area (BSA)
in patients under 10 years or over 50 years of
age
 Partial-thickness and full-thickness burns
greater than 20% BSA in other age groups
 Partial-thickness and full-thickness involving
the face, eyes, ears, hands, feet, genitalia or
perineum or those that involve skin overlying
major joints
Criteria for admission
 Inhalation injury
 Full-thickness burns greater than 5%
BSA in any age group
 Significant electrical burns including
lightning injury
 Significant chemical burns
Summary

 Recognition of inhalation injury

 Identifying the extent and depth of the burn
 Establishing fluid guide lines according to
the weight of the patient
 Initiating a patient-care flow sheet
 Obtaining baseline X-ray studies
 Maintaining peripheral circulation in
circumferential burns by performing
escharotomy
 Identifying patients who need admission
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