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 ( via Wikimedia Commons
1. Severity & extent
Skin layer Image credit: Simon Yiu Derived from work by Persian Poet Gal at en.wikipedia [GFDL ( or CC-BY-3.0 ( from Wikimedia Commons
Image credit: Simon Yiu Derived from work by Persian Poet Gal at en.wikipedia [GFDL ( or CC-BY-3.0 ( from Wikimedia Commons
1 st degree/Superficial Image credit: Simon Yiu Derived from work by Persian Poet Gal at en.wikipedia [GFDL ( or CC-BY-3.0 ( from Wikimedia Commons
2 nd degree/Partial thickness Image credit: Simon Yiu Derived from work by Persian Poet Gal at en.wikipedia [GFDL ( or CC-BY-3.0 ( from Wikimedia Commons
Superficial PT/2 nd degree By Cjr80 (Own work) [CC-BY-SA-3.0 ( sa/3.0)], via Wikimedia Commonshttp://creativecommons.org/licenses/by- sa/3.0 Image credit: Simon Yiu Derived from work by Persian Poet Gal at en.wikipedia [GFDL ( or CC-BY-3.0 ( from Wikimedia Commons
Deep PT/2 nd degree Image credit: Simon Yiu Derived from work by Persian Poet Gal at en.wikipedia [GFDL ( or CC-BY-3.0 ( from Wikimedia Commons Photo credit: The Victorian Adult Burns Service, Alfred Health, Melbourne, Australia
3 rd degree/Full thickness Image credit: Simon Yiu Derived from work by Persian Poet Gal at en.wikipedia [GFDL ( or CC-BY-3.0 ( from Wikimedia Commons Photo credit: The Victorian Adult Burns Service, Alfred Health, Melbourne, Australia
What body surface area?
Scattered areas Image credit: Simon Yiu
Knowing surface area -> who needs special burn unit care -> how much fluids to give
Photo credit: 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%
2. Diagnose Complications
Burn: Cellular level Local and systemic inflammatory response Capillaries permeable, fluids and proteins leak Edema and hypovolemia
Complications Fluid loss Airway Edema Chemical
Burn patients need ++ fluids
++ Fluids Parkland Formula (1 st 24 hrs) 4cc x %BSA (2-3deg) x Wt (kg)
++ Fluids 1 st half 8 hr from time 0 Time zero Hospital arrival time 8 hours
++ Fluids 1 st half 8 hr from time 0 Time zero Hospital arrival time 8 hours 1 st half to be given
MCQ 2: 80kg, Ant + post torso, left arm. Presents 4 hr post. Rate of fluids/first 4 hour? A.1800cc /hr B.1500 cc/hr C.1000 cc/hr D.900 cc/hr E.700 cc/hr
Image credit: Patrick J. Lynch, medical illustrator; C. Carl Jaffe, MD, cardiologist. via Wikimedia commons
Photo credit: The Victorian Adult Burns Service, Alfred Health, Melbourne, Australia
Who is at risk for inhalation injury? Face burn Soot Voice
Photo credit: Dr. Mark Silverberg
Face burn Soot: Mouth, nose, sputum Voice: Hoarse, change Intubate early even if no airway compromise
Edema
Tight skin + Edema Compartment syndrome
Escharotomy Photo credit: Drs. Mike Cadogan and Chris Nickson, lifeinthefastlane.com
Chemicals
Carbon Monoxide 200x Affinity to Hb
Carbon Monoxide is chased Atmos air T1/2 = 4 hours Atmos 100% Oxygen = 1 hour Hyperbaric oxygen = < 20 minutes
Cyanide chokes mitochondria
3. Initial management of burn patient
Photo credit: The Victorian Adult Burns Service, Alfred Health, Melbourne, Australia
CDMQ: Write your orders (6)
Iv Fluids Cardiac monitor (BP, HR, O2 sat) Pain control Tetanus CBC, lytes, Cr, CO level, Lactate, Trop, CXR
Who needs special care
Area Agent Vulnerable population
Area: 10% second or third (deep partial or full)
Area: Hands Perineum Face 2/3 Degree
Circumferential
Chemical burn
Electricity
Children
Burn unit
LMCC objectives Determine severity and extent Diagnose Complications Institute initial management of burn trauma