1. Chapter 9

2.  Estimate size of injury and determine associated injuries  Discuss the principles of initial assessment and treatment  Identify special problems and methods of treatment  Specify criteria for transfer of burn patient

3.  What should I do first?  How do I identify inhalational injury?  How do I estimate burn size and depth?  What is the rate and type of fluids administered to a burn patient?  Who do I transfer to a burn center?

4.  Assess the patient’s and stop the burning process.

5.  Establish and maintain ◦ Airway and Breathing ◦ Normal perfusion (C and D) ◦ Fluid and electrolyte balance (C) ◦ Normal body temperature (E)  Be aware of inhalational injury ◦ Face and neck burns, carbon deposits around mouth, singed hair, hoarseness ◦ Consider early ET intubation  Maintain adequate organ perfusion ◦ Monitor urinary output and vital signs

8.  AMPLE history  Tetanus status  Ringer’s lactate 4 mL/kg/% BSA in first 24 hours [half in first 8 hours]  Monitor HR and urinary output  Lab work  GI tube  Narcotics and antibiotics

9.  Determine type, duration, amount and concentration of substance  Brush away dry chemicals  Special consideration for specific chemicals

10.  Fascia and muscle damage, may spare overlying skin  Myoglobinura  Maintain adequate perfusion  Consider sodium bicarbonate  Possible fasciotomy

11.  >10% burns in 50 years old  >20% in all ages  Burns to face, hands, genitals and joints  Electrical and chemical burns  Inhalation injury  Comorbid diseases  Young children

12.  How does cold affect my patient?  How do I recognize a cold injury?  How do I treat local cold injuries?  How do I treat a systemic cold injury?

13.  Cold Injury Factors ◦ Temperatures ◦ Duration of exposure ◦ Environmental conditions ◦ Immobilization ◦ Moisture ◦ Vascular disease ◦ Open wounds

14.  Frostnip  Frostbite  Nonfreezing

15.  Do not delay  Replace cold or frozen clothing with warm blankets  Rewarm frozen part  Preserve damaged tissue  Prevent infection  Elevate exposed part  Analgesics, tetanus and antibiotics

16.  Rapid or slow drop in core temperature to less than 35 o C  Extremes of ages at highest risk  Low-range thermometer required  May have depressed LOC  May be gray and cyanotic  Variable vital signs  May have absence of cardiac activity

17.  Passive, external rewarming: warmed environment, blankets, and IV fluids  Active core rewarming: surgical rewarming technique  Do not delay transfer  Not dead until warm and dead!

18.  Burn injury ◦ Recognize and treat inhalational injury ◦ Fluid resuscitation ◦ Identify burn injuries requiring transfer  Cold injury ◦ Diagnose type ◦ Measure core temperature ◦ Rewarming techniques ◦ Monitor and support vital functions