1. Burns Dr. Stella Yiu Emergency Physician, TOH

2. LMCC objectives Determine severity and extent Diagnose Complications Institute initial management of burn trauma

3. By Sylvain Pedneault (Own work) [CC-BY-SA-3.0 (http://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons

4. 1. Severity & extent

6. Skin layer Image credit: Simon Yiu Derived from work by Persian Poet Gal at en.wikipedia [GFDL (http://www.gnu.org/copyleft/fdl.html) or CC-BY-3.0 (http://creativecommons.org/licenses/by/3.0)], from Wikimedia Commons

7. Image credit: Simon Yiu Derived from work by Persian Poet Gal at en.wikipedia [GFDL (http://www.gnu.org/copyleft/fdl.html) or CC-BY-3.0 (http://creativecommons.org/licenses/by/3.0)], from Wikimedia Commons

8. 1 st degree/Superficial Image credit: Simon Yiu Derived from work by Persian Poet Gal at en.wikipedia [GFDL (http://www.gnu.org/copyleft/fdl.html) or CC-BY-3.0 (http://creativecommons.org/licenses/by/3.0)], from Wikimedia Commons

9. 2 nd degree/Partial thickness Image credit: Simon Yiu Derived from work by Persian Poet Gal at en.wikipedia [GFDL (http://www.gnu.org/copyleft/fdl.html) or CC-BY-3.0 (http://creativecommons.org/licenses/by/3.0)], from Wikimedia Commons

10. Superficial PT/2 nd degree By Cjr80 (Own work) [CC-BY-SA-3.0 (http://creativecommons.org/licenses/by- 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 (http://www.gnu.org/copyleft/fdl.html) or CC-BY-3.0 (http://creativecommons.org/licenses/by/3.0)], from Wikimedia Commons

11. Deep PT/2 nd degree Image credit: Simon Yiu Derived from work by Persian Poet Gal at en.wikipedia [GFDL (http://www.gnu.org/copyleft/fdl.html) or CC-BY-3.0 (http://creativecommons.org/licenses/by/3.0)], from Wikimedia Commons Photo credit: www.vicburns.org.auwww.vicburns.org.au The Victorian Adult Burns Service, Alfred Health, Melbourne, Australia

12. 3 rd degree/Full thickness Image credit: Simon Yiu Derived from work by Persian Poet Gal at en.wikipedia [GFDL (http://www.gnu.org/copyleft/fdl.html) or CC-BY-3.0 (http://creativecommons.org/licenses/by/3.0)], from Wikimedia Commons Photo credit: www.vicburns.org.auwww.vicburns.org.au The Victorian Adult Burns Service, Alfred Health, Melbourne, Australia

13. What body surface area?

16. Scattered areas Image credit: Simon Yiu

17. Knowing surface area -> who needs special burn unit care -> how much fluids to give

18. Photo credit: www.vicburns.org.auwww.vicburns.org.au 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%

19. 2. Diagnose Complications

20. Burn: Cellular level Local and systemic inflammatory response Capillaries permeable, fluids and proteins leak Edema and hypovolemia

21. Complications Fluid loss Airway Edema Chemical

22. Burn patients need ++ fluids

23. ++ Fluids Parkland Formula (1 st 24 hrs) 4cc x %BSA (2-3deg) x Wt (kg)

24. ++ Fluids 1 st half 8 hr from time 0 Time zero Hospital arrival time 8 hours

25. ++ Fluids 1 st half 8 hr from time 0 Time zero Hospital arrival time 8 hours 1 st half to be given

26. 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

27. Image credit: Patrick J. Lynch, medical illustrator; C. Carl Jaffe, MD, cardiologist. http://creativecommons.org/licenses/by/2.5/, via Wikimedia commons http://creativecommons.org/licenses/by/2.5/

28. Photo credit: www.vicburns.org.auwww.vicburns.org.au The Victorian Adult Burns Service, Alfred Health, Melbourne, Australia

29. Who is at risk for inhalation injury? Face burn Soot Voice

30. Photo credit: Dr. Mark Silverberg

31. Face burn Soot: Mouth, nose, sputum Voice: Hoarse, change Intubate early even if no airway compromise

32. Edema

33. Tight skin + Edema  Compartment syndrome

34. Escharotomy Photo credit: Drs. Mike Cadogan and Chris Nickson, lifeinthefastlane.com

35. Chemicals

36. Carbon Monoxide 200x Affinity to Hb

37. Carbon Monoxide is chased Atmos air T1/2 = 4 hours Atmos 100% Oxygen = 1 hour Hyperbaric oxygen = < 20 minutes

38. Cyanide chokes mitochondria

39. 3. Initial management of burn patient

40. Photo credit: www.vicburns.org.auwww.vicburns.org.au The Victorian Adult Burns Service, Alfred Health, Melbourne, Australia

41. CDMQ: Write your orders (6)

42. Iv Fluids Cardiac monitor (BP, HR, O2 sat) Pain control Tetanus CBC, lytes, Cr, CO level, Lactate, Trop, CXR

43. Who needs special care

44. Area Agent Vulnerable population

45. Area: 10% second or third (deep partial or full)

46. Area: Hands Perineum Face 2/3 Degree

47. Circumferential

48. Chemical burn

49. Electricity

50. Children

51. Burn unit

52. LMCC objectives Determine severity and extent Diagnose Complications Institute initial management of burn trauma