ACS

Committee on Trauma Presents

Injuries Due

to Burns

and Cold

Injuries Due

to Burns

and Cold

ACS

Objectives

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

ACS

Key Questions: Burn Injury

What should I do first?

How do I identify inhalation 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?

ACS

What should I do first?

Assess the patient’s

A B C D E

and stop the burning process

ACS

Burn Management Principles

Establish and Maintain Airway and Breathing

Normal perfusion (C and D)

Fluid and electrolyte balance (C)

Normal body temperature (E)

ACS

Identify inhalation injury?

Carbonaceous sputum

Face and neck burns

Inflamed oropharynx

and hoarseness

Carbon deposits

Hair singeing

CO Hgb > 10%

ACS

Manage airway / breathing?

Assume: Direct thermal or inhalation injury

Establish and maintain patent airway early and consider early ET intubation

Oxygenate and ventilate

Obtain ABGs and CO levels

ACS

Adequate organ perfusion?

Adequate venous access

Monitor vital signs

Hourly urinary output Adult: 0.5 – 1.0 mL / kg / hour Child: 1.0 mL / kg / hour Infant: 2.0 mL / kg / hour

ACS

Estimate burn size and depth?

Palm + fingers = approximately

1% BSA

Rule of Nines

Infant

9%

13%2.5%

7%

4.5%

9%

4.5%

18%

1%7%

Adult

4.5%

18%

4.5%

18%

4.5% 4.5%

1%

9 %

9%

9% 9%

ACS

Second-degree Burn

ACS

Third-degree Burn

ACS

Rate and type of fluids?

4 mL warmed Ringers lactate / kg / % BSA in 1st 24 hours

Administer ½ in 1st 8 hours

Administer ½ in next 16 hours

Base on time from injury

Monitor heart rate and urinary output

ACS

What history do I need?

AMPLE history

Tetanus status

ACS

Other management?

Baseline blood analyses and chest x-ray

Gastric intubation

Narcotics

Antibiotics

Wound care

Flow sheet documentation

ACS

Manage chemical burns?

Determine type, duration, amount, and concentration

Brush away dry chemicals

Special consideration for specific chemicals

Flush with copious amounts of water for 20 – 30 minutes

ACS

Manage electrical burns?

Fascia and muscle damage, may spare overlying skin

Myoglobinuria: Fluids, mannitol

Maintain adequate perfusion

Sodium bicarbonate Fasciotomy

ACS

Whom do I transfer?

Second- and Third-degree Burns > 10% BSA in ages < 10 and > 50 years

> 20% BSA (all ages)

To unique areas (any size burn) Face Eyes Ears

Hands Feet Genitalia

Perineum Major joints

ACS

Whom do I transfer?

Third-degree burns > 5% BSA (all ages)

Electrical and chemical burns

Inhalation injury

Preexisting illnesses, associated injuries

Children

Special situations

ACS

Transfer procedures to use?

Coordinate with burn center doctor

Transfer with Documentation / information Laboratory results

ACS

Summary: Burn Injury

Recognize and treat inhalation injury

Fluid resuscitation

Identify burn injuries requiring transfer