burn cold injury

ACLS ( CH 9 ) - BURN 1

BURN , COLD INJURY

ACLS ( CH 9 ) - BURN 2

INJURY DUE TO BURN AND

COLD

ACLS ( CH 9 ) - BURN 3

OBJECTIVES

Estimate burn size, and determine presence of associated injuries.

Outline innitial stabilization, treatment measures, and transfer criteria.

Identify special problems and methods of treatment.

ACLS ( CH 9 ) - BURN 4

BURN / COLD INJURIES

Management Principles Timely application Maintain:

Airway Hemodynamic stability Fluid / electrolyte balance Normal body temperature

Prevent complications

ACLS ( CH 9 ) - BURN 5

Injury Due To Burn

ACLS ( CH 9 ) - BURN 6

LIFE-SAVING MEASURES

Establish airway Identify signs of distress Initiate supportive measures Obtain history

ACLS ( CH 9 ) - BURN 7

CLINICAL INDICATIONS Carbonaceous sputum Facial burns Hair singeing Carbon deposites Inflamed oropharynx History

Inhalation Injury

ACLS ( CH 9 ) - BURN 8

LIFE-SAVING MEASURES

Remove all: Injurious material Clothing, jewelry

Prevent hypothermia Two, large-caliber Ivs Ringer’s lactate

ACLS ( CH 9 ) - BURN 9

ASSESSMENT

History Mechanism of ijury Associated illness Allergies Tetanus status

ACLS ( CH 9 ) - BURN 10

Rule of Nines

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ASSESSMENT

Estimate Burn Size Surface of patient’s palm

represents 1% body surface area

ACLS ( CH 9 ) - BURN 12

Second-degree Burn

ACLS ( CH 9 ) - BURN 13

Third-degree Burn

ACLS ( CH 9 ) - BURN 14

MANAGEMENT

Airway Assess for injury Establish and maintain patient

airway early

ACLS ( CH 9 ) - BURN 15

Inhalation Injury Early

Management

ACLS ( CH 9 ) - BURN 16

MANAGEMENT

Breathing Assume CO exposure Inhalation of toxic fumes or carbon

particles Direct thermal injury

ACLS ( CH 9 ) - BURN 17

MANAGEMENT

Breathing Oxygen / ventilate Endotracheal intubation ABGs Carboxyhemoglobin levels

ACLS ( CH 9 ) - BURN 18

MANAGEMENT

Circulation Monitor vital signs Hourly urinary outputs

Adult: 30 – 50 mL / hr Child: 1.0 mL / kg / hr

ACLS ( CH 9 ) - BURN 19

MANAGEMENT

Circulation – Estimate of Fluid Needs 2 – 4 mL Ringer’s lactate / kg / %

BSA in first 24 hours One-half in first 8 hours One-half in next 16 hours Based on time from injury Monitor patient response

ACLS ( CH 9 ) - BURN 20

MANAGEMENT

Develop Treatment plan Estimate burn size / depth Identify associated injuries Weigh patient Baseline blood analyses Chest films Document on flow sheet

ACLS ( CH 9 ) - BURN 21

MANAGEMENT

Maintain Peripheral Circulation Remove all connstricting devices Assess distal circulation Escharotomy – surgical consultation

ACLS ( CH 9 ) - BURN 22

Escharotomy Sites

ACLS ( CH 9 ) - BURN 23

Escharotomy

ACLS ( CH 9 ) - BURN 24

MANAGEMENT

Nasogastric Intubation Nausea, vomiting, distention Burn > 20% BSA

Medications Narcotics – Spare use, IV only Antibiotics – Not indicated early

ACLS ( CH 9 ) - BURN 25

MANAGEMENT

Wound Care Cover with clean linen Do not

Break blisters Apply antiseptics Apply cold water

ACLS ( CH 9 ) - BURN 26

MANAGEMENT

Acid / Alkali Burns Duration, concentration, and

amount Flush with copious amount of water

for 20 – 30 minutes Brush away dry chemical before

irrigation

ACLS ( CH 9 ) - BURN 27

Chemical Burns

ACLS ( CH 9 ) - BURN 28

Fasciotomy – Electrical Burn

Electrical burn result in damage to the fascia and muscle, and may spare the overlying skin

ACLS ( CH 9 ) - BURN 29

MANAGEMENT

Electrical Burn ABCs Myoglobinuria

↑Fluid: 100 mL urine / hr Mannitol: 25 g IV

Metabolic acidosis Maintain adequate perfusion Sodium Bicarbonate

ACLS ( CH 9 ) - BURN 30

TRANSFER CRITERIA

2nd, 3rd degree burns > 10% BSA in age < 10 and > 50 years

2nd, 3rd degree burns > 20% BSA

2nd, 3rd degree burns to face, eyes, ears, hands, feet, genitalia, perineum, and major loints

ACLS ( CH 9 ) - BURN 31

TRANSFER CRITERIA

3rd degree burns > 5% BSA Electrical and chemical burns Inhalation injury Pre-existing illness, associated

injuries Children Special situations

ACLS ( CH 9 ) - BURN 32

TRANSFER PROCEDURE

Coordinate with burn-center physician

Transfer with all Documentation / information Laboratory results

ACLS ( CH 9 ) - BURN 33

Injury Due To Cold

ACLS ( CH 9 ) - BURN 34

COLD INJURY FACTORS

Temperature Duration of exposure Enviromental conditions Immobilizzation Moisture Vascular disease Open wounds

ACLS ( CH 9 ) - BURN 35

TISSUE-FREEZING INJURY FROSTBITE

1st Degree: Hyperemia, edema 2nd Degree: Vesicles, parttial-

thickness skin necrosis 3rd Degree: Full-thickness skin

necrosis 4th Degree: Skin, muscle, bone

necrosis

ACLS ( CH 9 ) - BURN 36

Second-degree Frostbite

ACLS ( CH 9 ) - BURN 37

Fourth-degree Frostbite

ACLS ( CH 9 ) - BURN 38

MANAGEMENT

Do nor delay Remove clothing Warmed blankets Rewarm frozen part

ACLS ( CH 9 ) - BURN 39

MANAGEMENT

Preserve damaged tissue Prevent infection Elevate and expose injured part Analgesics / tetanus / antibiotics

ACLS ( CH 9 ) - BURN 40

HYPOTHERMIA

Core temperature < 35 degrees Rapid / slow drop in core

temperature Elderly and children at greater risk Low-range thermometer required

ACLS ( CH 9 ) - BURN 41

HYPOTHERMIA

Clinical Findings Core temperature < 35 degrees Depressed level of consciousness Gray, cyanotic, variable vital signs Absence of cardiorespiratory activity

ACLS ( CH 9 ) - BURN 42

MANAGEMENT

ABCs, IV access Oxygenate and ventilate Prevent heat loss and rewarm Assess for associated disorders Blood analyses

ACLS ( CH 9 ) - BURN 43

MANAGEMEN

Passive External Rewarming Warm enviroment Warmed blankets and IV fluids

Active Core Rewarming Surgical rewarming techniques Do not delay transfer

Not dead until warm and dead

ACLS ( CH 9 ) - BURN 44

？

ACLS ( CH 9 ) - BURN 45

SUMMARY

Burn Injury Recognize inhalation injury Establish airway Fluid resuscitation Rremove all clothing

ACLS ( CH 9 ) - BURN 46

SUMMARY

Burn Injury Identify extend, depth of burn Establish fluid guidelines Initiate burn flow sheet Obtain baseline lab / radiology Maintain peripheral circulation Identify burns requiring transfer

ACLS ( CH 9 ) - BURN 47

SUMMARY

Cold Injury Diagnose type

History Clinical finding Measure core temperature

Rewarming techniques Monitor and support vital signs