burn cold injury

ACLS ( CH 9 ) - BURN 1

BURN , COLD INJURY


INJURY DUE TO BURN AND

COLD


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.


BURN / COLD INJURIES

Management Principles Timely application Maintain:

Airway Hemodynamic stability Fluid / electrolyte balance Normal body temperature

Prevent complications


Injury Due To Burn


LIFE-SAVING MEASURES

Establish airway Identify signs of distress Initiate supportive measures Obtain history


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

Inhalation Injury


LIFE-SAVING MEASURES

Remove all: Injurious material Clothing, jewelry

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


ASSESSMENT

History Mechanism of ijury Associated illness Allergies Tetanus status


Rule of Nines


ASSESSMENT

Estimate Burn Size Surface of patient’s palm

represents 1% body surface area


Second-degree Burn


Third-degree Burn


MANAGEMENT

Airway Assess for injury Establish and maintain patient

airway early


Inhalation Injury Early

Management


MANAGEMENT

Breathing Assume CO exposure Inhalation of toxic fumes or carbon

particles Direct thermal injury


MANAGEMENT

Breathing Oxygen / ventilate Endotracheal intubation ABGs Carboxyhemoglobin levels


MANAGEMENT

Circulation Monitor vital signs Hourly urinary outputs

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


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


MANAGEMENT

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


MANAGEMENT

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


Escharotomy Sites


Escharotomy


MANAGEMENT

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

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


MANAGEMENT

Wound Care Cover with clean linen Do not

Break blisters Apply antiseptics Apply cold water


MANAGEMENT

Acid / Alkali Burns Duration, concentration, and

amount Flush with copious amount of water

for 20 – 30 minutes Brush away dry chemical before

irrigation


Chemical Burns


Fasciotomy – Electrical Burn

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


MANAGEMENT

Electrical Burn ABCs Myoglobinuria

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

Metabolic acidosis Maintain adequate perfusion Sodium Bicarbonate


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


TRANSFER CRITERIA

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

injuries Children Special situations


TRANSFER PROCEDURE

Coordinate with burn-center physician

Transfer with all Documentation / information Laboratory results


Injury Due To Cold


COLD INJURY FACTORS

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


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


Second-degree Frostbite


Fourth-degree Frostbite


MANAGEMENT

Do nor delay Remove clothing Warmed blankets Rewarm frozen part


MANAGEMENT

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


HYPOTHERMIA

Core temperature < 35 degrees Rapid / slow drop in core

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


HYPOTHERMIA

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


MANAGEMENT

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


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


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SUMMARY

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


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


SUMMARY

Cold Injury Diagnose type

History Clinical finding Measure core temperature

Rewarming techniques Monitor and support vital signs

burn cold injury

Education

management airway

summary burn injury

management abcs

seconddegree burn

thirddegree burn

management breathing

management acid alkali

burncenter physician