Burn
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Burn Wounds Gomez, Cancio. EM Clinics of NA 2007. 25:135-46. 1 st degree burn: EPIDERMIS depth only; painful 2 nd degree (partial thickness) * Superficial - EPIDERMIS + SHALLOW DERMIS; moist, blistering; skin blanches; very painful; heals within 3 weeks * Deep – EPIDERMIS + DEEP DERMIS; heals in >3 weeks; looks between superficial partial thickness and 3 rd degree burn; may need skin graft 3 rd degree: EPIDERMIS + ENTIRE DERMIS; dark brown, charred, skin does not blanch, site insensate because burned nerve fibers; needs skin graft Total body surface area (TBSA)- • Rule of 9’s • Patient’s palm and fingers = 1% TBSA • In calculating TBSA % burn, do not include 1 st degree burns Burn unit referral • Partial thickness >10% TBSA • Burns of face, hands, feet, genitalia, perineum, major joints • 3 rd degree burn • Electrical or chemical burn • Inhalational injury • Patient with co-morbidities • Special considerations: social, emotional, or long-term rehab intervention Fluid resuscitation= 4 cc/kg/% TBSA of LR over 24 hrs with half given in first 8 hrs • Titrate to UOP of 30-50 cc/hr (adults),1 cc/kg/hr (children < 30 kg), 0.5-1 cc/kg/hr (age >2 yr), 1-2 cc/kg/hr (age <2 yr) • Start if >20% TBSA involvement Minor burns – tetanus immunization update, pain meds, debride dead skin, +/- unroof blisters >2 cm diameter, apply topical antimicrobial and dressing, 24 hr followup. Large burns – apply silver sulfadiazine or mafenide acetate as topical antimicrobial agent (gram negative coverage) What is high-voltage electrical injury? >1000 volts
description
Burn emergency procedures and algorithm on how to assess and apply interventions. Time limited and quick scenario.
Transcript of Burn
Burn Wounds Gomez, Cancio. EM Clinics of NA 2007. 25:135-46.
1st degree burn: EPIDERMIS depth only; painful 2nd degree (partial thickness) * Superficial - EPIDERMIS +
SHALLOW DERMIS; moist, blistering; skin blanches; very painful; heals within 3 weeks
* Deep – EPIDERMIS + DEEP DERMIS; heals in >3 weeks; looks between superficial partial thickness and 3rd degree burn; may need skin graft
3rd degree: EPIDERMIS + ENTIRE DERMIS; dark brown, charred, skin does not
blanch, site insensate because burned nerve fibers; needs skin graft Total body surface area (TBSA)- • Rule of 9’s • Patient’s palm and fingers = 1%
TBSA • In calculating TBSA % burn, do
not include 1st degree burns
Burn unit referral • Partial thickness >10% TBSA • Burns of face, hands, feet,
genitalia, perineum, major joints • 3rd degree burn • Electrical or chemical burn • Inhalational injury • Patient with co-morbidities • Special considerations: social,
emotional, or long-term rehab intervention
Fluid resuscitation= 4 cc/kg/% TBSA of LR over 24 hrs with half given in first 8 hrs • Titrate to UOP of 30-50 cc/hr (adults),1 cc/kg/hr (children < 30 kg), 0.5-1 cc/kg/hr
(age >2 yr), 1-2 cc/kg/hr (age <2 yr) • Start if >20% TBSA involvement
Minor burns – tetanus immunization update, pain meds, debride dead skin, +/- unroof
blisters >2 cm diameter, apply topical antimicrobial and dressing, 24 hr followup. Large burns – apply silver sulfadiazine or mafenide acetate as topical antimicrobial
agent (gram negative coverage) What is high-voltage electrical injury? >1000 volts
