Burns
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Burns Dr. Stella Yiu Emergency Physician, TOH
description
Burns. Dr. Stella Yiu Emergency Physician, TOH. LMCC objectives. Determine severity and extent Diagnose Complications Institute initial management of burn trauma. By Sylvain Pedneault (Own work) [CC-BY-SA-3.0 (http:// creativecommons.org /licenses/by- sa /3.0)], via Wikimedia Commons. - PowerPoint PPT Presentation
Transcript of Burns
BurnsDr. Stella YiuEmergency Physician, TOH
LMCC objectivesDetermine severity and extent
Diagnose Complications
Institute initial management of burn trauma
By Sylvain Pedneault (Own work) [CC-BY-SA-3.0 (http://creativecommons.org/licenses/by-sa/3.0)],
via Wikimedia Commons
1. Severity & extent
Skin layer
Image credit: Simon YiuDerived 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
Image credit: Simon YiuDerived 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
1st degree/Superficial
Image credit: Simon YiuDerived 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
2nd degree/Partial thickness
Image credit: Simon YiuDerived 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
Superficial PT/2nd degree
By Cjr80 (Own work) [CC-BY-SA-3.0 (http://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia
Commons
Image credit: Simon YiuDerived 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
Deep PT/2nd degree
Image credit: Simon YiuDerived 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.au The Victorian Adult Burns Service, Alfred
Health, Melbourne, Australia
3rd degree/Full thickness
Image credit: Simon YiuDerived 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.au The Victorian Adult Burns Service, Alfred
Health, Melbourne, Australia
What body surface area?
Must know this!
Scattered areas
Image credit: Simon Yiu
Knowing surface area-> who needs special burn unit care-> how much fluids to give
Photo credit: www.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%
2. Diagnose Complications
Burn: Cellular levelLocal and systemic inflammatory
response
Capillaries permeable, fluids and proteins leak
Edema and hypovolemia
Complications
Fluid loss AirwayEdema
Chemical
Burn patients need ++ fluids
++ FluidsParkland Formula (1st 24 hrs)
4cc x %BSA (2-3deg) x Wt (kg)
++ Fluids
1st half 8 hr from time 0
Time zero
Hospital arrival time
8 hours
++ Fluids
1st half 8 hr from time 0
Time zero
Hospital arrival time
8 hours
1st half to be given
MCQ 2: 80kg, Ant + post torso, left arm. Presents 4 hr post. Rate of fluids/first 4 hour?A.1800cc /hrB.1500 cc/hrC.1000 cc/hr D.900 cc/hrE. 700 cc/hr
Image credit: Patrick J. Lynch, medical illustrator; C. Carl Jaffe, MD, cardiologist. http://creativecommons.org/licenses/by/2.5/, via Wikimedia commons
Photo credit: www.vicburns.org.au The Victorian Adult Burns Service, Alfred Health, Melbourne, Australia
Who is at risk for inhalation injury?Face burn
Soot
Voice
Photo credit: Dr. Mark Silverberg
Face burn
Soot: Mouth, nose, sputum
Voice: Hoarse, change
Intubate early even if no airway compromise
Edema
Tight skin + Edema Compartment syndrome
Escharotomy
Photo credit: Drs. Mike Cadogan and Chris Nickson, lifeinthefastlane.com
Chemicals
Carbon Monoxide200x Affinity to Hb
Carbon Monoxide is chasedAtmos air T1/2 = 4 hours
Atmos 100% Oxygen = 1 hour
Hyperbaric oxygen = < 20 minutes
Cyanide chokes mitochondria
3. Initial management of burn patient
Photo credit: www.vicburns.org.au The Victorian Adult Burns Service, Alfred Health, Melbourne, Australia
CDMQ: Write your orders (6)
Iv Fluids
Cardiac monitor (BP, HR, O2 sat)
Pain control
Tetanus
CBC, lytes, Cr, CO level, Lactate, Trop, CXR
Who needs special care
Area
Agent
Vulnerable population
Area: 10% second or third (deep partial or full)
Area:
Hands
Perineum
Face
2/3 Degree
Circumferential
Chemical burn
Electricity
Children
Burn unit
LMCC objectivesDetermine severity and extent
Diagnose Complications
Institute initial management of burn trauma
