burns

Emergency Management of BurnsEmergency Management of Burns

Adult Burn Admissions

• Explosion & Flame• Scald - oil & water• Contact• Electrical• Chemical• Friction• Sun

48%

33%

8%

5%

3%

2%

1%

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Pathophysiology

• Tissue damage occurs in two stages:– Initial thermal injury– Secondary injury from ongoing dermal

ischaemia or trauma

• Early management is aimed at minimizing secondary damage

Jackson Burn Wound Model

Zone of Survival

Zone of Damage

Zone of Necrosis

Hyperaemia

Stasis

Coagulation

E.M.S.B

• Airway• Breathing• Circulation• Disability• Exposure• Fluids

AIRWAY and BREATHING

Early Symptoms: • sore throat • singing of nasal hairs/eyebrows/eyelashes • hoarseness • soot-tinged sputum Late Symptoms:• shortness of breath • stridor • indrawing

IF IN DOUBT INTUBATE

CIRCULATION

• BURN SCHOCK• Management focuses on fluid resuscitation,

pulmonary, cardiovascular and renal support. Ends with mobilization of fluid and establishment of cardiopulmonary and renal stability (lasts up to 48 hours or several days)

• FLUID RESUSCITATION – Parklands Formula

DISABILITY

• Beware the Confused Patient

• Intoxicated Or Hypoxic?• Electrolyte Imbalances• Shock

EXPOSURE

• REMOVAL OF ALL JEWELLERY AND CLOTHING WHILE KEEPING THE PATIENT WARM

• ASSESSMENT OF BURN SEVERITY AND EXTENT

• MANAGEMENT

SUPERFICIAL BURN

SPT VS DPT • SPT• Involves only the most superficial

dermis • Blistering or sloughing of

overlying skin, causing a red, painful wound Typically, the burn blanches but shows good capillary refill.

• Hairs cannot be pulled out easily. • Healing within 14 days, typically

without scarring or need for graft

• DPT• Involves more of the epidermis

with fewer epidermal appendages spared

• It may present as blisters, or a wound with white or deep red base

• Sensation is usually decreased• Healing takes more than 14 days.• Incidence of hypertrophic

scarring increased. Debriding and grafting is recommended by 2-3 weeks.

FULL THICKNESS BURN

Calculation of fluid commences from the time of burn

NOT from the time of presentation

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Limbs: Signs of Circulatory Obstruction

• Loss of distal circulation• pallor• coolness• absent pulse• loss capillary refill• decreased oxygen saturation

• Pain on passive extension• Deep pain at rest

Escharotomy

After Consultation with Burns Unit:

• Chest: To allow respiratory movement

• Limb: To restore circulation in limb with excess swelling under rigid eschar

INITIAL CARE

• JELONET/BACTIGRAS• SILVAZINE CREAM• GLAD WRAP• PAIN RELIEF - IV• IDC INSERTION TO MONITOR URINE OUTPUT

Further Management

• NG TUBE AND FEEDS• NO ANTIBIOTICS• TETANUS PROPHYLAXIS• AVOIDENCE OF HYPOTHERMIA

TRANSFER CRITERIA1. Partial thickness burns >= 15% TBSA in patients aged 10 - 50 years old. 2. Partial thickness burns >=10% TBSA in children aged 10 or adults aged 50

years old. 3. Full-thickness burns >= 5% TBSA in patients of any age. 4. Patients with partial or full-thickness burns of the hands, feet, face, eyes,

ears, perineum, and/or major joints. 5. Patients with high-voltage electrical injuries, including lightning injuries. 6. Patients with significant burns from caustic chemicals. 7. Patients with burns complicated by multiple trauma in which the burn

injury poses the greatest risk of morbidity or mortality8. Patients with burns who suffer inhalation injury.

BURNS EVOLVE !!!!• WHAT MAY APPEAR TO BE A SUPERFICIAL BURN ON FIRST PRESENTATION CAN VERY

EASILY PROGRESS TO A DEEPER BURN REQUIRING GRAFTING IN A FEW DAYS

• AS A RESULT THE BURN INJURY SHOULD BE REVIEWED AT A PERIOD NO LATER THAN 2 DAYS FROM THE INITIAL PRESENTATION.

• THE INJURIOUS AGENT ( HOT WATER,OIL FLAME ETC) DURATION OF CONTACT, RESUSCITATION STATUS,CLIMATE AND DRESSINGS USED WILL ALL CONTRIBUTE IN VARYING DEGREES TO THE DEPTH AND PROGRESSION OF THE BURN WOUND

• IT IS THEREFORE, IMPORTANT THAT APPROPRIATE DRESSINGS ARE USED FROM THE INITIAL INJURY TO MINIMISE THE INJURY OVER TIME AND AN APPROPRIATE MULTIDISCIPLINIARY TEAM IS INVOLVED IN THE CARE OF ALL BURN WOUNDS