Burns

last authored Aug 2009

 

Introduction

 

 

Causes and Risk Factors

Flame injuries are the most common in adults; splash injuries the most common in children.

 

Alkalais are worse than acids.

 

Acids

Electric burns are almost always deeper than appearances suggest.

 

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Pathophysiology

First degree burns:

Second degree burns: extend into the dermis, with blistering

Third degree burns: full-thickness burn; leathery white, brown, black

Fourth degree burns: burn extends into organs or bone

 

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Signs and Symptoms

  • history
  • physical exam

History

Mechanism of injury

  • temperature an

Time

Treatment this far

query abuse in children, seniors, or other at-risk patients

Physical Exam

ABCs

  • signs of airway invlovement include: peri-oral burns, oropharyngeal erythema/edema, singed nasal/facial hair

breathing: symmetrical chest expansion and sounds, oxygen saturation

circulation: pulse and blood pressure

 

 

 

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Investigations

  • lab investigations
  • diagnostic imaging

Lab Investigations

CBC

electroytes

Diagnostic Imaging

 

 

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Differential Diagnosis

 

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Treatments

If airway compromise is present or threatened, intubate.

Oxygen and two large-bore IVs with crystalloid (Ringer's or normal saline)

Parkland Formula

Amount of fluid required in the first 24 hours since burn

4cc x total burned surface area up to 50 x body weight (kg)

  • + 2L D5W because patient is NPO

Give 1/2 this amount in the first 8 hours, the second half over
the next 16 hours

Give half the above on day 2

 

 

 

 

 

 

 

Fluid needs are greater in electrical burns.

If you are under-resuscitating someone, increase their volume by 1/3

 

 

Keep patients warm, as the temperature control capacity of the skin becomes seriously compromised.

Foley catheter to measure urine output (aim for 1-2 ml/kg/hr).

 

Escharotomy is necessary in circumferential burns to prevent compartment syndrome.

 

Tetanus

 

Analgesia

Opioids such as fentanyl

 

Indications for transfer to a burn unit

 

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Dressing

Saline soaks

Flamazine (sp) is one of the most appropriate dressings but is messy; avoid using it until the definitive providers are involved and have evaluated the burn.

Silver sulfadiazine is often used.

 

Surgery

Early excision and grafting should be carried out to save costs, minimize pain, and complications.

Consequences and Course

 

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Clinical Vignette 1

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Clinical Vignette 2

 

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Additional Resources

 

 

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Topic Development

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