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Burn
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Burn

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  • 1. Burns and Thermal Injuries
  • 2. Introduction  Skin is the largest organ in the body and isolates chemically, thermally, biologically and mechanically the inside from the outside.
  • 3. Initial Assessment of Burns Primary Survey: A. Airways: • Secure the airway first. • Get history as much as reasonably possible before intubation • Soot or singed nasal hairs?
  • 4. B. Breathing: • High flow Oxygen for all. • Listen: verify breath sounds • Assess rate & depth. C. Circulation: • Monitor Blood Pressure, Pulse, and Skin color. • Establish IV access. • Warm IV fluids. • Monitor peripheral pulses in circumferential burns.
  • 5. D. Disability: • Associated Injuries? • CO poisoning? • Substance abuse? • Hypoxia? • Pre-existing medical condition. E. Exposure: • Remove clothes and jewelry. • Ensure warm environment. • Clean dry blankets. • It is OK to use water to stop the burning process and clean but not at the expense of reducing body core temperature.
  • 6. • Secondary Survey: – Repeat primary survey. – Complete History of Present Illness (HPI). • What type of burn (flame, chemical, scald) • Duration of exposure • What time did burn occur? • What treatment already provided? (chemical brushed off, water to cool, etc) • Did burn occur in house fire/enclosed space? (think inhalation injury)
  • 7. Order labs and x rays  CBC, KFT, LFT,  Chest X-ray (CXR)  Blood gas  Insert Foley  EKG (especially in electrical injury) Special considerations; • Abuse patterns – Children, elderly • Concomitant trauma – C-spine precautions – Trauma protocols if trauma is majority of injuries
  • 8. Major Steps in Burn Treatment  IV fluids for burns > 10% TBSA  Wound cleaning, dressing, and serial assessment (Use Hibiclens and sterile water (not saline – it stings more when mixed with Hibiclens).  Supportive measures  Transfer or referral of selected patients to burn centers  Surgery and physical therapy for deep partial thickness and full-thickness burns
  • 9. Commence Fluid Resuscitation Adults  Fluid resuscitation is recommended for the following injuries: – Adults (>15%TBSA burn) – Children (>10%TBSA burn)  The goal of fluid resuscitation is to anticipate prevent hypovolemic shock.  A variety of fluids have been recommended for use, such as plasma, human albumin solution (HAS), dextran and Hartmann’s solution.
  • 10. Commence Fluid Resuscitation Adults  Formula: The amount of fluid given in the first 24h (mls)= 3 – 4 mls/kg/TBSA% Rate: ½ in the first 8h ¼ in the second 8 hrs ¼ in the third 8 hrs
  • 11. Commence Fluid Resuscitation Children  Maintenance fluids should also be added over and above the Modified the formula for children weighing less than 30kgs.  Use 5% Dextrose in Lactated Ringer's (D5LR): hypertonic (pH: 4-6.5) – Each 100ml contains 5g of Dextrose Monohydrate, 600mg of Sodium Chloride, 310mg of Sodium Lactate Anhydrous, 30mg of Potassium Chloride, and 20mg of Calcium Chloride Dihydrate.
  • 12. Rule of Nine
  • 13. Inhalation Injury
  • 14. First Degree Burn  A first degree burn is confined exclusively to the outer surface and is not considered a significant burn.  No skin barrier functions are altered.  The most common form is sunburn which heals by itself in less than a week without a scar.
  • 15. Second Degree Burn  Second degree burns cause damage to the epidermis and portions of the dermis.  Since it does not extend through both layers, it is termed partial thickness.  There are a number of depths of a second degree or partial thickness burn which are used to characterize the burn.
  • 16. Third Degree Burn Full thickness buns  Both layers of skin are completely destroyed leaving no cells to heal.  Any significant burn will require skin grafting.  Small burns will heal with scar.  Entire destruction of the epidermis and dermis, leaving no residual epidermal cells to repopulate.
  • 17. Thank you Ahmad Thanin

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