BURN , COLD INJURY
INJURY DUE TO BURN AND COLD
OBJECTIVES <ul><li>Estimate burn size, and determine presence of associated injuries. </li></ul><ul><li>Outline innitial s...
BURN / COLD INJURIES <ul><li>Management Principles </li></ul><ul><ul><li>Timely application </li></ul></ul><ul><ul><li>Mai...
<ul><li>Injury Due To Burn   </li></ul>
LIFE-SAVING MEASURES <ul><li>Establish airway </li></ul><ul><li>Identify signs of distress </li></ul><ul><li>Initiate supp...
<ul><li>CLINICAL INDICATIONS </li></ul><ul><ul><li>Carbonaceous sputum </li></ul></ul><ul><ul><li>Facial burns </li></ul><...
LIFE-SAVING MEASURES <ul><li>Remove all: </li></ul><ul><ul><li>Injurious material </li></ul></ul><ul><ul><li>Clothing, jew...
ASSESSMENT <ul><li>History </li></ul><ul><ul><li>Mechanism of ijury </li></ul></ul><ul><ul><li>Associated illness </li></u...
<ul><li>Rule of Nines </li></ul>
ASSESSMENT <ul><li>Estimate Burn Size </li></ul><ul><ul><li>Surface of patient’s palm represents 1% body surface area </li...
<ul><li>Second-degree Burn </li></ul>
<ul><li>Third-degree Burn </li></ul>
MANAGEMENT <ul><li>Airway </li></ul><ul><ul><li>Assess for injury </li></ul></ul><ul><ul><li>Establish and maintain patien...
<ul><li>Inhalation Injury  </li></ul><ul><li>Early Management </li></ul>
MANAGEMENT <ul><li>Breathing </li></ul><ul><ul><li>Assume CO exposure </li></ul></ul><ul><ul><li>Inhalation of toxic fumes...
MANAGEMENT <ul><li>Breathing </li></ul><ul><ul><li>Oxygen / ventilate </li></ul></ul><ul><ul><li>Endotracheal intubation <...
MANAGEMENT <ul><li>Circulation </li></ul><ul><ul><li>Monitor vital signs </li></ul></ul><ul><ul><li>Hourly urinary outputs...
MANAGEMENT <ul><li>Circulation – Estimate of Fluid Needs </li></ul><ul><ul><li>2 – 4 mL Ringer’s lactate / kg / % BSA in f...
MANAGEMENT <ul><li>Develop Treatment plan </li></ul><ul><ul><li>Estimate burn size / depth </li></ul></ul><ul><ul><li>Iden...
MANAGEMENT <ul><li>Maintain Peripheral Circulation </li></ul><ul><ul><li>Remove all connstricting devices </li></ul></ul><...
Escharotomy Sites
Escharotomy
MANAGEMENT <ul><li>Nasogastric Intubation </li></ul><ul><ul><li>Nausea, vomiting, distention </li></ul></ul><ul><ul><li>Bu...
MANAGEMENT <ul><li>Wound Care </li></ul><ul><ul><li>Cover with clean linen </li></ul></ul><ul><ul><li>Do not </li></ul></u...
MANAGEMENT <ul><li>Acid / Alkali Burns </li></ul><ul><ul><li>Duration, concentration, and amount </li></ul></ul><ul><ul><l...
Chemical Burns
Fasciotomy – Electrical Burn <ul><li>Electrical burn result in damage to the fascia and muscle, and may spare the overlyin...
MANAGEMENT <ul><li>Electrical Burn </li></ul><ul><ul><li>ABCs </li></ul></ul><ul><ul><li>Myoglobinuria </li></ul></ul><ul>...
TRANSFER CRITERIA <ul><li>2nd, 3rd degree burns > 10% BSA in age < 10 and > 50 years </li></ul><ul><li>2nd, 3rd degree bur...
TRANSFER CRITERIA <ul><li>3rd degree burns > 5% BSA </li></ul><ul><li>Electrical and chemical burns </li></ul><ul><li>Inha...
TRANSFER PROCEDURE <ul><li>Coordinate with burn-center physician </li></ul><ul><li>Transfer with all </li></ul><ul><ul><li...
Injury Due To Cold
COLD INJURY FACTORS <ul><li>Temperature </li></ul><ul><li>Duration of exposure </li></ul><ul><li>Enviromental conditions <...
TISSUE-FREEZING INJURY FROSTBITE <ul><li>1st Degree:   Hyperemia, edema </li></ul><ul><li>2nd Degree:   Vesicles, parttial...
Second-degree Frostbite
Fourth-degree Frostbite
MANAGEMENT <ul><li>Do nor delay </li></ul><ul><li>Remove clothing </li></ul><ul><li>Warmed blankets </li></ul><ul><li>Rewa...
MANAGEMENT <ul><li>Preserve damaged tissue </li></ul><ul><li>Prevent infection </li></ul><ul><li>Elevate and expose injure...
HYPOTHERMIA <ul><li>Core temperature < 35 degrees </li></ul><ul><li>Rapid / slow drop in core temperature </li></ul><ul><l...
HYPOTHERMIA <ul><li>Clinical Findings </li></ul><ul><ul><li>Core temperature < 35 degrees </li></ul></ul><ul><ul><li>Depre...
MANAGEMENT <ul><li>ABCs, IV access </li></ul><ul><li>Oxygenate and ventilate </li></ul><ul><li>Prevent heat loss and rewar...
MANAGEMEN <ul><li>Passive External Rewarming </li></ul><ul><ul><li>Warm enviroment </li></ul></ul><ul><ul><li>Warmed blank...
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SUMMARY <ul><li>Burn Injury </li></ul><ul><ul><li>Recognize inhalation injury </li></ul></ul><ul><ul><li>Establish airway ...
SUMMARY <ul><li>Burn Injury </li></ul><ul><ul><li>Identify extend, depth of burn </li></ul></ul><ul><ul><li>Establish flui...
SUMMARY <ul><li>Cold Injury </li></ul><ul><ul><li>Diagnose type </li></ul></ul><ul><ul><ul><li>History </li></ul></ul></ul...
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Burn Cold Injury

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INJURY DUE TO BURN AND COLD

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Burn Cold Injury

  1. 1. BURN , COLD INJURY
  2. 2. INJURY DUE TO BURN AND COLD
  3. 3. OBJECTIVES <ul><li>Estimate burn size, and determine presence of associated injuries. </li></ul><ul><li>Outline innitial stabilization, treatment measures, and transfer criteria. </li></ul><ul><li>Identify special problems and methods of treatment. </li></ul>
  4. 4. BURN / COLD INJURIES <ul><li>Management Principles </li></ul><ul><ul><li>Timely application </li></ul></ul><ul><ul><li>Maintain: </li></ul></ul><ul><ul><ul><li>Airway </li></ul></ul></ul><ul><ul><ul><li>Hemodynamic stability </li></ul></ul></ul><ul><ul><ul><li>Fluid / electrolyte balance </li></ul></ul></ul><ul><ul><ul><li>Normal body temperature </li></ul></ul></ul><ul><ul><li>Prevent complications </li></ul></ul>
  5. 5. <ul><li>Injury Due To Burn </li></ul>
  6. 6. LIFE-SAVING MEASURES <ul><li>Establish airway </li></ul><ul><li>Identify signs of distress </li></ul><ul><li>Initiate supportive measures </li></ul><ul><li>Obtain history </li></ul>
  7. 7. <ul><li>CLINICAL INDICATIONS </li></ul><ul><ul><li>Carbonaceous sputum </li></ul></ul><ul><ul><li>Facial burns </li></ul></ul><ul><ul><li>Hair singeing </li></ul></ul><ul><ul><li>Carbon deposites </li></ul></ul><ul><ul><li>Inflamed oropharynx </li></ul></ul><ul><ul><li>History </li></ul></ul><ul><ul><ul><li>Inhalation Injury </li></ul></ul></ul>
  8. 8. LIFE-SAVING MEASURES <ul><li>Remove all: </li></ul><ul><ul><li>Injurious material </li></ul></ul><ul><ul><li>Clothing, jewelry </li></ul></ul><ul><li>Prevent hypothermia </li></ul><ul><li>Two, large-caliber Ivs </li></ul><ul><li>Ringer’s lactate </li></ul>
  9. 9. ASSESSMENT <ul><li>History </li></ul><ul><ul><li>Mechanism of ijury </li></ul></ul><ul><ul><li>Associated illness </li></ul></ul><ul><ul><li>Allergies </li></ul></ul><ul><ul><li>Tetanus status </li></ul></ul>
  10. 10. <ul><li>Rule of Nines </li></ul>
  11. 11. ASSESSMENT <ul><li>Estimate Burn Size </li></ul><ul><ul><li>Surface of patient’s palm represents 1% body surface area </li></ul></ul>
  12. 12. <ul><li>Second-degree Burn </li></ul>
  13. 13. <ul><li>Third-degree Burn </li></ul>
  14. 14. MANAGEMENT <ul><li>Airway </li></ul><ul><ul><li>Assess for injury </li></ul></ul><ul><ul><li>Establish and maintain patient airway early </li></ul></ul>
  15. 15. <ul><li>Inhalation Injury </li></ul><ul><li>Early Management </li></ul>
  16. 16. MANAGEMENT <ul><li>Breathing </li></ul><ul><ul><li>Assume CO exposure </li></ul></ul><ul><ul><li>Inhalation of toxic fumes or carbon particles </li></ul></ul><ul><ul><li>Direct thermal injury </li></ul></ul>
  17. 17. MANAGEMENT <ul><li>Breathing </li></ul><ul><ul><li>Oxygen / ventilate </li></ul></ul><ul><ul><li>Endotracheal intubation </li></ul></ul><ul><ul><li>ABGs </li></ul></ul><ul><ul><li>Carboxyhemoglobin levels </li></ul></ul>
  18. 18. MANAGEMENT <ul><li>Circulation </li></ul><ul><ul><li>Monitor vital signs </li></ul></ul><ul><ul><li>Hourly urinary outputs </li></ul></ul><ul><ul><ul><li>Adult: 30 – 50 mL / hr </li></ul></ul></ul><ul><ul><ul><li>Child: 1.0 mL / kg / hr </li></ul></ul></ul>
  19. 19. MANAGEMENT <ul><li>Circulation – Estimate of Fluid Needs </li></ul><ul><ul><li>2 – 4 mL Ringer’s lactate / kg / % BSA in first 24 hours </li></ul></ul><ul><ul><li>One-half in first 8 hours </li></ul></ul><ul><ul><li>One-half in next 16 hours </li></ul></ul><ul><ul><li>Based on time from injury </li></ul></ul><ul><ul><li>Monitor patient response </li></ul></ul>
  20. 20. MANAGEMENT <ul><li>Develop Treatment plan </li></ul><ul><ul><li>Estimate burn size / depth </li></ul></ul><ul><ul><li>Identify associated injuries </li></ul></ul><ul><ul><li>Weigh patient </li></ul></ul><ul><ul><li>Baseline blood analyses </li></ul></ul><ul><ul><li>Chest films </li></ul></ul><ul><ul><li>Document on flow sheet </li></ul></ul>
  21. 21. MANAGEMENT <ul><li>Maintain Peripheral Circulation </li></ul><ul><ul><li>Remove all connstricting devices </li></ul></ul><ul><ul><li>Assess distal circulation </li></ul></ul><ul><ul><li>Escharotomy – surgical consultation </li></ul></ul>
  22. 22. Escharotomy Sites
  23. 23. Escharotomy
  24. 24. MANAGEMENT <ul><li>Nasogastric Intubation </li></ul><ul><ul><li>Nausea, vomiting, distention </li></ul></ul><ul><ul><li>Burn > 20% BSA </li></ul></ul><ul><li>Medications </li></ul><ul><ul><li>Narcotics – Spare use, IV only </li></ul></ul><ul><ul><li>Antibiotics – Not indicated early </li></ul></ul>
  25. 25. MANAGEMENT <ul><li>Wound Care </li></ul><ul><ul><li>Cover with clean linen </li></ul></ul><ul><ul><li>Do not </li></ul></ul><ul><ul><ul><li>Break blisters </li></ul></ul></ul><ul><ul><ul><li>Apply antiseptics </li></ul></ul></ul><ul><ul><ul><li>Apply cold water </li></ul></ul></ul>
  26. 26. MANAGEMENT <ul><li>Acid / Alkali Burns </li></ul><ul><ul><li>Duration, concentration, and amount </li></ul></ul><ul><ul><li>Flush with copious amount of water for 20 – 30 minutes </li></ul></ul><ul><ul><li>Brush away dry chemical before irrigation </li></ul></ul>
  27. 27. Chemical Burns
  28. 28. Fasciotomy – Electrical Burn <ul><li>Electrical burn result in damage to the fascia and muscle, and may spare the overlying skin </li></ul>
  29. 29. MANAGEMENT <ul><li>Electrical Burn </li></ul><ul><ul><li>ABCs </li></ul></ul><ul><ul><li>Myoglobinuria </li></ul></ul><ul><ul><ul><li>↑ Fluid: 100 mL urine / hr </li></ul></ul></ul><ul><ul><ul><li>Mannitol: 25 g IV </li></ul></ul></ul><ul><ul><li>Metabolic acidosis </li></ul></ul><ul><ul><ul><li>Maintain adequate perfusion </li></ul></ul></ul><ul><ul><ul><li>Sodium Bicarbonate </li></ul></ul></ul>
  30. 30. TRANSFER CRITERIA <ul><li>2nd, 3rd degree burns > 10% BSA in age < 10 and > 50 years </li></ul><ul><li>2nd, 3rd degree burns > 20% BSA </li></ul><ul><li>2nd, 3rd degree burns to face, eyes, ears, hands, feet, genitalia, perineum, and major loints </li></ul>
  31. 31. TRANSFER CRITERIA <ul><li>3rd degree burns > 5% BSA </li></ul><ul><li>Electrical and chemical burns </li></ul><ul><li>Inhalation injury </li></ul><ul><li>Pre-existing illness, associated injuries </li></ul><ul><li>Children </li></ul><ul><li>Special situations </li></ul>
  32. 32. TRANSFER PROCEDURE <ul><li>Coordinate with burn-center physician </li></ul><ul><li>Transfer with all </li></ul><ul><ul><li>Documentation / information </li></ul></ul><ul><ul><li>Laboratory results </li></ul></ul>
  33. 33. Injury Due To Cold
  34. 34. COLD INJURY FACTORS <ul><li>Temperature </li></ul><ul><li>Duration of exposure </li></ul><ul><li>Enviromental conditions </li></ul><ul><li>Immobilizzation </li></ul><ul><li>Moisture </li></ul><ul><li>Vascular disease </li></ul><ul><li>Open wounds </li></ul>
  35. 35. TISSUE-FREEZING INJURY FROSTBITE <ul><li>1st Degree: Hyperemia, edema </li></ul><ul><li>2nd Degree: Vesicles, parttial-thickness </li></ul><ul><li>skin necrosis </li></ul><ul><li>3rd Degree: Full-thickness skin necrosis </li></ul><ul><li>4th Degree: Skin, muscle, bone necrosis </li></ul>
  36. 36. Second-degree Frostbite
  37. 37. Fourth-degree Frostbite
  38. 38. MANAGEMENT <ul><li>Do nor delay </li></ul><ul><li>Remove clothing </li></ul><ul><li>Warmed blankets </li></ul><ul><li>Rewarm frozen part </li></ul>
  39. 39. MANAGEMENT <ul><li>Preserve damaged tissue </li></ul><ul><li>Prevent infection </li></ul><ul><li>Elevate and expose injured part </li></ul><ul><li>Analgesics / tetanus / antibiotics </li></ul>
  40. 40. HYPOTHERMIA <ul><li>Core temperature < 35 degrees </li></ul><ul><li>Rapid / slow drop in core temperature </li></ul><ul><li>Elderly and children at greater risk </li></ul><ul><li>Low-range thermometer required </li></ul>
  41. 41. HYPOTHERMIA <ul><li>Clinical Findings </li></ul><ul><ul><li>Core temperature < 35 degrees </li></ul></ul><ul><ul><li>Depressed level of consciousness </li></ul></ul><ul><ul><li>Gray, cyanotic, variable vital signs </li></ul></ul><ul><ul><li>Absence of cardiorespiratory activity </li></ul></ul>
  42. 42. MANAGEMENT <ul><li>ABCs, IV access </li></ul><ul><li>Oxygenate and ventilate </li></ul><ul><li>Prevent heat loss and rewarm </li></ul><ul><li>Assess for associated disorders </li></ul><ul><li>Blood analyses </li></ul>
  43. 43. MANAGEMEN <ul><li>Passive External Rewarming </li></ul><ul><ul><li>Warm enviroment </li></ul></ul><ul><ul><li>Warmed blankets and IV fluids </li></ul></ul><ul><li>Active Core Rewarming </li></ul><ul><ul><li>Surgical rewarming techniques </li></ul></ul><ul><ul><li>Do not delay transfer </li></ul></ul><ul><li>Not dead until warm and dead </li></ul>
  44. 44.
  45. 45. SUMMARY <ul><li>Burn Injury </li></ul><ul><ul><li>Recognize inhalation injury </li></ul></ul><ul><ul><li>Establish airway </li></ul></ul><ul><ul><li>Fluid resuscitation </li></ul></ul><ul><ul><li>Rremove all clothing </li></ul></ul>
  46. 46. SUMMARY <ul><li>Burn Injury </li></ul><ul><ul><li>Identify extend, depth of burn </li></ul></ul><ul><ul><li>Establish fluid guidelines </li></ul></ul><ul><ul><li>Initiate burn flow sheet </li></ul></ul><ul><ul><li>Obtain baseline lab / radiology </li></ul></ul><ul><ul><li>Maintain peripheral circulation </li></ul></ul><ul><ul><li>Identify burns requiring transfer </li></ul></ul>
  47. 47. SUMMARY <ul><li>Cold Injury </li></ul><ul><ul><li>Diagnose type </li></ul></ul><ul><ul><ul><li>History </li></ul></ul></ul><ul><ul><ul><li>Clinical finding </li></ul></ul></ul><ul><ul><ul><li>Measure core temperature </li></ul></ul></ul><ul><ul><li>Rewarming techniques </li></ul></ul><ul><ul><li>Monitor and support vital signs </li></ul></ul>

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