This document provides guidance on the management of burn patients. It describes evaluating airway and breathing, estimating burn extent, initiating fluid resuscitation, and monitoring urine output initially. Ongoing management in the ICU focuses on respiratory support, fluid resuscitation, cardiovascular stabilization, pain control, thrombosis prevention, wound care, nutrition, and infection prevention. Factors like under or over resuscitation, sepsis, and organ dysfunction increase mortality risk, which tools like R-Baux scoring can help predict. Priorities include gastric decompression, escharotomies if needed, medications like pain control without antibiotics, and wound care.

1. MANGEMENT OF BURN
DR.LAYLA ALI HAKEEM
Consultant of anaesthesia & Intensive care

2. Objectives
• Describe initial evaluation and management
of a burn patient
• Improve resuscitation
• Enhance wound coverage
• Infection control
• Management of inhalation injuries

3. Types of Burns
Fire/Flame
Scald
Contact
Electrical
Chemical
Other

4. Skin Anatomy

6. Common Injuries That associated
with burn
• Fractures: 45-64%
• Complex soft tissue injuries: 36-52%
• Traumatic brain injury:17-26%
• Thoracic &abdominal injuries:4-24%

7. Severe burn?
Is one complicated by:
• Major trauma OR Inhalational injury
• Chemical burn
• High voltage electrical burn
• Adult, Any burn <20% TSBA
• For older adults &young children ,A burn >
20% TSBA may be considered severe

8. CRITERIA FOR INTENSIVE CARE
• Patients require mechanical
ventilation(inhalational injury, massive fluid
resuscitation)
• Require cardiac or other hemodynamic
monitoring to guide fluid therapy
• Risk factor for multisystem organ failure

9. Initial Evaluation & Management
• Assess airway/breathing
• Ensure source of heat removed
• Estimate extent of burn
• Obtain/ensure adequate IV access
• Initiate/continue resuscitation
• Closely monitor urine output
• Keep patient warm

10. Patient’s palmar surface = 1% TBSA
Rule of Nines
Estimate % TBSA Burned

11. Lund and Browder Chart
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Estimate % TBSA Burned

12. Pediatric patients <20 kg
• Parkland Formula - LR
• 2 ml x 13 kg x 45% tbsa burned
• 1170 ml
• Start LR at 75 ml/hr
• Also run maintenance fluid
• D5 LR at maintenance rate
• Calculated Using the "4-2-1" Rule:
• For 0-10kg: 4 mL/kg/hr
• For 10-20kg: + 2 mL/kg/hr
• For >20kg: + 1 mL/kg/hr
• 46 ml/hr
• Continuous infusion- don’t titrate
Calculated Resuscitation in First 24
Hours

13. Monitor Urine Output
• Place Foley if > 20% TBSA
• Adequate output is:
– 1mL/kg/hr in children
– 0.5 mL/kg/hr in adults (30 – 50 mL/hr)
• Titrate LR to maintain urine output
• Do not use diuretics to increase urine output
• Urine output goal 100mL/hr if concern for
myoglobinuria

14. MANGEMENT TO BE CONTINUE IN
ICU:
• Respiratory support
• Fluid resuscitation
• Cardiovascular stabilization
• Pain control
• Thromboprophylaxis
• Local management of burn wounds
• Nutrition support
• Control of hyper metabolism
• Prevention of infection

15. Point To Be consider
• Early intubation :deep facial burn, full thickness neck
burns ,oropharyngeal edema, hypoxemia, stridor,
hypercapnia and Glasgow Coma Scale less than 8.
TRACHEOSTOMY caution is needed( sever facial and
neck burns,upper airway edema).
• Fluid Resuscitation: Under resuscitation results in
reduced cardiac output,Inadequate tissue/organ
perfusion, oliquria and increasing lactate trends.
Over resuscit ation: worsening of upper airway edema,
pulmonary edema,prolongation of mechanical
ventilation, cerebral edema and compartment syndroms.

16. Warring organ dysfunction is high
This is due to:
• Under resuscitation(acute kidney injury)
• Exacerbation of underlying medical co
morbidities
• sepsis

17. SEPSIS
• Is independent risk factor for mortality especially when multiorgan
system failure is present. So signs of SIRS and Labroratory
markers(WBC,Procalcitonin ,C-reactive protien, human leukocyte
antigen D related DR expression and others have been proposed as
early indicators of sepsis.
• Infection inform of: VAP ,Blood stream ,Urinary tract infections and
wound infection.
• Emergence Of Multidrug Resistance Bacteria
• Most burn experts infective bacteria :S aureus and epidermis ,and
by 5 days are predominantly colonized with gut flora such as
Peeudomonas aeruginosa, Enerobacter cloacae and Escherichia
coli.
• Cleansing and debridement required and proper AB cover according
to culture and s.ensitivity

18. COPMLICATIONS RELATED TO BURN
IN ICU
• Organ dysfunction(AKI).
• Compartment syndromes(abdominal
compartment syndrome extremity
compartment syndrome)
• Respiratory complications(pulmonary edema.
ARRDS)
• Generalized edema

19. Prediction of mortality
• Baux Score {which is calculated as age +TBSA}
NO more used for mortality prediction….
• R-Baux Score (TBSA+ age+{17*R}) {R=1 if
patient has inhalational injury and R=0 if not}

20. R-Baux Score

21. • Insert NG tube
• Escharotomies
• Medications
• Wound care
Next Priorities

22. Escharotomies
• Only for leathery, circumferential,
full-thickness burns
• Rarely needed if transport < 12
hours
• Almost always done at the Burn
Center
• Emergent indications:
– Unable to ventilate
– Pulseless, painful extremity

23. • Pain control
• Pain control
• More pain control
• Tetanus immunization
• NO need for systemic antibiotics
Medications

24. Pain Medications
• IV Narcotics
– Dilaudid
– Fentanyl
– Morphine
• Oral Narcotics
– Oxycodone