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  1. 1. Burns and Thermal Injuries
  2. 2. Introduction  Skin is the largest organ in the body and isolates chemically, thermally, biologically and mechanically the inside from the outside.
  3. 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. 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. 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. 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. 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. 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. 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. 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. 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. 12. Rule of Nine
  13. 13. Inhalation Injury
  14. 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. 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. 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. 17. Thank you Ahmad Thanin