Emergency Management of Burns
Adult Burn Admissions• Explosion & Flame     48%• Scald - oil & water   33%• Contact               8%• Electrical         ...
Pathophysiology• Tissue damage occurs in two stages:  – Initial thermal injury  – Secondary injury from ongoing dermal    ...
Jackson Burn Wound ModelZone of SurvivalZone of DamageZone of Necrosis                   Coagulation                      ...
E.M.S.B•   Airway•   Breathing•   Circulation•   Disability•   Exposure•   Fluids
AIRWAY and BREATHING    Early Symptoms:•    sore throat•    singing of nasal hairs/eyebrows/eyelashes•    hoarseness•    s...
IF IN DOUBT INTUBATE
CIRCULATION• BURN SCHOCK• Management focuses on fluid resuscitation,  pulmonary, cardiovascular and renal support. Ends  w...
DISABILITY• Beware the Confused Patient• Intoxicated Or Hypoxic?• Electrolyte Imbalances• Shock
EXPOSURE• REMOVAL OF ALL JEWELLERY AND CLOTHING WHILE KEEPING  THE PATIENT WARM• ASSESSMENT OF BURN SEVERITY AND EXTENT• M...
SUPERFICIAL BURN
SPT VS DPT•   SPT                                   •   DPT•    Involves only the most superficial   •      Involves more ...
FULL THICKNESS BURN
Calculation of fluid commences     from the time of burn              NOT from the time of presentation             ©EMSB
Limbs: Signs of Circulatory Obstruction       • Loss of distal circulation             • pallor             • coolness    ...
EscharotomyAfter Consultation with Burns Unit:• Chest: To allow respiratory movement• Limb: To restore circulation in limb...
INITIAL CARE•   JELONET/BACTIGRAS•   SILVAZINE CREAM•   GLAD WRAP•   PAIN RELIEF - IV•   IDC INSERTION TO MONITOR URINE OU...
Further Management•   NG TUBE AND FEEDS•   NO ANTIBIOTICS•   TETANUS PROPHYLAXIS•   AVOIDENCE OF HYPOTHERMIA
TRANSFER CRITERIA1. Partial thickness burns >= 15% TBSA in patients aged 10 - 50 years old.2. Partial thickness burns >=10...
BURNS EVOLVE !!!!•     WHAT MAY APPEAR TO BE A SUPERFICIAL BURN ON FIRST PRESENTATION CAN VERY    EASILY PROGRESS TO A DEE...
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Burns

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Burns

  1. 1. Emergency Management of Burns
  2. 2. Adult Burn Admissions• Explosion & Flame 48%• Scald - oil & water 33%• Contact 8%• Electrical 5%• Chemical 3%• Friction 2%• Sun 1% ©EMSB
  3. 3. Pathophysiology• Tissue damage occurs in two stages: – Initial thermal injury – Secondary injury from ongoing dermal ischaemia or trauma• Early management is aimed at minimizing secondary damage
  4. 4. Jackson Burn Wound ModelZone of SurvivalZone of DamageZone of Necrosis Coagulation Stasis Hyperaemia
  5. 5. E.M.S.B• Airway• Breathing• Circulation• Disability• Exposure• Fluids
  6. 6. AIRWAY and BREATHING Early Symptoms:• sore throat• singing of nasal hairs/eyebrows/eyelashes• hoarseness• soot-tinged sputum Late Symptoms:• shortness of breath• stridor• indrawing
  7. 7. IF IN DOUBT INTUBATE
  8. 8. CIRCULATION• BURN SCHOCK• Management focuses on fluid resuscitation, pulmonary, cardiovascular and renal support. Ends with mobilization of fluid and establishment of cardiopulmonary and renal stability (lasts up to 48 hours or several days)• FLUID RESUSCITATION – Parklands Formula
  9. 9. DISABILITY• Beware the Confused Patient• Intoxicated Or Hypoxic?• Electrolyte Imbalances• Shock
  10. 10. EXPOSURE• REMOVAL OF ALL JEWELLERY AND CLOTHING WHILE KEEPING THE PATIENT WARM• ASSESSMENT OF BURN SEVERITY AND EXTENT• MANAGEMENT
  11. 11. SUPERFICIAL BURN
  12. 12. SPT VS DPT• SPT • DPT• Involves only the most superficial • Involves more of the epidermis dermis with fewer epidermal• Blistering or sloughing of appendages spared overlying skin, causing a red, • It may present as blisters, or a painful wound Typically, the burn wound with white or deep red blanches but shows good base capillary refill. • Sensation is usually decreased• Hairs cannot be pulled out easily. • Healing takes more than 14 days.• Healing within 14 days, typically • Incidence of hypertrophic without scarring or need for graft scarring increased. Debriding and grafting is recommended by 2-3 weeks.
  13. 13. FULL THICKNESS BURN
  14. 14. Calculation of fluid commences from the time of burn NOT from the time of presentation ©EMSB
  15. 15. Limbs: Signs of Circulatory Obstruction • Loss of distal circulation • pallor • coolness • absent pulse • loss capillary refill • decreased oxygen saturation • Pain on passive extension • Deep pain at rest
  16. 16. EscharotomyAfter Consultation with Burns Unit:• Chest: To allow respiratory movement• Limb: To restore circulation in limb with excess swelling under rigid eschar
  17. 17. INITIAL CARE• JELONET/BACTIGRAS• SILVAZINE CREAM• GLAD WRAP• PAIN RELIEF - IV• IDC INSERTION TO MONITOR URINE OUTPUT
  18. 18. Further Management• NG TUBE AND FEEDS• NO ANTIBIOTICS• TETANUS PROPHYLAXIS• AVOIDENCE OF HYPOTHERMIA
  19. 19. TRANSFER CRITERIA1. Partial thickness burns >= 15% TBSA in patients aged 10 - 50 years old.2. Partial thickness burns >=10% TBSA in children aged 10 or adults aged 50 years old.3. Full-thickness burns >= 5% TBSA in patients of any age.4. Patients with partial or full-thickness burns of the hands, feet, face, eyes, ears, perineum, and/or major joints.5. Patients with high-voltage electrical injuries, including lightning injuries.6. Patients with significant burns from caustic chemicals.7. Patients with burns complicated by multiple trauma in which the burn injury poses the greatest risk of morbidity or mortality8. Patients with burns who suffer inhalation injury.
  20. 20. BURNS EVOLVE !!!!• WHAT MAY APPEAR TO BE A SUPERFICIAL BURN ON FIRST PRESENTATION CAN VERY EASILY PROGRESS TO A DEEPER BURN REQUIRING GRAFTING IN A FEW DAYS• AS A RESULT THE BURN INJURY SHOULD BE REVIEWED AT A PERIOD NO LATER THAN 2 DAYS FROM THE INITIAL PRESENTATION.• THE INJURIOUS AGENT ( HOT WATER,OIL FLAME ETC) DURATION OF CONTACT, RESUSCITATION STATUS,CLIMATE AND DRESSINGS USED WILL ALL CONTRIBUTE IN VARYING DEGREES TO THE DEPTH AND PROGRESSION OF THE BURN WOUND• IT IS THEREFORE, IMPORTANT THAT APPROPRIATE DRESSINGS ARE USED FROM THE INITIAL INJURY TO MINIMISE THE INJURY OVER TIME AND AN APPROPRIATE MULTIDISCIPLINIARY TEAM IS INVOLVED IN THE CARE OF ALL BURN WOUNDS

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