10. C - Fluid loss
♦ Replace fluid loss from time of injury
♦ Adults and children
♦ Hartman’s solution
♦ Equation...
♦ BSA
♦ Parkland formula…
♦ Maintenance fluids
14. Parkland formula
4ml / kg / %burn over 24hrs…
=
2 ml x kg x %burn over 8hrs
+
2ml x kg x %burn over 16hrs
Add in maintenance fluids
4ml / kg / hr for first 10kg
2 ml / kg / hr for next 10 kg
1 ml / kg / hr for rest of weight
15. Example
♦ 10kg child with 8% burns
♦ 60ml / hr for 8 hrs
= 20ml / hr plus 40 ml/hr maintenance
♦ 50ml / hr for 16 hrs
= 10ml / hr plus 40 ml/hr maintenance
♦ Clinical parameters
16. Treatment (First Aid)
A Airway
B Ventilation
C Fluid replacement
D Other injuries
E Exposure
Simultaneously
♦ Stop the burn /
constriction
♦ Pain management
♦ Dressings...
♦ Tetanus??
♦ Safeguarding
20. Special Considerations
♦ Joints
♦ Circumferential burns
♦ Hands / Feet / Perineum / Face
♦ Other Injuries
♦ Inhalation of CO / CN
♦ Cyanokit
♦ HBO?
21. Follow-Up
♦ “Major Burns” – Referral to 3° centre
♦ “Consider” if >1% partial thickness
♦ Special considerations
♦ Minor Burns
♦ By local arrangement
♦ Less than 10% BSA
♦ Demarcation / Healing
♦ Late referral
♦ Not healing (> 2 weeks)
♦ Depth
♦ Unwell
24. Immunisation
status
Clean Wound
Tetanus Prone Wound (see definition below)
Vaccine Vaccine Human tetanus immunoglobulin (TIG) Alternative normal
immunoglobulin product if
TIG
is unavailable
Fully immunised i.e.
has received a total of
5 doses of tetanus
vaccine at appropriate
intervals
None required None required Only if high risk (heavy contamination with
material likely to contain tetanus spores and/or
extensive devitalised tissue)
500 units (2ml) TIG IM
Normal immunoglobulin
Subgam ® brand only, 1.5g IM
given at a minimum of two
separate sites.
Primary immunisation
complete, boosters
incomplete but up to
date
None required
(unless next dose
due soon and
convenient to give
now)
None required
(unless next dose
due soon and
convenient to give
now)
Only if high risk
(heavy contamination with material likely to
contain tetanus spores and/or extensive
devitalised tissue)
500 units (2ml) TIG IM
Normal Immunoglobulin
Subgam ® brand only, 1.5g IM
given at a minimum of two
separate sites.
Primary immunisation
incomplete or
boosters not up to
date
A reinforcing dose
of vaccine and
further doses as
required to
complete the
recommended
schedule (to
ensure future
immunity)
A reinforcing dose
of vaccine and
further doses as
required to
complete the
recommended
schedule (to
ensure future
immunity)
Yes: one dose TIG at a different site.
250 units (1ml) IM if < 24 hours since injury,
not heavy contamination and not following a
burn
or
500 units (2ml) IM if >24 hours since injury or
risk of heavy contamination or following burns
Normal immunoglobulin
Subgam ® brand only 750mg
IM
or
Normal Immunoglobulin
Subgam ® brand only, 1.5g IM
given at a minimum of two
separate sites
Not immunised or
immunisation status
not known or
uncertain
An immediate
dose of vaccine
followed, if records
confirm this is
needed, by
completion of a full
5 dose course to
ensure future
immunity
An immediate
dose of vaccine
followed, if records
confirm this is
needed, by
completion of a full
5 dose course to
ensure future
immunity
Yes: one dose of TIG at a different site.
250 units (1ml) IM if < 24 hours since injury,
not heavy contamination and not following a
burn
or
500 units (2ml) IM if >24 hours since injury or
risk of heavy contamination or following burns
Normal immunoglobulin
Subgam ® brand 750mg IM
or
Normal immunoglobulin
Subgam ® brand only, 1.5g IM
given at a minimum of two
separate sites
25. Sepsis
♦ Toxic Shock
♦ Staph aureus or strep pyogenes
♦ Temperature>38°C
♦ Rash
♦ D&V
♦ Unwell
♦ What are the subtle signs?
♦ Poor appetite
♦ Listless
♦ “just not right”
26. Safeguarding
♦ Red flags
♦ Multiple ages / delay to presentation
♦ Changing or bizarre history
♦ Child’s history
♦ Multiple presentations
♦ Parental “pathology”
♦ Interaction
♦ Register
27. Safeguarding
♦ Patterns of injury
♦ Clear imprints
♦ Cig burns
♦ Dunking
♦ Depth inconsistent with history
♦ Who do you inform?
29. Summary
Treat first, question later
ABC
Analgesia & fluids
Special considerations
Tetanus
Safeguarding
http://www.lsebn.nhs.uk/
Editor's Notes
Depth is a function of exposure x temp. Average water temp = 60OC;
Time for superficial burn = 5-7 seconds
Time for full thick burn = 60-90 seconds
Children’s skin burns with 4 times the speed
