1. BURNS AND OTHER SOFT
TISSUE INJURIES

2. BURNS AND OTHER SOFT
TISSUE INJURIES
REMEMBER YOUR ABC's

3. BURNS AND OTHER SOFT
TISSUE INJURIES
REMEMBER YOUR ABC's

4. BURNS AND OTHER SOFT
TISSUE INJURIES
REMEMBER YOUR ABC's
David McCollum, MD

5. STATISTICS

6. STATISTICS
>1,000,000/year

7. STATISTICS
>1,000,000/year
500,000 injuries require
treatment

8. STATISTICS
>1,000,000/year
500,000 injuries require
treatment
40,000 admissions/year
60% to Burn Centers

9. STATISTICS
>1,000,000/year
500,000 injuries require
treatment
40,000 admissions/year
60% to Burn Centers
4,000 deaths/year
75% occur at the scene of
injury

10. STATISTICS

11. STATISTICS
46% due to fire/flame

12. STATISTICS
46% due to fire/flame
32% due to scald

13. STATISTICS
46% due to fire/flame
32% due to scald
8% hot object contact

14. STATISTICS
46% due to fire/flame
32% due to scald
8% hot object contact
4% electrical

15. STATISTICS
46% due to fire/flame
32% due to scald
8% hot object contact
4% electrical
3% chemical

16. STATISTICS
46% due to fire/flame
32% due to scald
8% hot object contact
4% electrical
3% chemical
6% other

18. SELF-IMMOLATION

19. SCALD (2˚)

20. CHILD
ABUSE -
IMMERSION
Text

21. CHEMICAL - BATTERY ACID -
CRIMINAL INTENTIONAL INJURY
Text

22. HOT TAR IN A ROOFER
Text

23. ELECTRICAL
Text

24. DETERMINATION OF
SEVERITY OF BURN

25. DETERMINATION OF
SEVERITY OF BURN
Size of the burn

26. DETERMINATION OF
SEVERITY OF BURN
Size of the burn
Depth of the burn

27. DETERMINATION OF
SEVERITY OF BURN
Size of the burn
Depth of the burn
Age of the patient

28. DETERMINATION OF
SEVERITY OF BURN
Size of the burn
Depth of the burn
Age of the patient
Part of the body burned

29. DETERMINATION OF
SEVERITY OF BURN
Size of the burn
Depth of the burn
Age of the patient
Part of the body burned
Past medical history

30. DETERMINATION OF
SEVERITY OF BURN
Size of the burn
Depth of the burn
Age of the patient
Part of the body burned
Past medical history
Associated injuries

31. ESTIMATING SIZE BY “RULE
OF NINES”
Each body part a multiple of “9”
Quick method
Best for average adults

33. ESTIMATING BURN SIZE
RULE OF NINES

36. ESTIMATING DEPTH OF
BURN

37. ESTIMATING DEPTH OF
BURN
Second Characteristic Third

38. ESTIMATING DEPTH OF
BURN
Second Characteristic Third
Normal or Decreased or
Sensation absent
Increased
Large fluid Thin-walled
Blisters
filled
Pink, will White,
blanch Color brown black
or red
Normal or Firm or
Texture
firm Leathery

39. Follicle
Epidermis
Epidermis
Dermis
Adipose
Muscle

40. Burn Survival and Age
100
M 5-34
75
F 5-34
M
50 F
M
25 F
M 60+
0 F 60+
10 20 30 40 50 60 70 80 90

41. Burn Survival and Age
100
M 5-34
75
F 5-34
M
50 F
M
25 F
M 60+
0 F 60+
10 20 30 40 50 60 70 80 90

42. Burn Survival and Age
100
M 5-34
75
F 5-34
M
50 F
M
25 F
M 60+
0 F 60+
10 20 30 40 50 60 70 80 90

43. Burn Survival and Age
100
M 5-34
75
F 5-34
M
50 F
M
25 F
M 60+
0 F 60+
10 20 30 40 50 60 70 80 90

44. Burn Survival and Age
100
M 5-34
75
F 5-34
M
50 F
M
25 F
M 60+
0 F 60+
10 20 30 40 50 60 70 80 90

45. Burn Survival and Age
100
M 5-34
75
F 5-34
M
50 F
M
25 F
M 60+
0 F 60+
10 20 30 40 50 60 70 80 90

46. Burn Survival and Age
100
M 5-34
75
F 5-34
M
50 F
M
25 F
M 60+
0 F 60+
10 20 30 40 50 60 70 80 90

47. Burn Survival and Age
100
M 5-34
75
F 5-34
M
50 F
M
25 F
M 60+
0 F 60+
10 20 30 40 50 60 70 80 90

48. Burn Survival and Age
100
M 5-34
75
F 5-34
M
50 F
M
25 F
M 60+
0 F 60+
10 20 30 40 50 60 70 80 90

49. Criteria For Inhalation Injury

50. Criteria For Inhalation Injury
“Closed-space” injury

51. Criteria For Inhalation Injury
“Closed-space” injury
Presence of noxious gases or fumes

52. Criteria For Inhalation Injury
“Closed-space” injury
Presence of noxious gases or fumes
Burns about the face, mouth, lips, posterior
pharynx

53. Criteria For Inhalation Injury
“Closed-space” injury
Presence of noxious gases or fumes
Burns about the face, mouth, lips, posterior
pharynx
Carbonaceous sputum

54. Criteria For Inhalation Injury
“Closed-space” injury
Presence of noxious gases or fumes
Burns about the face, mouth, lips, posterior
pharynx
Carbonaceous sputum
Hoarseness or stridor

55. Criteria For Inhalation Injury
“Closed-space” injury
Presence of noxious gases or fumes
Burns about the face, mouth, lips, posterior
pharynx
Carbonaceous sputum
Hoarseness or stridor
Rales, rhonchi, wheezes

56. Criteria For Inhalation Injury
“Closed-space” injury
Presence of noxious gases or fumes
Burns about the face, mouth, lips, posterior
pharynx
Carbonaceous sputum
Hoarseness or stridor
Rales, rhonchi, wheezes
Hypoxemia

57. Acute Respiratory Complications
Of Burns

58. Acute Respiratory Complications
Of Burns
Asphyxia

59. Acute Respiratory Complications
Of Burns
Asphyxia
Carbon Monoxide Poisoning

60. Acute Respiratory Complications
Of Burns
Asphyxia
Carbon Monoxide Poisoning
Cyanide Inhalation -Check Lactate

61. Acute Respiratory Complications
Of Burns
Asphyxia
Carbon Monoxide Poisoning
Cyanide Inhalation -Check Lactate
Upper Airway Obstruction

62. Acute Respiratory Complications
Of Burns
Asphyxia
Carbon Monoxide Poisoning
Cyanide Inhalation -Check Lactate
Upper Airway Obstruction
Inhalation Injury

63. Acute Respiratory Complications
Of Burns
Asphyxia
Carbon Monoxide Poisoning
Cyanide Inhalation -Check Lactate
Upper Airway Obstruction
Inhalation Injury
Restrictive Disease Due to Eschar

64. Carbon Monoxide Poisoning
Level Severity Symptoms
≤20 Mild Headache, mild confusion,
mild dyspnea, visual changes
20-40 Moderate Irritability, diminished
judgement, dim vision, nausea,
fatigability
Hallucinations, confusion,
40-60 Severe
ataxia, collapse, coma

65. Upper Airway Obstruction

66. Upper Airway Obstruction
Diagnosis:
Stridor
Soot, Erythema, Edema

67. Upper Airway Obstruction
Diagnosis:
Stridor
Soot, Erythema, Edema

68. Upper Airway Obstruction
Diagnosis:
Stridor
Soot, Erythema, Edema
Management:
ndotracheal Intubation
E
Tracheotomy

69. Inhalation Injury

70. Inhalation Injury
Cause: Incomplete products of combustion

71. Inhalation Injury
Cause: Incomplete products of combustion
Pathology: Chemical tracheobronchitis and
alveolitis

72. Inhalation Injury
Cause: Incomplete products of combustion
Pathology: Chemical tracheobronchitis and
alveolitis
Stages:

73. Inhalation Injury
Cause: Incomplete products of combustion
Pathology: Chemical tracheobronchitis and
alveolitis
Stages:
1) Bronchospasm

74. Inhalation Injury
Cause: Incomplete products of combustion
Pathology: Chemical tracheobronchitis and
alveolitis
Stages:
1) Bronchospasm
2) Pulmonary edema

75. Inhalation Injury
Cause: Incomplete products of combustion
Pathology: Chemical tracheobronchitis and
alveolitis
Stages:
1) Bronchospasm
2) Pulmonary edema
3) Bacterial pneumonia

76. Sources of Noxious Chemicals
Polyethylene, Polypropylene
Polystyrene
Wool, Cotton
Polyvinylchlorides
Fire Retardants
Nitrogen containing compounds

77. CLASSIFICATION OF BURNS

78. CLASSIFICATION OF BURNS
MAJOR

79. CLASSIFICATION OF BURNS
MAJOR
Second Degree Burns Greater Than 25% Body
Surface Area

80. CLASSIFICATION OF BURNS
MAJOR
Second Degree Burns Greater Than 25% Body
Surface Area
Third Degree Burns Greater Than 10%

81. CLASSIFICATION OF BURNS
MAJOR
Second Degree Burns Greater Than 25% Body
Surface Area
Third Degree Burns Greater Than 10%
All Electrical Burns

82. CLASSIFICATION OF BURNS
MAJOR
Second Degree Burns Greater Than 25% Body
Surface Area
Third Degree Burns Greater Than 10%
All Electrical Burns
All Inhalation Injury

83. CLASSIFICATION OF BURNS
MAJOR
Second Degree Burns Greater Than 25% Body
Surface Area
Third Degree Burns Greater Than 10%
All Electrical Burns
All Inhalation Injury
Complicated By Other Trauma

84. CLASSIFICATION OF BURNS
MAJOR
Second Degree Burns Greater Than 25% Body
Surface Area
Third Degree Burns Greater Than 10%
All Electrical Burns
All Inhalation Injury
Complicated By Other Trauma
Burns Involving Hands, Face, Ears, Feet,
Perineum

85. CLASSIFICATION OF BURNS
MAJOR
Second Degree Burns Greater Than 25% Body
Surface Area
Third Degree Burns Greater Than 10%
All Electrical Burns
All Inhalation Injury
Complicated By Other Trauma
Burns Involving Hands, Face, Ears, Feet,
Perineum
All Poor Risk Patients

86. CLASSIFICATION OF BURNS
MODERATE
Second Degree Burns 15-25% BSA
Third Degree Burns Less Than 10%

87. CLASSIFICATION OF BURNS
MINOR
Second Degree Burns Less Than 15%
Third Degree Burns Less Than 2%

88. Other Associated Injuries

89. Other Associated Injuries
Ocular

90. Other Associated Injuries
Ocular
Orthopedic

91. Other Associated Injuries
Ocular
Orthopedic
CNS

92. Other Associated Injuries
Ocular
Orthopedic
CNS
Spinal Cord

93. Other Associated Injuries
Ocular
Orthopedic
CNS
Spinal Cord
Cardiac

95. What Are You To Do?

96. What Are You To Do?
Evaluate

97. What Are You To Do?
Evaluate
Remove Burning Clothing

98. What Are You To Do?
Evaluate
Remove Burning Clothing
Remove Constrictive Rings/Bracelets

99. What Are You To Do?
Evaluate
Remove Burning Clothing
Remove Constrictive Rings/Bracelets
Follow Pulses in Burned Extremities

100. What Are You To Do?
Evaluate
Remove Burning Clothing
Remove Constrictive Rings/Bracelets
Follow Pulses in Burned Extremities
Watch for Hypoxia - Anxiety May Be Clue

101. What Are You To Do?
Evaluate
Remove Burning Clothing
Remove Constrictive Rings/Bracelets
Follow Pulses in Burned Extremities
Watch for Hypoxia - Anxiety May Be Clue
Protect From Hypothermia

102. Baxter Formula
Ringer’s Lactate
4cc/kg/%burn given in first 24 hours