2. Introduction
Skin is the largest organ in the body and isolates
chemically, thermally, biologically and
mechanically the inside from the outside.
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. 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. 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. • 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. 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. 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. 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. 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. 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.
19. 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.
20. 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.
21.
22. 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.
