The document discusses emergency management of burns. It provides information on common causes of burns, pathophysiology involving initial and secondary tissue damage, burn wound classification models, and initial management following the EMSB (airway, breathing, circulation, disability, exposure, fluids) protocol. Key points include fluid resuscitation using the Parkland formula, monitoring for signs of circulatory obstruction in limbs, considering escharotomy if needed, and criteria for burn patient transfer to a specialized burn unit.

2. Emergency Management of Burns

3. Adult Burn Admissions
• Explosion & Flame 48%
• Scald - oil & water 33%
• Contact 8%
• Electrical 5%
• Chemical 3%
• Friction 2%
• Sun 1%
©EMSB

4. 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

5. Jackson Burn Wound Model
Zone of Survival
Zone of Damage
Zone of Necrosis
Coagulation
Stasis
Hyperaemia

6. E.M.S.B
• Airway
• Breathing
• Circulation
• Disability
• Exposure
• Fluids

14. AIRWAY and BREATHING
Early Symptoms:
• sore throat
• singing of nasal hairs/eyebrows/eyelashes
• hoarseness
• soot-tinged sputum
Late Symptoms:
• shortness of breath
• stridor
• indrawing

19. IF IN DOUBT INTUBATE

20. 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

21. DISABILITY
• Beware the Confused Patient
• Intoxicated Or Hypoxic?
• Electrolyte Imbalances
• Shock

22. EXPOSURE
• REMOVAL OF ALL JEWELLERY AND CLOTHING WHILE KEEPING
THE PATIENT WARM
• ASSESSMENT OF BURN SEVERITY AND EXTENT
• MANAGEMENT

24. SUPERFICIAL BURN

27. 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.

31. FULL THICKNESS BURN

38. Calculation of fluid commences
from the time of burn
NOT
from the time of presentation
©EMSB

39. 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

40. Escharotomy
After Consultation with Burns Unit:
• Chest: To allow respiratory movement
• Limb: To restore circulation in limb with
excess swelling under rigid eschar

49. INITIAL CARE
• JELONET/BACTIGRAS
• SILVAZINE CREAM
• GLAD WRAP
• PAIN RELIEF - IV
• IDC INSERTION TO MONITOR URINE OUTPUT

50. Further Management
• NG TUBE AND FEEDS
• NO ANTIBIOTICS
• TETANUS PROPHYLAXIS
• AVOIDENCE OF HYPOTHERMIA

51. TRANSFER CRITERIA
1. 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 mortality
8. Patients with burns who suffer inhalation injury.

52. 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