Professional Documents
Culture Documents
Systemic Changes
z Release of inflammatory mediators, produce vasodilation
and vasoconstriction -> increased capillary permeability
and oedema
z Loss of plasma volume, increased peripheral vascular
resistance ->decreased cardiac output
z Decreased renal blood flow, decreased GFR -> oliguria
z If untreated, develop acute tubular necrosis and renal
failure (development of acute renal failure assoc with
higher mortality)
z Immunosuppression & increased infectious complications
z Increased gut mucosal permeability, mucosal atrophy and
changes in digestive absorption
z Hypermetabolism after severe burn because of release of
inflammatory hormones -> gluconeogenesis, lipolysis and
proteolysis
Emergency Treatment of Acute
Burns
Immediate Emergency Burn Care
z ABCD assessment
z maintain clear airway
z remove source of injury and/or prevent ongoing thermal
injury
z Use airway and C-spine precautions
Emergency Burn Management
1. Airway management
z Administer high flow oxygen
z consider early intubation if signs of inhalational injury or
very large burns
z Features associated with inhalational injury
-Hx of fire in enclosed space, Hx of unconsciouness,
carbonaceous sputum, facial burns, singed nasal hairs
2. Intravenous access
z 2 x large bore IV ( away fm burned tissues if possible)
3. Analgesia – opioids, titrated intravenously
4. Insert IDC
Fluid Resuscitation, Assessment
of Burn Size and Depth
z Fluid resuscitation
- IV fluid required is determined by burn size and weight of
patient in Kg’s
z Careful examination of all body surfaces to determine
percentage of burns
z Use Wallace ‘Rule of Nines’ or standard Lund-Browder
chart
Estimation of Burn Size
z ‘Rule of Nines’
- differs in children
- child’s head represents a larger proportion and lower
extremities a lesser proportion of TBSA
- palm of patient’s hand represents approximately 1% of
patient’s body surface area (helps estimate irregular burns
area)
z Only include 2nd degree burns or greater in TBSA for burn
fluid calculations
‘Rule of Nines’
z Blood Tests
- FBE, U&E,Type and crossmatch, carboxyhemoglobin,
serum glucose, arterial blood gas and pregnancy test in all
females of childbearing age.
z X-Rays
- CXR, repeat after intubation or insertion of central
lines
- assessment of associated injuries
Additional Evaluation
z 2nd degree burns are painful when air currents pass over
burned surface. Cover with clean linen
z Do not break blisters or apply antiseptic cream
z Do not apply cold compresses
z Do not apply cold water to patient with extensive burns
z Maintain body heat
z Elevation of burned limbs
Special Burn Requirements
1. Chemical Burns
z Tissue damage dependent on chemical nature of agent,
concentration of agent and duration of skin contact
z Alkali burns more serious than acid burns (alkali
penetrates deeper)
z Immediately flush away chemical with copious amounts
of water (min 15-20L of tap water)
z Care to drain away from uninjured areas
z If dry powder present, brush away before irrigation
z Neutralizing agents should not be used
2. Electrical Burns
z Often have large underlying tissue damage, may be more
progressive and deeper than apparent
z Muscle sustains most damage
z Institute therapy for myoglobinuria if urine is dark
z High voltage injury may cause cardiac arrythmias
z Often require large volume fluid resuscitation (as most
of wounds is deep, can’t rely on values predicted based
on wound area)
Fluid Resuscitation