03 Burns

Degrees

  • 1st: sunburns, epidermis intact, erythema/warmth/pain

  • 2nd: partial thickness, broken epidermis, increased pain, blisters, infection/fluid become issue

  • 3rd: full thickness, through dermis, muscle/bone exposed. No pain. White charred region of flesh. Surrounded by second degree

Chemical

  • alkali/acid

  • alkali worse

  • skin/eyes

    • never buffer. Irrigate with water

  • Ingested

    • never buffer. Never induce emesis. Never NG (can perforate esophagus)

    • Monitor. Serial exams (repeat xray, NPO, watch). Eventual EGD

  • Respiratory: hot stuff in respiratory (close fires, explosions, inhalation)

    • edema response to burn = close airway

    • signs: Stridor, soot/singed nares

    • treatment: monitor O2/ABG, peak flow, eventual bronchoscopy. Prophylactic intubation if deterioration

Electrical

  • pt: struck by lightning, high voltage wires, entrance/exit wound

  • symptoms:

    • die from arrythmia

    • bones heat up and burns muscles around it = rhabdo

    • posterior shoulder dislocation (nerves contract with such force that shoulder dislocates)

  • management: if still alive, ck level, cr

  • may need IVF, mannitol

Circumferential burns

  • any burns that's circumferential compromises vascular supplies

  • regular burn vs circumferential:

  • clinical diagnosis

  • treatment: cut the eschar to eleviate pressure

Parkland Formula

  • pt: rule of 9's, 50-50, 8-16

  • only 2nd, 3rd degree

  • 4xkgx%BSA = how much fluid to give

  • give 50% in first 8 hours, 50% in next 16 hours

  • early movement and early grafting is key with IV analgesics, infection prophylaxis (topical mupirocin, sulfadiazeine, PO don't count)

Previous02 PediatricNext03 Gyn

Last updated