Burn Flashcards
Calculate the surface area of the burn?
According to Wallace rule of nine’s
Or Lund and Browd
Burn Management?
A. Airway:
• Look for signs of airway burns and inhalational injury as it may cause airway edema
• Consider intubation if there is airway edema
B. Breathing and ventilation:
• Ensure that adequate ventilation can be achieved as tracheal or pulmonary burns can impair effective gas
exchange, also full thickness chest burns can impede chest expansion
C. Circulation:
• 2 large bore cannulae and fluid resuscitation (any patient > 15% TBSA, any child > 10%)
Parkland formula
Crystalloid only e.g. Hartman’s solution / Ringers’ lactate)
Total fluid requirement in 24 hours =
4ml x total burn surface area (%) x body weight (kg)
• 50% given in first 8 hours
• 50% given in next 16 hours
Why not to give colloids in burn?
because of the increased capillary permeability occurring during the first 24 h, colloids will pass to the extravascular
space, exert an oncotic effect, and cause a paradoxical augmentation of the third space (interstitial space).
How do you assess the adequacy of fluid therapy?
A number of clinical parameters may be used
• Clinical measures of the cardiac index
o Peripheral warmth
o Capillary refill time
o Urine output
• Central venous pressure and its response to fluid challenges
• Core temperature, e.g. rectal temperature
• Hematocrit (Hct), which determines the plasma volume and the red cell mass. This is unreliable if there has
been a recent transfusion or hemolysis
What are you afraid of? Complications of burns?
• Burns shock’: hypovolemic shock due to plasma loss following loss of skin cover. Leads to hypotension,
tachycardia, increased systemic vascular resistance and a fall in the cardiac output
• Sepsis
• ARDS
• Renal failure (myoglobinuria)
• Constricting circumferential burns (ischemia in limbs / ventilators problems in chest- require escharotomy.
• Electrolyte disturbances: Hypo or hypernitremia, hyperkaliemia, hypocalcaemia
• Coagulopathy due to disseminated intravascular coagulation and hypothermia
• Hemolysis leading to hemoglobinuria and anaemia
How to tell if he has superficial or deep burn?
• Partial thickness: red/white, blistering, sensate
• Full thickness: white, leathery, desensate
