EM Burn and Wound Management Flashcards
Who most commonly get burns?
Dudes…m/c seen in males age 18-35
About 10% require hospitalization
What are the burn depth classifications?
Superficial thickness (first degree)
Partial or intermediate thickness (second degree)
Full thickness (third degree)
Fourth degree (involves muscle or bone, leads to loss of burned area)
In a burn patient, what will distort the airway?
What needs to be considered? Ordered?
Mucosal and pulmonary edema
Need to anticipate worsening of airway, consider early intubation
ABG, get CO2 level
When do you consider intubation in a burn patient?
Consider intubation if airway is burned or there is soot, voice change, swelling of the nexk/chest/face, wheezing, sore throat, stridor
Also consider if > 20% TBSA is burned
How can you determine how much TBSA is burned?
Why is it critical to determine TBSA?
- Lund-Browder (used by burn centers, modified for kiddos)
- Rule of 9’s
- Palm rule (easiest)
Used to determine how much fluids need to be given
What is the initial fluid resuscitation in thermal burns?
Start with LR bolus 500cc, then calculate by either Parkland or Modified Brooke formulas
What gets compressed first in compartment syndrome?
Veins
What is the treatment for escharotomies?
Fasciotomy into healthy tissue layer to releive pressure
Longitudinal insicisions for extremities
Bilateral mid-axillary line to 12th rib with connecting transverse incision for throracic compartment syndrome
What are the signs of cyanide inhalation?
What is the treatment?
- HA
- Confusion
- Seizure
- Dysrhythmias
- Pulmonary edema
- Vomiting
- flushed skin
- Renal failure
- hepatic necrosis
- rhabdomyolysis
Treat empirically with Cyanokit (hydroxocobalamin - binds cyanide)
What is part of the diagnostics in burns?
Will depend on burn severity
- CBC
- CMP
- VBG
- Lactate
- CO
- Cyanide levels (takes days, not usually ordered)
What is considered a severe burn?
- Trauma
- Inhalation injury
- Chemical burn
- Electrical burn
- > 20% BSA
What burns require transfer to a burn center?
- Circumferential burns
- > 10% TBSA partial thickness burn
- Involves face, hands, feet, perineum, genitals, involves major joint
- Concern for smoke inhalation or respiratory compromise
- Electrical burns
- Chemical burns
- Social situations
Do burns receive emperic antibiotics?
No, watch for infections
What is xeroform?
nonadherent dressing - mesh gauze that is impregnated to prevent sticking
Is an acid or a base chemical burn worse?
Base - causes fat to liquify
