Emergency Burn Management

Question 1

Emergency Burn Management

Answer 1

Focus is to save life, minimize disability, & prepare for definitive care

Question 2

Emergency Healthcare Professionals

Answer 2

• Remove all rings, watches, & jewelry
• Obtain large bore IV access
• Obtain hx of injury

Question 3

Respiratory Management

Answer 3

• Circumferential, full-thickness burns to chest wall can lead to restriction of chest wall expansion & dcrd compliance
  > dcrd lung compliance requires higher vent pressures to provide adequate tidal vols
  > non-intubated pt: CMs of chest wall restriction include rapid, shallow resps; poor chest wall excursion; and severe agitation
  > intubated pt: incring peak airway pressure values
• ABGs: incrd PaCO2
• Escharotomy

Question 4

Escharotomy

Answer 4

• Burn eschar incisions
• May be needed immediately to incr compliance & for improved ventilation
• Usually made bilaterally along anterior axillary lines and are connected by a transverse incision at costal margin

Question 5

Circulatory Management

Answer 5

• Focus on fluid resusitation
• Parkland Formula
  > 1st 8hrs: 50% of calculated amnt admind
  > 2nd 8hrs (9-16): 25% is given
  > 3rd 3hrs (17-24): 25% is given
• Rate of fluid admind is adjusted according to response
  > monitor urine output, HR, BP, LOC
  > document I/Os

Question 6

Underresuscitation

Answer 6

May result in inadequate cardiac output, leading to inadequate organ perfusion and potential for wound conversion from partial-thickness to full-thickness
end-organ perfusion issues

Question 7

Overresuscitation

Answer 7

May lead to modersate to severe pulm edema, to escessive wound edema causing a dcr in perfusion of unburned tissue in distal portions of extrems. or to edema inhibiting perfusion of the zone of stasis resulting in wound conversion

Question 8

Pathophysiology of Burn Shock

Answer 8

• Pt may present in shock r/t intravascular vol loss, dcrd tissue perfusion
• This occurs as a result of firect injury to capillaries and release of vasoactive substances
• The capillaries become more permeable, and proteins move out of the intravascular spaces into interstitium; hypovolemia & edema result
  > once hypovolemic state affects EOP; shock state

Question 9

Rate of Fluid Loss from Intravascular Spaces Depends on

Answer 9

• Age
• Burn size & depth
• Intravascular pressures
• Time elapsed since burn injury

Question 10

Burn Shock - Hemodynamic Alterations

Answer 10

• Dcrd myocardial contractility & dcrd CO despite adequate vol resuscitation
  > dcrd preload
• Incrd systemic vascular resistance (SVR), and incrd pulm vascular resistance (PVR)
  > incrd PVR can lead to pulm edema
• these are compensatory mechanisms

Question 11

Emergency Management - Kidney Management

Answer 11

• If fluid resuscitation is inadequate, AKI may occur
  > can progress to failure
• Indwelling urinary catheter may be placed to monitor the effectiveness of fluid resuscitation
• A catheter may be necessary if the burn extends into the perineal area bc of the presence or development of edema

Question 12

Emergency Management - GI System Management

Answer 12

• NG or OG tube
  > to prevent abdominal distention, emesis, & potential aspiration
• Prophylaxis w/ histamine blockers or sucralfate is initiated bc pts w/ burns are prone to ileus
• Enteral nutrition
  > should be promptly initiated for pts w/ burns via nasoduodenal or nasojejunal tube

Question 13

Emergency Management - Extremity Pulse Assessment

Answer 13

• Edema formation may cause neurovascular compromise to the extremities; frequent assessments are necessary to evaluate pulses, skin color, capillary refill & sensation
  > arterial circulation is at greatest risk w/ circumferential burns if not corrected, reduced arterial flow causes ischemia & necrosis
  > doppler flow probe
  > an escharotomy may be required to restore arterial circulation and to allow for further swelling

Question 14

Emergency Management - Laboratory Assessment

Answer 14

• Initial lab studiese include complete blood count, electrolytes, BUN, creatinine, urinalysis, glucose, & blood screening
  > inhalation injury warrants arterial blood gas measurements, HbCO lvl determination, cultures, alcohol & drug screens, & cyanide lvls
  > a baseline nutrition status: albumin
  > burns: creatine kinase, urinalysis, & urine myoglobin are good indicators of rhabdo
  > serum lactate: inflamm marker indicating burn severity
  > an ECG is obtained for all pts w/ electrical burns or preexisting heart disease

Question 15

Emergency Management - Wound Care

Answer 15

• After wounds have been assessed, topical antimicrobial therapy IS NOT a priority during emergency care
  > wounds must be covered w/ clean, dry dressungs or sheets
  > measures to prevent hypothermia
  > tetanus prophylaxis