Thermal injury Flashcards
How does hypovolemia from burn injury differ from hypovolemia from other forms of trauma
Due to inflammatory response and capillary leak, ongoing.
Other trauma is due to haemorrhagic loss where Tx is stop the leak and fill the space
Initial Mx of burn
- Stop the burning process
- Cleanse the wound, cover to reduce pain
- Protect it from infection
- Prevent hyperthermia
Remove clothing
Brush off dry chemical powder
Prevent overexposure
Saline wash for 20-30 mins
Indication for early intubation
Signs of airway obstruction - additional noises, increased WOB
Signs of respiratory compromise - difficulty clearing secretions, fatigue, poor oxygenation and ventilation
> 40% TBSA burn
Extensive deep facial burn
Full thickness circumferential neck and chest burn
Burns inside mouth
Dysphagia
Reduced GCS where airway protective reflexes are impaired
Prolonged transfer
ETT size for adults
> 7.5mm to clear slough, debris and secretions
Burn shock resuscitation Parkland formula
2ml Hartmann’s x kg x %TBSA (do not include superfical burn)
1/2 over 8h
1/2 over 16h
Adjust IVI based on urine output, target 30-50ml/hr for adults
1-1.5ml/kg/hr for teens
Monitoring requirements Primary survey
Carboxyhaemoglobin level
ABG
Elevate head and chest 30 degreees to reduce oedema
Catheter for urine output - main parameter for perfusion
ETT and cannula positioning - can dislodge as oedema progresses
Intubate + 100% oxygen
Superficial vs deep partial thickness injury
Superficial is moist, hypersensitive to even air current over wound, blisters, pink and blanching
Deep is dry, painless, blisters, red/mottled without blanching
What is the goal of burns resuscitation
Maintain end-organ perfusion with inflammatory response causing ongoing intravascular volume loss
Important burns documentation
- Burn depth
- Extent of burn
- IVI and urine output
- Additional treatment e.g. Escharotomy
What factors high risk of compartment syndrome and may require fasciotomy
Skeletal trauma
Crush injury
High-voltage electrical injury
If concomitant injury causing haemorrhage with burns - what is the best management
Control haemorrhage before burns resuscitation
Two interventions for treating rhabdomylosis
- Increase IVI to target u/o of 100ml/hr to wash out myoglobin
- Administer mannitol which is a diuretic and helps the above
Signs and complications of severe electrical burn injury
Contracted extremity with entrance wound
Local thrombosis and nerve injury
Skeletal muscle damage also possible
Mx of electrical and tar burns
Electrical - IVI, 100ml/hr u/o, ECG monitoring, r/v for compartment syndrome
Tar burns - remove clothing, mineral oil
