Burn management
1 / 19

Burn Management - PowerPoint PPT Presentation

  • Updated On :

Burn Management. Tad Kim, M.D. UF Surgery [email protected] (c) 682-3793; (p) 413-3222. Overview. Pathophysiology of Burns Burn Classifications Criteria for Transfer to Burn Center Initial Assessment & Management Airway Management Smoke Inhalation Injury

I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
Download Presentation

PowerPoint Slideshow about 'Burn Management' - ancelin

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.

- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
Burn management

Burn Management

Tad Kim, M.D.

UF Surgery

[email protected]

(c) 682-3793; (p) 413-3222


  • Pathophysiology of Burns

  • Burn Classifications

  • Criteria for Transfer to Burn Center

  • Initial Assessment & Management

  • Airway Management

    • Smoke Inhalation Injury

  • Shock & Fluid Resuscitation

  • Burn Wound Management

    • Electrical Injury & Chemical Burns

Pathophysiology of burns
Pathophysiology of Burns

  • Burns cause coagulative necrosis

    • Chemical/Electricity also cause direct injury to cell membranes, in addition to heat transfer

  • Causes:

    • Flame, Scald, Contact, Chemical, Electricity

  • Depth of burn depends on:

    • 1. Temperature

    • 2. Time exposed

    • 3. Specific heat (higher for grease)

Pathophysiology of burns1
Pathophysiology of Burns

  • Burns a/w release of inflamm. mediators

  • Increased capillary permeability

    • Leak proteins into interstitium

  • Get edema in burned & non-burned skin

  • Large fluid loss due to fluid shifts & also losses from exposed burned skin

  • Characteristic “Ebb and Flow” of burns

    • Ebb: Low metabolism/cardiac output, ↓Temp

    • Flow: hypermetabolism, high cardiac output, hyperglycemia, increased heat produx

Classification of burn depth
Classification of Burn Depth

  • 1st degree: localize to epidermis (sunburn)

  • 2nd degree: injury to both dermis/epidermis

    • Superficial 2nd: papillary dermis

      • Typically red, painful, blister, “wet” appearing

      • Regen in 7-14 days from hair follicles/sweat glands

    • Deep 2nd: reticular dermis

      • Typically more pale/mottled, dry, ↓sensation

  • 3rd degree: full thickness epidermis/dermis

    • Hard, leathery eschar, painless

  • 4th degree: involves muscle, bone, etc.

Criteria for burn center referral

Partial thickness > 10%

Inv. face, hands, feet, genital/perineum, joints

Any full thickness burn

Electrical injury

Chemical burn

Inhalational injury

Comorbidities (CHF)

Concomitant trauma


Special emotional, social, or rehab needs

Criteria for Burn Center Referral

Initial assessment
Initial Assessment

  • Called to the ER for a 35yo male rescued from housefire w face/trunk/extrem burns

  • Always start with ABC

    • In trauma/burns, ABCDE (disability/exposure)

  • Airway can be an issue with severe burns or inhalational injury (esp. with indoor fire)

    • Direct injury from heated air/smoke -> edema

    • Edema from inflammatory response to burns

    • Edema from the resuscitation fluids

Initial assessment1
Initial Assessment

  • Suspect airway injury if:

    • Facial burns, singed nasal hairs, wheezing, carbonaceous sputum, tachypnea

  • Give pt oxygen & put on pulse oximetry

  • Progressive hoarseness is a sign of impending airway obstruction

  • Pre-emptively intubate anyone with:

    • Respiratory distress, inhalational injury, large burns (due to inevitable edema from resusc)

    • Bronchoscopy to help dx inhalational injury

Initial assessment2
Initial Assessment

  • Breathing (Breath sounds, chest rise, ET CO2)

    • Chest escharotomies if constrictive eschar

  • Circulation: get vitals (HR & BP)

    • 2 large bore IV (unburned before burned skin)

    • Start burn resuscitation with Lactated Ringer’s

    • Place patient on continuous EKG / monitor

    • Palpate or doppler extremity signals with circumferential extremity burns

  • Disability (GCS less than eight -> intubate)

  • Exposure: remove all clothing

Initial assessment3
Initial Assessment

  • AMPLE history

    • Allergies

    • Medications (also ask about last tetanus)

    • Past medical history (CHF – careful w fluids)

    • Last meal

    • Events regarding the injury (how did the fire start, how long was the exposure, what type of exposure – flame, grease)

Initial assessment4
Initial Assessment

  • Burn Resuscitation with Lactated Ringer’s

  • Figure out burn size by “rule of nines” or entire palmar surface of pt’s hand = 1%

  • Parkland formula

    • 4 x Wt(kg) x %TBSA = mL to give in 1 day

    • Half over 1st 8hrs (subtract what was given)

    • Give other Half over next 16 hours

    • In reality, titrate to UOP of 0.5mL/kg/hr in adults and 1mL/kg/hr in children

  • Do not give colloid in first 24 hrs

Burn resuscitation
Burn Resuscitation

  • 70kg male with 40% TBSA

    • EMS administered 1.5L of fluids already

  • What rate of LR should he receive?

Burn wound management
Burn Wound Management

  • Circumferential deep 2nd or 3rd degree extremity burn can compromise circulation

  • Assess for the 6 P’s

    • Pain, pallor, pulselessness (check Doppler), paresthesias, paralysis, poikilothermia

    • Directly measure tissue pressure (30 is cutoff)

  • Dx: Compartment syndrome

  • Tx: Escharotomy

  • (Give tetanus toxoid if not up to date)

Burn wound management1
Burn Wound Management

  • Burn patients are susceptible to infection

    • Due to immunologic insult of large burns

    • Also because dead tissue is easily colonized

  • Initially clean/debride & cover with topical antimicrobial (no data for oral or IV abx)

  • Superficial 2nd: can use temporary pigskin

  • 3rd & (most) deep 2nd need early excision & grafting, except palm/soles/face/genitals

    • Perform at ~3-7 days post-burn

Topical antimicrobials
Topical Antimicrobials

  • Sulfamylon for ears

    • Good at penetrating eschar & is painful

    • Side effect: metabolic acidosis via carbonic anhydrase inhibition

  • Bacitracin for face

    • Few side effects

  • Silvadene for trunk, neck, extremities

    • Does not penetrate eschar very well

    • Side effects: neutropenia/thrombocytopenia

Electrical burns
Electrical Burns

  • Most significant injury is within deep tissue

  • Edema can compromise circulation

  • Be ready to perform eschar-/fasciotomies

  • Explore & debride necrotic tissue

  • May have to re-explore questionable areas

  • EKG if heart was in conduction path

  • Follow serial CPK & urine myoglobin due to possibility of rhabdomyolysis

Chemical burns
Chemical Burns

  • Speed is essential

  • ABCDE – remove all clothing

  • Irrigate with 15-20L of water

    • Brush off any dry powder before irrigation

  • Alkalis generally cause worse damage

  • Do not attempt to counteract acid burns using alkali or alkali burns using acid

Take home points
Take Home Points

  • Always start with ABCDE for trauma/burns

  • Know what can compromise airway in burn patients

    • Chest escharotomy may be needed

  • Know and apply the Parkland formula

  • Recognize the need for limb escharotomy

  • Know depths of burn & which req excision

  • Know the types & side effects of topicals

  • Basics of treating chemical/electrical burns