Thermal Burns. Todd Ring Nov. 27/03. You will know…. Types, severity, and extent of thermal burns Pre-hospital management goals Smoke inhalation injury and treatment Evidence behind the Parkland formula and fluid resuscitation goals Treatment of major and minor burn wounds
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A 55 yo. male is brought into the ED after lighting himself on fire. He has sustained burns to his face, anterior thorax and anterior aspect of his right arm and leg. The burns on his face are red with blisters while those on his trunk and extremities are white.
Burns consist of three geographic zones
Superficial partial thickness burn involves the papillary dermis; painful; blisters are present or may develop; heal over 2-3 weeks with no scar
Deep partial thickness burn damages both papillary and reticular dermis plus deeper sweat glands and follicles; may or may not be painful; 3 or more weeks to heal and often will scar
Head 9 %
Arm 9 %
Front 18 %
Back 18 %
Leg 18 %
Perineum 1 %
*palm of hand 1 %
• Less than 15% TBSA burns in adults or less than 10% TBSA burns in children or the elderly with less than 2% full-thickness injury
• Partial- and full-thickness burns of 15-25% TBSA in young adults, 10-20% in children younger than 10 and adults older than 40
• Full-thickness burns less than 10% TBSA, not involving special care area
• Greater than 25% TBSA burns in young adults or greater than 20% TBSA in children younger than 10 and adults older than 40.
• Full-thickness burns of 10% or greater. All burns of special care areas that are likely to result in either functional or cosmetic impairment (i.e., face, hands, ears, or perineum).
• All burns complicated by inhalation injury, high-voltage electrical injury, or associated major trauma. High-risk patients include infants, the elderly, and patients with complicated medical problems.
Adapted from: American Burn Association 1984 Guidelines for Service Standards and Severity Classifications in the Treatment of Burn Injury.Burn Severity Classification
A 33yo male is involved in a confined gas plant explosion. EMS patches in that the patient has extensive burns on his face and neck and is stridourous. His O2 sat is 98 %.
*Above available as kit
A 22 yo male was lighting his BBQ in the house (minus 20 outside). The BBQ exploded causing 3rd degree burns over 40 % of his body, 2nd degree burns over 10 % and 1st degree burns over 10 %. His HR is 115 and BP 95/60.
Mansfield et al. Burns. 1996; 22: 549-51
Holm et. al. Resuscitation 2000; 44:157-64
An 18 month toddler is brought into the ED after suffering 3rd degree burns to his right arm and leg following a boiling grease spill.
Sydney et al. Management of burns during pregnancy. Burns 2000. 27: 394-7.