BURNS
MANAGEMENT OF ACUTE BURNS
v
I. PRIMARY ASSESSMENT
A Airway control.
B Breathing and ventilation
C Circulation
D Disability – neurological status
E Exposure with environmental control
O
F Fluid resuscitation.
II. COOL THE BURN WOUND
Give a through wash : ~ cool down the BURN
Recommended period of wash: 15-20 mins
Preferred fluid : Tap water & Room temperature
Effective till what time after burn : - It
III. GIVE OXYGEN
IV. ELEVATE THE PATIENT
WARNING SIGNS FOR INTUBATION
~ voice change [Hoarsness of Voice]
~
Inspiratory Stridor
~ severe
wheezing
~
Laryngeal Edema [Facial Burns]
O
- CRITERIA FOR ACUTE ADMISSION TO A BURN UNIT
~
Suspected airway or inhalational injury
Any burn likely to require fluid resuscitation
↓
Any burn likely to require surgery
v Patients with burns of any significance to the -
hands, face, feet or
perineum
-9 . O Q Q
V Patients whose psychiatric or social background makes it in
-
advisable to send them home
v Any suspicion of non-accidental injury
-
v Any burn in a patient at the extremes of age < loy or > 50yr
v Any burn with associated potentially serious sequelae, including
high-tension electrical burns and concentrated hydrofluoric acid
burns [ Electical burns & Acid burns]
BURN WOUND ASSESSMENT WALLACE RULE (RULE OF 9)
/ Rule used for % BSA BURNT Wallace Rule :
ADULT CHILDREN
BEST
would assessment) Und
method for Browdersa
Burn
Ja %: Head &
neck
J
Head & Neck
I Jurgen
~ ~
v Upperlines
v
Power
PALM - -
>
perinum
limb
>
-
LOWER
LIMB
if age is
T
17 15 % BSA BURNT
not
-
# I
I SIGNIFICANT BURN
-
mentioned
+ ↓ +
10%S >
10-soyrs 50yUS
↓ ↓ ↓
1 10 % BSA 20% TBSA 10 % TBSA
BURNT BURNT BURNT
CLASSIFICATION OF BURN WOUNDS BASED ON DEPTH
CRITERIA FIRST SECOND SECOND THIRD FOURTH
DEGREE DEGREE DEGREE DEGREE DEGREE
SUPERFICIAL DEEP
Structures Epidermis Epidermis Spidermis Epidermis
involved
+ +
underlying
Papillary dermis Papillary
+
dermis +
Structure
Dermis
Reticular dermis
Pain + + + + + + ⑦ ⑦ ⑦
Pin quick
sensation
Blisters # ⑦Q ⑦ 10 O ⑦
Color Bright Red motted pink
leathery Charred
Enythema
- Pale Waxy
White
Heels
v ~ ~ X X
Scar
O O ⑦ ⑦ ⑦
Eschar O O v
- -
v ~
layer of Fibrotic tissue
Over the BURNT site .
RESUSCITATION IN BURNS PATIENT
Crystalloids : RL (fluid of choice)
PARKLAND
- -
4ml/kg/%TBSA burnt
- -
FORMULA
-
MOST COMMON FLUID USED: RL
ATLS V
2/19/ % TRSA
I
20 Adult : BURNT
-
- Child : 3/1/ % BSA BURNT
30 L
<
140S
40/Electric : mi/19) % BSA BURNT
BURN
-
30.7BSABURNT
PROTOCOL FOR
ADMINISTRATION
WID , BURNA s
-
be administered In 24hrs
*
Most
S400M1
--
mil /
1st half And half
↓ ↓
Slow I V c
Fast IV
.
in Shus In 16 hrs
4 2 1
50
o= n
thid Home
:
- Exters :
intering - -
↑
some = 110mi/hor
↑
+ 10 + = 100 mill
10
4O 10
COLLOIDS
Most commonly used colloid in burn resuscitation: Human Albumin Solution
Ideal time to administer colloids : > 24HUS
~
We (kg) % TBSA A portion
of Colloid
=
X
MUIR AND BARCLAY 0 5
.
x
12hor 12 Do 12 Dr
- L
PROTOCOL FOR ADMINISTRATION: 41414 616 12
BURN WOUND MANAGEMENT
Topical agents Pseudomonas Gram Eschar Side effect
negative
1. 1% silver NOT
mic sulphadiazine & + + + + +
EFFECTIVE
*
cream
2. 0.5% silver NOT *
nitrate + +
+ + + Blackening
EFFECTIVE of skin
solution
3. Mafenide Can Penetral Pain **
+ +
acetate cream * M Acidosis
Eschar
.
4. Silver
BEST
sulphadiazine + + + + + +
can
①
Penetrate
and cerium
nitrate Eschar
PYQ
* / method for Burn Wound assessment : Wallace Rule
* BEST 11 II 17 1) : Lund a Browders Chart
* Fluid of Choice : RL
* method used for
Caliculating BURN FWID : A TLS
.
* M/ organism BURN WOUND INFECTION :
Pseudomonas
*
Mic
malignany post BURNS : ow grade So-call Carcinoma of stain
MARTOLINS
VICER
* / immediate 0 of Death :
Asphyxia > Neurogenic Shock
* Hypovolemic
Mic Early ② " 1)
:
shock
* M/c Delayed O Il : Sepsis/SepticShock
* /c Overall / !
Sepsis
