BURNS
SILVA, GWYNETH MARIE L.
INITIAL EVALUATION
Four crucial assessments:
● Airway management
● Evaluation of other injuries
● Estimation of burn size
● Diagnosis of CO and cyanide poisoning
AIRWAY MANAGEMENT
● Rapid and severe airway edema is potentially lethal
○ With direct thermal injury to the upper airway
○ Smoke inhalation
● Anticipating the need for intubation and establishing an early airway are
critical.
● Signs of impending respiratory compromise
○ Hoarse voice, wheezing, or stridor; subjective dyspnea is a
particularly concerning symptom and should trigger prompt elective
endotracheal intubation.
● Orotracheal intubation is the preferred method for securing the airway.
● Nasotracheal intubation
○ Useful for patients with associated facial trauma when experienced
providers are present
○ Avoided if oral intubation is safe and easy.
PRIMARY SURVEY & IV ACCESS
Primary Survey:
● Evaluate injuries systematically (ATLS).
● Initiate fluid resuscitation during survey.
IV Access:
● Use two large-bore peripheral IVs for burns >40% TBSA.
● Burned skin is safe for IV placement; secure catheters
carefully.
● Consider central or intraosseous access if peripheral access
fails.
SECONDARY SURVEY & IMAGING
Secondary Survey:
● Assess associated trauma (e.g., falls, collisions).
● Radiology: Urgent (e.g., chest X-ray) vs. non-urgent imaging
(extremities).
Hypothermia:
● Common prehospital complication that contributes to
resuscitation failure
● Use clean blankets during transport.
● Avoid cooling for burns >20% TBSA.
INFECTION PREVENTION AND
VACCINATION
Prophylactic Antibiotics:
● Contraindicated → Promotes resistant organisms and fungal
infections.
Tetanus Booster:
● Administer as needed based on immunization status.
PAIN & ANXIETY MANAGEMENT
Pain Control:
● Use multimodal strategies to minimize opioid use.
● Establish an opioid weaning plan early.
Anxiety Management:
● Conservative use of benzodiazepines to reduce delirium
risks.
ESTIMATING BURN SIZE
Methods:
● Rule of Nines: Quick and effective.
● Rule of Palm: Palmar surface = 1% TBSA.
● Lund & Browder Chart: Accurate for children and adults.
Key Considerations:
● Exclude superficial burns from TBSA.
● Clean soot/debris before estimation.
CHALLENGES IN BURN SIZE ESTIMATION
Physician Bias:
● Small burns often overestimated.
● Large burns often underestimated.
Impact: Misjudgments can lead to inadequate resuscitation
efforts.
BURN CLASSIFICATION
Categories:
● Thermal Burns: Flame, contact, scald.
● Electrical Burns.
● Chemical Burns.
Key Concerns: Injury mechanism dictates management.
THERMAL BURNS
Flame Burns:
● Most common for hospital
admissions.
● Highest mortality due to
inhalation injury and CO
poisoning.
Common Causes: Structural
fires.
ELECTRICAL BURNS
Incidence:
● 3% of U.S. burn admissions.
Special Concerns:
● Cardiac arrhythmias → Baseline ECG
recommended.
● High-voltage (>1000 V): Risk of
rhabdomyolysis and compartment syndrome
→ Fasciotomies may be required.
● Long-term complications: Neurologic
symptoms, cataracts.
Management: Neurologic and ophthalmologic
evaluations advised.
CHEMICAL BURNS
Incidence:
● 3% of burn admissions.
Mechanisms:
● Acid chemical burns: Coagulation necrosis.
● Alkali chemical burns: Liquefactive necrosis (e.g.,
hydrofluoric acid).
Initial Treatment:
● Remove toxic agents.
● Irrigate with water (≥30 minutes).
● Avoid water for dry chemicals (e.g., lye, concrete).
HYDROFLUORIC ACID BURNS
Unique Challenges:
● Causes hypocalcemia, progressive tissue damage, and pain.
Treatment:
● Topical: Calcium gluconate.
● Systemic: IV calcium gluconate for hypocalcemia.
● Advanced: Intra-arterial calcium gluconate infusion →
Requires continuous cardiac monitoring.
Emergent Care: Persistent hypocalcemia with ECG changes →
Burn excision.
BURN DEPTH CLASSIFICATION
Types of Burns:
● First-Degree: Superficial
(e.g. sunburn)
● Second-Degree: Partial-
thickness
(superficial/deep).
● Third-Degree: Full-
thickness.
● Fourth-Degree: Involves
underlying soft tissue.
● Fifth-Degree: Rare; involve
muscle and bone.
● Sixth-Degree: (charring
CLINICAL CHARACTERISTICS BY BURN
First-Degree: DEPTH
● Painful, no blisters.
Second-Degree:
● Dermal involvement;
extremely painful, weeping,
blisters.
Third-Degree:
● Leathery, painless,
nonblanching.
ZONES OF TISSUE INJURY (JACKSON’S
Zone of Coagulation: MODEL)
● Central, most severe, necrotic
tissue → Requires excision/grafting.
Zone of Stasis:
● Peripheral, ischemic, variable
outcomes.
● Appropriate care prevents wound
deepening.
Zone of Hyperemia:
● Outermost, minimal damage →
Heals without scarring.
CLINICAL RELEVANCE OF BURN DEPTH
Partial-Thickness Burns:
● Superficial: Heal non-operatively.
● Deep: Often require excision and grafting.
Wound Evolution:
● Burn depth can evolve over 48–72 hours.
● Infection or poor perfusion may worsen depth.
BURN DEPTH ASSESSMENT TOOLS
Advanced Techniques:
● Full-Thickness Biopsy: Accurate but painful and slow.
● Laser Doppler: Measures skin perfusion (sensitivity 83%, specificity
97%).
● Noncontact Ultrasound: Painless, allows serial measurements.
Limitations: High cost, limited superiority, and slow adoption in practice.
PROGNOSIS
Key Predictors of Mortality:
● Age.
● Burn size (%TBSA).
● Inhalation injury.
SCORING SYSTEMS
Baux Score:
● Mortality risk = Age + %TBSA.
● Limitations: No longer fully accurate due to advances in
care.
Revised Baux Score:
● Includes age, burn size, and inhalation injury → Strong
predictor of mortality.
MORTALITY FACTORS
Non-Elderly Patients:
● Influenced by comorbidities: HIV, cancer, kidney/liver
disease.
Elderly Patients:
● Age alone is a major determinant.
Additional Risks:
● Coexistent trauma, pneumonia, race, gender, and
hospital type.
QUALITY OF LIFE POST-BURN
Impact Areas:
● Appearance, mobility, functional status, and employment.
Reduction in Quality of Life:
● Short-term: ~30%.
● Long-term: ~11%.
Predictors of Poor Outcomes:
● Older age, female gender, larger %TBSA.
COMPLICATIONS AFFECTING RECOVERY
Physical Issues:
● Itching, hypertrophic scarring, contractures, heterotopic
ossification.
Psychological and Social Impacts:
● Anxiety and difficulty reintegrating into work or school.
RESUSCITATION IN BURN PATIENTS
Key Goal: Maintain intravascular volume to counter capillary
leak from inflammation.
Common Formula:
● Parkland Formula: 3-4 mL/kg/%TBSA of Lactated Ringer’s.
○ 50% in first 8 hours.
○ 50% over next 16 hours.
● New Recommendation: 2 mL/kg/%TBSA to avoid over-
resuscitation
GUIDELINES FOR FLUID ADMINISTRATION
Monitoring Parameters:
● Adults: Urine output ≥ 30 mL/h.
● Pediatrics: 1–1.5 mL/kg/h.
● Maintain Mean Arterial Pressure (MAP) ≥ 60 mmHg.
COMPLICATIONS OF OVER-
RESUSCITATION
Common complications:
● Abdominal, extremity, and intraocular compartment
syndromes.
● Pleural effusions.
Predictors of High Fluid Needs:
● Inhalation injuries.
● Age, weight, %TBSA, and intubation on admission.
Outcomes: Increased risk of complications and mortality.
PEDIATRIC & SPECIAL CONSIDERATIONS
● Children <20 kg: Require glucose supplementation due to
limited glycogen stores.
● Additional Monitoring: Serum lactate and base deficit for
tissue perfusion assessment.
ADJUNCT THERAPIES
Colloids (e.g., Albumin):
● Reduces fluid volume during late resuscitation.
● Mortality benefit remains unclear.
Hypertonic Solutions:
● Reduces total fluid volume but may cause hyperchloremic
acidosis.
High-Dose Vitamin C: Decreases fluid requirements.
TECHNOLOGY IN RESUSCITATION
Bedside Ultrasound:
● Noninvasive cardiac function and volume status
assessment.
● Detects pneumothorax.
Machine Learning:
● Enhances fluid management in the first 48 hours.
BLOOD TRANSFUSION CONSIDERATIONS
Restrictive Strategy:
● Target hemoglobin 7 g/dL vs. traditional 10 g/dL.
● Associated with fewer infections and lower mortality.
Complications: Transfusion-related lung injury,
immunomodulatory effects
INHALATION & VENTILATOR
● MANAGEMENT
Inhalation Injury Prevalence: Present in 35% of
hospitalized burn patients, increasing mortality and
complications.
● Mortality Rates: Up to 25%, escalating to 50% in ≥20%
TBSA burns and 100% in severe ARDS.
● Complications: Pneumonia, ARDS, prolonged hospital
stays, and tracheostomy needs.
MECHANISMS OF INJURY
Upper Airway:
● Heat injury → edema, airway obstruction (maximal
swelling in 24–48 hours).
Lower Airway:
● Combustion product inhalation → inflammation,
mucosal sloughing, bronchoconstriction, and
obstruction.
PHYSIOLOGICAL IMPACTS
● Decreased lung compliance and increased airway
resistance.
● Increased fluid resuscitation needs.
● Enhanced metabolic demands.
DIAGNOSIS
Bronchoscopy:
● Grades injury (0–4), identifies complications, and isolates
pathogens for early pneumonia treatment.
Clinical Indicators:
● Decreased PaO2:FiO2 ratio (<350), carbon deposits,
edema, and bronchorrhea.
Supportive Tools:
● Thoracic CT and xenon ventilation-perfusion scans (less
commonly used).
TREATMENT APPROACHES
Supportive Care:
● Aggressive pulmonary toilet.
● Nebulized bronchodilators (e.g., albuterol), N-acetylcysteine, and
heparin.
Adjunct Therapies:
● Aerosolized anticoagulants (heparin, tissue plasminogen activator).
● Nitric oxide and surfactant as salvage options.
Carbon Monoxide (CO) Poisoning:
● Immediate 100% oxygen therapy.
● Hyperbaric oxygen therapy (select cases).
Cyanide Poisoning:
● Hydroxocobalamin (immediate treatment) and sodium thiosulfate
VENTILATOR STRATEGIES
Lung-Protective Ventilation:
● Low tidal volume (6 cc/kg) reduces mortality.
Prone Positioning:
● Beneficial for refractory hypoxemia; logistical challenges in
burn patients.
High-Frequency Percussive Ventilation (HFPV):
● Promising in inhalation injury, especially for burns <40%
TBSA.
Extracorporeal Membrane Oxygenation (ECMO):
● Reserved for salvage cases; outcomes improving with
increased utilization.
TOPICAL ANTIMICROBIALS
Silver Sulfadiazine
● Properties: Wide antimicrobial coverage, low systemic
absorption, inexpensive, and soothing.
● Limitations:
○ Contraindicated near skin grafts (destroys grafts).
○ May retard epithelial migration in partial-thickness
burns.
○ Rare allergic reactions to sulfa component.
Mafenide Acetate
● Uses: Effective for infected eschar and fresh grafts
(cream/solution).
● Side Effects: Pain on application, historically linked to
metabolic acidosis (rare).
TOPICAL ANTIMICROBIALS
Silver Nitrate
● Features: Broad-spectrum activity (requires 0.5%
dilution).
● Complications: Electrolyte disturbances
(hyponatremia), methemoglobinemia, and black
staining.
Dakin’s Solution (0.5% Sodium Hypochlorite)
● Advantages: Inexpensive and effective alternative.
TOPICAL OINTMENTS
Agents: Bacitracin, Neomycin, Polymyxin B.
Applications:
● Small burns or nearly healed larger burns.
● Superficial partial-thickness facial burns.
● Meshed skin grafts with nearly closed interstices.
Caution: Potential nephrotoxicity with excessive use in
large burns.
MRSA-SPECIFIC TREATMENT
Mupirocin: Use only for culture-positive MRSA burn infections to
prevent resistance.
ADVANCED DRESSINGS
Silver-Impregnated Dressings
● Advantages: Fewer dressing changes, improved comfort,
shorter hospital stay.
● Limitation: Restricts serial wound assessments.
Biologic Membranes (e.g., Biobrane)
● Uses: Fresh, superficial, uncontaminated partial-thickness
burns.
● Function: Prolonged barrier aiding healing under
occlusion.
NUTRITION
Importance of Nutrition
● Critical for immune responsiveness and recovery.
● Hypermetabolic Response:
○ Increases metabolic rates by up to 200%.
○ Leads to muscle protein catabolism and loss of
lean body mass.
○ Delays functional recovery.
EARLY ENTERAL FEEDING
Benefits:
● Reduces lean body mass loss and slows
hypermetabolism.
● Enhances protein metabolism and reduces wound
infections.
● Decreases ICU stay duration.
Strategies:
● Start within hours of admission to prevent gastric
ileus.
● Use metoclopramide or nasojejunal feeding if needed.
● Feeding does not need to be interrupted for OR trips in
SUPPLEMENTATION
Immune-Modulating Supplements:
● Glutamine reduces infection risks (mechanism: prevents
T-cell suppression).
● Antioxidants (vitamin E, ascorbic acid) and trace minerals
(selenium, zinc, copper) support healing and immune
function.
CALORIC NEEDS
Formulas:
● Harris-Benedict Equation: Common but may overestimate
for <40% TBSA burns.
○ Curreri Formula: Suitable for <40% TBSA burns.
■ Formula: 25 kcal/kg/day + 40 kcal/%TBSA/day.
○ Indirect Calorimetry: Optional but not superior to
predictive formulas.
Titration: Avoid overfeeding to prevent fat storage instead of
muscle anabolism.
MODULATING HYPERMETABOLISM
β-Blockers:
● Reduce heart rate, energy expenditure, and protein catabolism
(studied in pediatric burns).
● Limited data for adults; monitor for hypotension and
bradycardia.
Oxandrolone (Anabolic Steroid):
● Improves lean body mass, bone density, and weight gain.
● Associated with reduced mortality and improved functional
recovery.
Glucose Control:
● Intensive Insulin Therapy: Prevents hyperglycemia, enhances
lean body mass, and reduces inflammation.
COMPLICATIONS IN BURN CARE
1. Postinjury Pneumonia
● Common in burn patients, especially with inhalation injuries.
● Prevention Measures:
○ Elevate head of the bed.
○ Maintain oral hygiene and pulmonary care.
● Diagnosis & Management:
○ Use quantitative bronchoscopic cultures to guide
treatment.
○ Early tracheostomy may reduce subglottic stenosis but
does not significantly lower pneumonia rates.
2. Abdominal Compartment Syndrome (ACS)
● Caused by massive resuscitation.
● Symptoms:
○ Increased airway pressures, hypoventilation,
reduced urine output, and hemodynamic
instability.
● Management:
○ Initiate measures like escharotomies, minimizing
fluid, and chemical paralysis.
○ Decompressive laparotomy as a last resort due to
poor prognosis.
● Elevated intraocular pressure may require lateral
3. Deep Vein Thrombosis (DVT) & Pulmonary Embolism
● Up to 25% of burn patients develop DVT.
● Prevention:
○ Low molecular weight heparin prophylaxis is effective
and safe.
● Risks:
○ Heparin-induced thrombocytopenia (HIT):
■ Incidence: ~1.6%.
■ Associated complications: DVT, pulmonary
embolism, and arterial thrombosis.
4. Central Venous Catheter-Related Infections
● Higher risk in burn patients due to anatomical challenges.
● Prevention:
○ Avoid rewiring catheters; use a new insertion site if
possible.
○ Regularly monitor for bloodstream infections.
● Burn ICUs report the highest infection rates among all
ICUs.
SURGERY
1. Compartment Syndrome in Burns
● Causes: Full-thickness burns with rigid eschar and progressive edema.
● Common Sites:
○ Extremities: Circumferential burns.
○ Abdomen: Decreased urine output, hypotension, increased airway
pressures.
○ Thorax: Hypoventilation, increased airway pressures, hypotension.
● Warning Signs:
○ Paresthesias, pain, decreased capillary refill, and loss of distal pulses.
● Treatment:
○ Escharotomies:
■ Performed bedside using electrocautery to minimize blood loss.
■ Incisions placed along anatomical positions: lateral and medial
limbs, anterior axillary lines, and subcostal/subclavicular
extensions.
■ Digital escharotomies not recommended.
2. Early Excision and Grafting
● Benefits:
○ Improved survival outcomes, reduced hospital stays,
and decreased reconstruction surgeries and costs.
● Timing:
○ Begins within the first few days after resuscitation
and hemodynamic stabilization.
○ Larger burns may require serial excisions.
3. Surgical Techniques
● Tangential Excision:
○ Removes layers of tissue with a Watson or Goulian blade until viable
tissue is visible.
○ High blood loss managed with:
■ Epinephrine tumescence solution.
■ Pneumatic tourniquets for extremities.
■ Fibrin sealants (e.g., Tisseel) for hemostasis and graft adherence.
○ Healthy dermis may be preserved when punctate bleeding is evident.
● Fascial Excision:
○ Removes tissue down to fascia using electrocautery.
○ Reduces blood loss but sacrifices subcutaneous tissue, resulting in inferior
cosmetic outcomes.
● Specialized Tools:
○ Pressurized water dissector for precision in delicate areas (face, eyelids,
hands).
WOUND COVERAGE IN BURN CARE
1. Permanent Wound Coverage
● Split-Thickness Sheet Autografts:
○ Durable and cosmetically appealing.
○ Preferred for areas like face, neck, and hands (non-
meshed for better aesthetics).
● Meshed Autografts:
○ Expands coverage for larger burns.
○ Allows drainage to prevent graft loss.
● Meek Micrografting Technique:
○ "Postage-stamp" method achieving up to a 9:1
expansion ratio.
○ Suitable for patients with limited donor sites.
○ Steep learning curve, requiring further research.
2. Temporary Wound Coverage
● Human Cadaveric Allograft:
○ Temporary biologic coverage until donor sites
regenerate.
○ Rejected by the immune system over time.
● Xenografts:
○ Cost-effective alternative to allograft with
similar function.
3. Synthetic Skin Substitutes
● Integra:
○ Bilayer: Porous collagen-chondroitin sulfate inner
layer + outer silastic sheet.
○ Forms a neodermis after vascularization, supporting
thin autografts.
● Alloderm:
○ Cryopreserved acellular human dermis.
● NovoSorb Biodegradable Matrix:
○ FDA-approved biodegradable polyurethane substitute.
● Cultured Epithelial Autografts:
○ Option for extensive burns with limited donor sites.
○ Limitations: Long culturing time and fragile grafts.
4. Donor Sites
● Thighs: Convenient, aesthetically concealed.
● Back: Thicker skin for older patients with healing
challenges.
● Buttocks: Ideal for infants/toddlers with diaper
coverage.
● Scalp:
○ Rapid healing due to abundant hair follicles.
○ Requires epinephrine for hemostasis and smooth
harvesting.
5. Donor Site Dressings
● Options: Transparent films, hydrocolloids,
petrolatum gauze, silver-impregnated dressings.
● Selection Principles:
○ Ease of care, comfort, infection control, cost-
effectiveness.
● Institution-Dependent Practices: No universally
superior dressing identified.
REHABILITATION
Rehabilitation is a critical component of the clinical
care plan for burn patients.
Initiation: Begins on admission to prevent functional
loss and promote recovery.
PHYSICAL AND OCCUPATIONAL THERAPY
Immediate & Ongoing:
● Mandatory to prevent functional loss.
Passive Range-of-Motion (ROM):
● For non-active participants: At least twice daily,
especially for burns over joints (e.g., hands).
Patient Education:
● Teach self-exercises to maintain full ROM.
MOBILITY & EXTREMITY CARE
Foot & Extremity Burns:
● Independent Walking (without crutches) to:
○ Prevent swelling.
○ Desensitize burned areas.
○ Avoid disuse atrophy.
● Elevation of Extremity: When not ambulating,
elevate to reduce swelling.
POSTOPERATIVE CONSIDERATIONS
Graft Care:
● Early & frequent evaluation for graft protection.
● Resume active exercises as soon as possible.
OUTPATIENT TRANSITION
Physical & Occupational Therapy:
● Focus on exercises for:
○ Activities of Daily Living (ADLs).
○ Job-specific tasks.
PRESSURE GARMENTS
Purpose:
● Provide vascular support during healing.
● Help with comfort.
Debated Role:
● Effectiveness in preventing hypertrophic scars remains
unclear.
LATE COMPLICATIONS OF BURN INJURIES
● Hypertrophic scars.
● Contractures.
● Heterotopic ossification (HO).
HYPERTROPHIC SCARS
Symptoms:
● Pruritus, erythema, pain, thickened/tight skin, contractures.
Causes:
● Inflammatory response, neovascularization, abnormal
cytokines, excess collagen.
Nonsurgical Treatments:
● Compression garments, silicone sheeting, massage, physical
therapy, corticosteroids.
Surgical Treatments:
● Scar excision, revision, and laser therapies (PDL & CO₂).
LASER THERAPIES FOR HYPERTROPHIC
Pulsed Dye Laser (PDL): SCARS
● Coagulates small capillaries.
● Improves vascular malformations.
CO₂ Laser:
● Ablates scar tissue.
● Stimulates collagen reorganization.
Benefits:
● Reduces symptoms like pain, pruritus, and contractures.
● Improves scar appearance and pliability.
CONTRACTURES
Definition:
● Restriction of joint motion due to scar or wound contraction.
Prevalence:
● Up to 33% of burn patients.
● Commonly affects shoulders, elbows, wrists, ankles, and knees.
Risk Factors:
● Burn depth, %TBSA, ICU stay duration.
Treatment Options:
● Nonsurgical: Pressure garments, splints, physiotherapy.
● Surgical: Laser therapy, excision.
HETEROTOPIC OSSIFICATION (HO)
Definition:
● Pathologic bone growth in peripheral tissues.
Prevalence:
● 1–3% of burn patients.
Symptoms:
● Pain, swelling, decreased joint mobility.
Risk Factors:
● 30% TBSA, arm burns/grafts, ventilator use, multiple surgeries.
Treatment:
● Physiotherapy, NSAIDs, bisphosphonates, radiation, surgical excision
(rare).
PSYCHOLOGICAL RECOVERY IN BURN
PATIENTS
Importance: Psychological rehabilitation is as critical as
physical recovery.
Common Challenges:
● Depression (4–54%).
● PTSD.
● Body image concerns and social anxiety.
Prevalence:
● Psychological distress affects ~38% of burn patients,
often persisting post-discharge.
FACTORS INFLUENCING PSYCHOLOGICAL
Depression: OUTCOMES
● Higher risk in women.
● Affects up to 43% of patients 2 years post-injury.
PTSD Contributors:
● Gender, forgiveness capacity, trauma context, alcohol use,
emotional response.
Coping Support:
● Clinical psychologists and psychiatrists play a vital role in
providing coping strategies.
Goal Setting:
● Encourage return to work/school to foster recovery.
BURN PREVENTION STRATEGIES
Cornerstone for burn prevention programs
● The Five Step Process:
○ Assessing, implementing, evaluating burn hazards
and, subsequent intervention impact
The Five E’s:
● Engineering/Environment.
● Enforcement.
● Education.
● Emergency response.
● Economic initiatives.
SUCCESSFUL BURN PREVENTION
Education Programs: INITIATIVES
● School-based and community interventions improve
safety awareness.
● Long-term retention seen in school-age children.
Smoke Alarms:
● Proven to reduce mortality but require long-term
maintenance efforts.
Hot Water Temperature Regulation:
● Effective when combined with community education and
inspections
CHALLENGES IN PREVENTION
Knowledge Gaps:
● Many patients lack awareness of burn prevention
strategies.
● Burn professionals also need better education on fire
safety and prevention best practices.
Global Perspective:
● Success seen in low- and middle-income countries
through tailored prevention programs.
BURN DISASTERS
Challenges:
● Sudden events, resource limitations, and lack of burn-
specific expertise.
Statistics:
● Up to 30% of mass casualty patients have burn injuries.
● 752 burn disasters recorded globally (1990–2016).
● Predominantly in Asia & Middle East due to
industrialization, poor fire prevention, and building codes.
PREPAREDNESS FOR BURN DISASTERS
Key Aspects:
● General surgeons must handle initial care for up to 72
hours.
● Initial actions include evaluation, resuscitation,
intubation, and escharotomies.
Coordination Levels:
● Institutional, interfacility, and regional.
Resource Allocation:
● Utilize the American Burn Association Age/TBSA
survival grid.
●
CHEMICAL WARFARE AND BURNS
White Phosphorus:
● Highly corrosive, causes cardiac effects
(hypocalcemia, hyperphosphatemia).
● Treatment: irrigation, cool saline gauze, surgical
excision.
Sulfur Mustard (Mustard Gas):
● Causes blistering, mast cell degranulation.
● Treatment: scrubbing, irrigation, and traditional
burn care.
THANK
YOU!
