Title Page

Emergency Department

Thermal & Electrical

BURN
Int.Warongkorn Lakanawiwat
Title Page Pathophysiologic

Pathophysiologic

Guilabert, Patricia & Usúa. (2016). Fluid resuscitation management in patients with burns:
Update. British Journal of Anaesthesia. 117. 284-296. 10.1093/bja/aew266.
Title Page Pathophysio Initial

Initial evaluation and treatment

Initial evaluation
and treatment
1. Primary survey and resuscitation
2. Patient assessment; Hx, Types, Depth, BSA
3. Secondary survey and related adjuncts
 Title Page Pathophysio Primary survey

Initial evaluation and treatment

Primary survey and resuscitation

1st STOP THE BURNING PROCESS

•Completely remove the patient’s clothing
•Decontaminate the burn areas: warm saline irrigation, rinsing warm shower
•Once burn stopped —> prevent hypothermia with warm, clean, dry linens
 Title Page Pathophysio Primary survey

Initial evaluation and treatment

Primary survey and resuscitation

Signs of inhalational injury

History of flame burns or burns in an enclosed space
Full-thickness or deep dermal burn to face, neck or upper thorax
Singed nasal hair
Carbonaceous sputum or carbon particle in oropharynx
 Title Page Pathophysio Primary survey

Initial evaluation and treatment

Primary survey and resuscitation

Indication for Early intubation

Advanced Trauma Life Support Course, 10th Edition

 Title Page Pathophysio Primary survey

Initial evaluation and treatment

Primary survey and resuscitation

Adequate ventilation

•Burn injury —> inhalation injury, circumferential chest burn —> HYPOXIA
•Assume CO exposure in patient burned in enclosed areas
•Breathing 100% oxygen —> HbCO half-life can be reduced to 40 mins
•Any patient suspected CO exposure should receive high-flow 100% oxygen
via non-rebreathing mask
•Pulse oximetry cannot distinguish HbO2 from HbCO —> ABG should be obtained
 Title Page Pathophysio Primary survey

Initial evaluation and treatment

Manage circulation with burn shock resuscitation

resuscitation fluids for deep partial and full thickness burn

•Adults : >20% TBSA

•Children: ≥15% TBSA
•Infant: ≥10% TBSA
Title Page Pathophysio Primary survey

Initial evaluation and treatment

1/2 of volume —> first 8 hours

Remaining 1/2 of volume —> subsequent 16 hours
 Title Page Pathophysio Primary survey

Initial evaluation and treatment

Patient assessment
 Title Page Pathophysio Primary survey

Initial evaluation and treatment

Patient assessment
Title Page Pathophysio Primary survey

Patient assessment
Title Page Pathophysio Primary survey

Patient assessment
 Title Page Pathophysio Primary survey Secondary survey

Initial evaluation and treatment

Baseline determinations

•CBC
•ABG with HbCO
•Serum glucose
•Electrolytes
•UA
•BUN/Cr ratio
•CXR (intubated, suspected inhalation injury)
Title Page Pathophysio Primary survey Secondary survey

Initial evaluation and treatment

Secondary survey and related adjuncts

Gastric tube insertion

-N/V, abdominal distension, burn>20%TBSA

Narcotics, analgesics, and sedatives

-simple covering the wound will decrease the pain.

Advanced Trauma Life Support Course, 10th Edition

Title Page Pathophysio Primary survey Secondary survey

Initial evaluation and treatment

Secondary survey and related adjuncts

Antibiotics
-no indication for prophylactic ATB,
use for treatment infection.

Tetanus

Advanced Trauma Life Support Course, 10th Edition

Title Page Pathophysio Primary survey Secondary survey

Secondary survey and related adjuncts

Wound care
•Clean with soap and water
•Superficial wound: lotion, aloe vera
•Partial/full thickness wound: topical ATB (silveron)
 Title Page Pathophysio Primary survey Secondary survey Unique burn

burn injuries

Unique burn injuries

Electrical burn
•Devastating injuries that result in injury to the skin as well as other
tissues including nerve, tendons, and bone

Mx
•ATLS + EKG
•Evaluate N/V status
•Beware compartment syndrome >> fasciotomy
•Myoglobinuria >> IV fluid
 Title Page Pathophysio Primary survey Secondary survey Unique burn Refer

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Criteria for Burn center

1. Partial thickness burns > 10% TBSA
2. Third degree burns in any age group
3. Burns that involve the face,hands,feet,genitalia,perineum or major jounts
4. Electrical burns,including lightning injury
5. Chemical burn
6. Inhalation injury
7. Burn injury in patients with preexisting medical disorders
8. Any patients with burns and concomitant trauma (such as fractures) in which the burn injury
poses the greatest risk of morbidity or mortality.
9. Burned children in hospitals without qualified personnel or equipment for the care of children
10. Burn injury in patients who will require special social, emotional, or rehabilitative intervention

Excerpted from Guidelines for the Operation of Burn Centers (pp.79-86), Resources for Optimal Care of the Injured Patient 2006,
Committee on Trauma , American College of Surgeons
Title Page Pathophysio Primary survey Secondary survey Unique burn Conclusion

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Take home message

•Stop burning process
•ATLS: ABCDE
•Area of burn assessment
•Adequate fluid resuscitation
•Pain control
•Tetanus prophylaxis
•Appropriated wound management
 Title Page Pathophysio Primary Secondary survey Unique burn Take Conclusion References

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References
Title Page Pathophysio Primary Secondary survey Unique burn Take Conclusion References

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