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Burns :fire: (Chemical
Alkali
way worse
Acid
Pt:
someone…
Burns :fire:
Chemical
Pt:
- someone who has burned skin or eyes :eyes:
-
neutralize, converts to thermal burn
- irrigate for a long time :potable_water::sweat_drops::sweat_drops:
- accidental ingestion
-
neutralize
-
induce emesis
-
NG lavage
- serial exams (CXR, NPO, watchful waiting) :eyes::timer_clock:
- eventually EGD (grading) :telescope:
- OR :hocho:
Respiratory Burn
Pt: Closed fire (in the bldg), near explosions :fireworks: :explode:
- inhalation of smoke or chemicals
- may not look bad, but burns in airway get edematous (close off)
- stridor đŸ’¨
- soot at nares, singed nares :nose::skin-tone-5:
Dx:
- ABG
- SpO2
- peak flows
- deterioration = intubation
- not sure? broncoscopy :telescope:
Tx: intubate
Electrical Burns :zap:
Pt: struck by lightning :lightning:
- or touched high volt. wires :hand::skin-tone-3::zap:
- :zap: burns have entrance and exit wounds
- follows path of least resistance
- heats up tissue
- :<3: arrhythmias (death after strike)
- :skull_and_crossbones: rhabdo : bones char muscles surrounding them :meat_on_bone:
- Posterior dislocation of shoulder
- only occur in :lightning:lightning strikes & seizures
Dx:
- what's the next step on a lightning strike patient? = CK level, then creatinine
- (+) blood on urine dip, (-) RBC : myoglobinuria
Tx: IVF :ocean: & mannitol
Circumferential Burns
Pt: compromises vascular supply
- eschar makes a lot of edema, crushing artery
Dx: clinical
Tx: Cut the eschar :hocho:
- removes the pressure
- done at bedside, no anesthesia
Pretest (surgery)
- Fasciotomy >> escarotomy : compartment syndrome 2/2 burn
- alveoli damage can cause infx, common cause of death
- electricity can cause cataracts :eyes:
1st
- Sunburn :sunny:
- intact epidermis
- erythema
- warmth :hotsprings:
- some pain
- 1st degree burns don't count
- no tx
- no volume resuscitation
- integument intact
2nd
- Partial thickness
- erythema
- warmth :hotsprings:
- increased pain
- blisters
3rd
- Full thickness burn
- thru the dermis
- muscle & bone exposed :skull_and_crossbones:
- no pain
- white charred region of flesh
- always surrounding 2nd degree burn
When to refer to a burn center:
- hands :hand::skin-tone-4:
- face :man::skin-tone-2:
- genitals
10% of surf area on body
- :black_circle: circumferential burns
How to calculate body surface area: Parkland formula
- rule of 9's & 50-50 8-16
- only 2nd & 3rd degree burns, duh
- Parkland: how much fluid in 24hr
- basically everything is 9% for each side
- exception is arms which are 4.5% for ea side
- genitals are 1%
Tx: early movement!
early grafting!
- this sucks, encourage them to move
- then adequately control px
- infx ABx : Topical mupiricin, Silver sulfadiazine, Mafenide
-
PO Abx, PO steroids
- recognize and ID thermal burns
- grade by degree
- fluid, resuscitation management tools
- ∆ types of burns other than thermal, & what to do