BURN , COLD INJURY

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BURN , COLD INJURY

• 90-02-24
• ?????
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• INJURY DUE TO BURN AND COLD

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OBJECTIVES

• Estimate burn size, and determine presence of
  associated injuries.
• Outline innitial stabilization, treatment
  measures, and transfer criteria.
• Identify special problems and methods of
  treatment.

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BURN / COLD INJURIES

• Management Principles
• Timely application
• Maintain
• Airway
• Hemodynamic stability
• Fluid / electrolyte balance
• Normal body temperature
• Prevent complications

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• Injury Due To Burn

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LIFE-SAVING MEASURES

• Establish airway
• Identify signs of distress
• Initiate supportive measures
• Obtain history

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• CLINICAL INDICATIONS
• Carbonaceous sputum
• Facial burns
• Hair singeing
• Carbon deposites
• Inflamed oropharynx
• History
• Inhalation Injury

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LIFE-SAVING MEASURES

• Remove all
• Injurious material
• Clothing, jewelry
• Prevent hypothermia
• Two, large-caliber Ivs
• Ringers lactate

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ASSESSMENT

• History
• Mechanism of ijury
• Associated illness
• Allergies
• Tetanus status

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• Rule of Nines

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ASSESSMENT

• Estimate Burn Size
• Surface of patients palm represents 1 body
  surface area

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• Second-degree Burn

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• Third-degree Burn

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MANAGEMENT

• Airway
• Assess for injury
• Establish and maintain patient airway early

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• Inhalation Injury
• Early Management

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MANAGEMENT

• Breathing
• Assume CO exposure
• Inhalation of toxic fumes or carbon particles
• Direct thermal injury

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MANAGEMENT

• Breathing
• Oxygen / ventilate
• Endotracheal intubation
• ABGs
• Carboxyhemoglobin levels

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MANAGEMENT

• Circulation
• Monitor vital signs
• Hourly urinary outputs
• Adult 30 50 mL / hr
• Child 1.0 mL / kg / hr

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MANAGEMENT

• Circulation Estimate of Fluid Needs
• 2 4 mL Ringers lactate / kg / BSA in first
  24 hours
• One-half in first 8 hours
• One-half in next 16 hours
• Based on time from injury
• Monitor patient response

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MANAGEMENT

• Develop Treatment plan
• Estimate burn size / depth
• Identify associated injuries
• Weigh patient
• Baseline blood analyses
• Chest films
• Document on flow sheet

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MANAGEMENT

• Maintain Peripheral Circulation
• Remove all connstricting devices
• Assess distal circulation
• Escharotomy surgical consultation

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Escharotomy Sites
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Escharotomy
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MANAGEMENT

• Nasogastric Intubation
• Nausea, vomiting, distention
• Burn gt 20 BSA
• Medications
• Narcotics Spare use, IV only
• Antibiotics Not indicated early

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MANAGEMENT

• Wound Care
• Cover with clean linen
• Do not
• Break blisters
• Apply antiseptics
• Apply cold water

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MANAGEMENT

• Acid / Alkali Burns
• Duration, concentration, and amount
• Flush with copious amount of water for 20 30
  minutes
• Brush away dry chemical before irrigation

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Chemical Burns
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Fasciotomy Electrical Burn

• Electrical burn result in damage to the fascia
  and muscle, and may spare the overlying skin

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MANAGEMENT

• Electrical Burn
• ABCs
• Myoglobinuria
• ?Fluid 100 mL urine / hr
• Mannitol 25 g IV
• Metabolic acidosis
• Maintain adequate perfusion
• Sodium Bicarbonate

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TRANSFER CRITERIA

• 2nd, 3rd degree burns gt 10 BSA in age lt 10 and gt
  50 years
• 2nd, 3rd degree burns gt 20 BSA
• 2nd, 3rd degree burns to face, eyes, ears, hands,
  feet, genitalia, perineum, and major loints

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TRANSFER CRITERIA

• 3rd degree burns gt 5 BSA
• Electrical and chemical burns
• Inhalation injury
• Pre-existing illness, associated injuries
• Children
• Special situations

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TRANSFER PROCEDURE

• Coordinate with burn-center physician
• Transfer with all
• Documentation / information
• Laboratory results

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Injury Due To Cold
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COLD INJURY FACTORS

• Temperature
• Duration of exposure
• Enviromental conditions
• Immobilizzation
• Moisture
• Vascular disease
• Open wounds

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TISSUE-FREEZING INJURY FROSTBITE

• 1st Degree Hyperemia, edema
• 2nd Degree Vesicles, parttial-thickness
• skin necrosis
• 3rd Degree Full-thickness skin necrosis
• 4th Degree Skin, muscle, bone necrosis

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Second-degree Frostbite
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Fourth-degree Frostbite
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MANAGEMENT

• Do nor delay
• Remove clothing
• Warmed blankets
• Rewarm frozen part

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MANAGEMENT

• Preserve damaged tissue
• Prevent infection
• Elevate and expose injured part
• Analgesics / tetanus / antibiotics

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HYPOTHERMIA

• Core temperature lt 35 degrees
• Rapid / slow drop in core temperature
• Elderly and children at greater risk
• Low-range thermometer required

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HYPOTHERMIA

• Clinical Findings
• Core temperature lt 35 degrees
• Depressed level of consciousness
• Gray, cyanotic, variable vital signs
• Absence of cardiorespiratory activity

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MANAGEMENT

• ABCs, IV access
• Oxygenate and ventilate
• Prevent heat loss and rewarm
• Assess for associated disorders
• Blood analyses

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MANAGEMEN

• Passive External Rewarming
• Warm enviroment
• Warmed blankets and IV fluids
• Active Core Rewarming
• Surgical rewarming techniques
• Do not delay transfer
• Not dead until warm and dead

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SUMMARY

• Burn Injury
• Recognize inhalation injury
• Establish airway
• Fluid resuscitation
• Rremove all clothing

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SUMMARY

• Burn Injury
• Identify extend, depth of burn
• Establish fluid guidelines
• Initiate burn flow sheet
• Obtain baseline lab / radiology
• Maintain peripheral circulation
• Identify burns requiring transfer

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SUMMARY

• Cold Injury
• Diagnose type
• History
• Clinical finding
• Measure core temperature
• Rewarming techniques
• Monitor and support vital signs