Thermal Burns

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Thermal Burns

• Tricia Ann Missall
• March 27, 2007

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Approach to Thermal Injury

• Initial assessment ABCs
• Resuscitation
• Assessing and classifying burn wounds
• Area
• Depth
• Management
• Surgical implications

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Thermal injury

• 2/3 of all burns occur at home
• gt 2 million burn injuries each year in US require
  medical attention
• 50,000-75,000 require hospitalization
• 25,000 of them remain for gt 2 months
• 14,000 deaths/yr in US from burns
• 75 from house fires
• Advances in treatment / management
• Improved understanding of resuscitation
• Enhanced wound coverage and infection control
• Better support of hypermetabolic response
• Improved treatment of inhalation injuries

Demling, 2007 Wolf and Herndon, 2004
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Initial Assessment

• Inhalation injury - Major cause of death in burn
  patients
• Carbon monoxide poisoning
• Heat injury to airway
• Inhalation of noxious gases
• Anticipate laryngeal edema and intubate if
  inhalation injury is suspected

Cohen and Moelleken, 2006 Morgan and Miser, 2007
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Resuscitation

• Massive release of inflammatory mediators
• Results in generalized / systemic symptoms
• Accelerated fluid loss need vascular access
• Parkland formula 4 ml/kg per TBSA crystalloid

Cohen and Moelleken, 2006 Wolf and Herndon, 2004
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Assessment of burn injuries

• Extent / Surface area ( TBSA)
• Use rule of nines for quick estimation
• Depth
• Gives severity/degree of burn
• Terminology changing, but same concept
• Determine grade of burn
• Based on TBSA and other factors

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Rule of 9s

• Head 9
• Arm 9
• Leg 18
• Trunk front 18
• Trunk back 18
• Perineum 1

Wolf and Herndon, 2004
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Depth

• Superficial / 1st degree
• Superficial partial-thickness / 2nd degree
• Deep partial-thickness / 3rd degree
• Full thickness / 4th degree

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Superficial / 1st degree

• Red
• Blanch
• Painful
• Heals 3-6 days

Demling, 2007 Morgan et al., 2000
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Superficial partial-thickness / 2nd degree

• Blistering
• Blanch with pressure
• Moist, red, weeping
• Painful to temp and air
• Heals 7-20 days

Demling, 2007 Morgan et al., 2000
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Deep partial-thickness / 3rd degree

• Blisters unroof easily
• Do not blanch
• Waxy dry or wet
• Patchy to cheesy white to red
• Perceptive of pressure only
• Heals gt21 days

Demling, 2007 Morgan et al., 2000
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Full thickness / 4th degree

• Waxy white or leathery gray
• Dry and inelastic
• No blanching
• Insensate
• Never heals if gt2TBSA
• Requires surgical treatment

Demling, 2007 Morgan et al., 2000
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American Burn Association grading system for burn
injury
Young/old lt10 or gt50 yrs
Hartford, 1990
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BurnManagement

• Outpt vs inpt vs burn center
• Fluids / calories
• Pain management
• Infection prevention
• Surgical implications
• Debridement
• Fasciotomy
• Escharotomy
• If circulation or ventilation is compromised
• Chest burns or circumferential extremity burns
• Skin grafts / skin substitutes

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Determining size of burn
Demling, 2007