The EM Burns section provides High Yield information for the Medical School, Residency, and in the future career as a Physician. Prepare and Learn Ahead! Educating, Preparing, and Proving high-yield content, quizzes, and medical resources. to students who are interested in the medical field.
First degree burn
- Presentation:
- only epidermis involved
- area is painful and erythematous
- No blisters
- capillary refill intact
- Looks like sunburn
Second degree burn
- epidermis and partial thickness of the dermis are involved.
- area is painful and blisters are present
Third degree burn
- epidermis
- full thickness of the dermis, and potentially deeper tissues are involved
- area is painless, white, and charred
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Circumferential Burns
- Management: Consider escharotomy
Rule of 9s
| Adults | Estimate % BSA in adults Head & each Arm = 9% Back and Chest each = 18% Each Leg = 18%- Perineum = 1% |
| Children | Head = 18% Each Arm = 9% Back and Chest each = 18% Each Leg = 14% |
Burn Work up and Tx
- Parkland Formula:
- Kg x % BSA x 3-4
- Kg x % BSA x 2-4
- Give ½ over the 1st 8hrs and the rest over next 16hrs
- Ringers lactate or normal saline
- NO PO or IV abx: Give topical.
- Doesn’t penetrate eschar and can cause leukopenia: Silver Sulfadiazine
- Penetrates eschar but hurts like hell: Mafenide
- Doesn’t penetrate eschar and causes hypo-K and HypoNa: Silver Nitrate
Burn Checklist
- Singed nose hairs, wheezing, soot in mouth/nose = Low threshold for intubation
- Patient w/ confusion, HA, cherry-red skin:
- –Best test: Check carboxyHb (pulse ox = worthless)
- -Treatment: 100% O2 (hyperbaric if CO-Hb is ↑↑↑
- Chemical burn: Irrigate >30min prior to ER
- Electrical Burn, best 1st step: EKG!
- If abnormal: 48 hours of telemetry (also if LOC)
- If urine dipstick + for blood but microscopic exam is negative for RBCs? Myoglobinuria -> ATN
- Then what do you check: K+! (When cells break)
- If the affected extremity is extremely tender, numb, white, cold with barely dopplerable pulses: Compartment syndrome!!
- –Criteria: 5 Ps or compartment pressure >30mmHg
- –Treatment: May require fasciotomy. (at bedside!)
Urine Output
- Adult – 1ml per 1 kg per 1 hour.
- Child – .5ml per 1 kg per 1 hour.
Burn Complications
| Infectious | pseudomonal infection |
Burn Management
| Supportive Measures | tetanus stress ulcer prophy IV narcotic analgesia |
| Monitor | Count respirations for Opioid overdose |
| Antimicrobial Prophylaxis | topical silver sulfadiazine and mafenide |
| Medication | IV route preferred – act quickly and act fast. If IM injections are going to work, you need adequate perfusion to the muscle. Albumin: Holds onto fluid in vascular space ▪ Vascular volume INCREASES. ▪ Kidney perfusion INCREASES. ▪ BP INCREASES. ▪ Cardiac output INCREASES. By increasing the vascular volume by giving albumin – the workload of the heart will also increase. Be careful of stressing the heart too much and throwing the client into a fluid volume EXCESS. Monitor: CVP to prevent fluid volume excess CO output decrease and lung crackles – Fluid volume excess |
| Fluid Goal for Fluid Repletion | 1cc/kg/hr of UOP |
| Parkland Formula | Fluids for first 24hrs = 4 (pt weight in kg x %BSA) 50% over 8hrs 50% over next 16hrs Calculate what is needed for the first 24 hours, and give half of the volume calculated during the first 8 hours. 2nd 8 hours – 1/4 of the total volume Same with the 3rd 8 hours. |
| Treatment for Burns > 20-25% TBSA | 1. Fluid Replacement. 2. Emergency Management. 3. Medication Management. 4. Pain Management. |
Indications to Transfer Pt to Burn Center
| – full thickness burn >5% of BSA – partial thickness burn >10% BSA – any full or partial burn over critical areas (face, hands, feet, genitals, perineum, major joints) – circumferential burns; chemical, electrical, or lightning injury; inhalation injury – any special psychosocial or rehabilitative care needs |
Immunization for Burn patient
- The Tetanus Toxoid – it is a form of active immunity and can take up to 2-4 weeks to develop own immunity.
- Over 10 years or they can’t remember:
Airway Injury
- Signs:
