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
- 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
- full thickness of the dermis, and potentially deeper tissues are involved
- area is painless, white, and charred
Craig0927 / Public domain
- 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
- 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!)
- Adult – 1ml per 1 kg per 1 hour.
- Child – .5ml per 1 kg per 1 hour.
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.
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.
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: