Burn Management: Assessment, Resuscitation, and Rehabilitation

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What is the primary reason for keeping the environment warm during assessment?

To prevent heat loss in the patient (correct)

To facilitate calculation of burn size

To improve visibility of the affected skin

To reduce anxiety in the patient

What is the percentage of deep partial thickness burns that indicates futile care?

>60%

>70%

>80% (correct)

>90%

Which of the following patient groups does NOT require extra fluid requirements?

Dehydrated patients

Electrical injury patients

Elderly patients (correct)

Inhalational injury patients

What is the primary goal of in-hospital care for burn patients?

Prevent sepsis and cover wounds Signup and view all the answers

What is the primary determinant of mortality rate in burn patients?

Surface area involved Signup and view all the answers

What is the maximum percentage of total body surface area that can be covered in a single sitting with autologous split skin grafts?

20% BSA Signup and view all the answers

What is the starting point for fluid resuscitation calculation?

Time of injury Signup and view all the answers

What is the primary purpose of the Parkland's formula?

To estimate the probable amount of fluid required Signup and view all the answers

Who is involved in the rehabilitation team for burn patients?

Physician, social worker, psychologist, dietician, and pastor Signup and view all the answers

What is the primary goal of early enteral feeding in burn patients?

To prevent malnutrition Signup and view all the answers

What is the recommended course of action for pigmented skin during assessment?

Remove all loose epidermal layers to calculate burn size Signup and view all the answers

What is the purpose of post-graft splinting in burn patients?

To improve range of motion Signup and view all the answers

What is the primary reason for keeping a burn patient warm during the initial assessment?

To prevent hypoperfusion and deepening of burn wounds Signup and view all the answers

What is the primary purpose of the secondary survey in burn patient assessment?

To identify concomitant injuries Signup and view all the answers

What is the most accurate method of estimating burn area in adults?

Lund and Browder Chart Signup and view all the answers

Why should erythema not be included when calculating burn area?

Because it can lead to an overestimation of burn area Signup and view all the answers

What is the primary advantage of the Lund and Browder Chart in assessing burn area?

It compensates for variation in body shape with age Signup and view all the answers

What is the primary reason for using a urinary catheter in burn patients with >20% TBSA burns?

To monitor fluid output Signup and view all the answers

What is the recommended dose of IV morphine for burn patients?

A dose titrated against pain and respiratory depression Signup and view all the answers

What is the primary advantage of the palmar surface method in assessing burn area?

It is useful for estimating small burns Signup and view all the answers

What is the primary goal of the initial assessment of a major burn patient?

To identify and manage any associated life-threatening injuries Signup and view all the answers

What is the indication for intubation in a burn patient?

Erythema or swelling of oropharynx on direct visualisation Signup and view all the answers

What is the effect of carbon monoxide on the body?

It binds preferentially to hemoglobin and intracellular proteins, leading to intra- and extracellular hypoxia Signup and view all the answers

What is the treatment for carbon monoxide intoxication?

Administration of 100% oxygen Signup and view all the answers

What is the indication for ventilation in a burn patient?

CXR shows an ARDS-like picture Signup and view all the answers

What is the primary focus of the 'C' part of the primary survey in a burn patient?

Establishment of IV access Signup and view all the answers

What is a complication of electrical burns?

Cardiac dysrhythmias Signup and view all the answers

What is the purpose of escharotomies?

To relieve mechanical restriction of breathing Signup and view all the answers

What is a sign of inhalational injury?

Singed nasal hair Signup and view all the answers

What is the goal of the primary survey in a burn patient?

To identify and manage any associated life-threatening injuries Signup and view all the answers

Study Notes

Management of Burns

Burns can be caused by thermal energy, electrical energy, and chemical energy (acid or alkaline)
Initial assessment of a major burn involves a modified ATLS primary survey, with emphasis on airway and breathing assessment
Burn injury must not distract from sequential assessment, as serious associated injuries may be missed

Initial Assessment of a Major Burn

Primary survey:
- A: Airway with C Spine Control
  - Assess for compromised or at-risk airway
  - Signs of inhalational injury: history of flame burns, deep dermal or full-thickness burns to face, neck, or upper torso, singed nasal hair, or carbonaceous sputum
- Indications for intubation: erythema or swelling of oropharynx, change in voice, stridor, tachypnoea, or dyspnoea
Breathing:
- All burn patients should receive humidified oxygen via a non-rebreathing mask
- Compromise can occur via mechanical restriction, blast injury, or smoke inhalation
Carboxyhaemoglobin:
- CO binds preferentially to Hb and intracellular proteins, leading to intra- and extracellular hypoxia
- Signs of CO intoxication vary with COHb levels
- Rx with 100% oxygen, and ventilate patients with COHb levels > 25-30%

Initial Assessment (Continued)

Circulation:
- Establish IV access with 2 large-bore cannulas, preferably through unburnt skin
- Hypovolaemia is not a normal initial response to a burn
D - Neurological Disability:
- Assess GCS
- Confusion may be due to hypoxia or hypovolaemia
E - Exposure with Environmental Control:
- Fully assess burn area and depth
- Check for concomitant injuries
- Keep warm to prevent hypothermia
F - Fluid Resuscitation:
- Use guidelines
- Urinary catheter mandatory in burns > 20% TBSA
- Analgesia: IV morphine titrated against pain and respiratory depression

Assessment of Burn Area

3 commonly used methods: palmar surface, Wallace rules of nines, and Lund and Browder chart
Erythema should not be included in burn area calculation
Palmar surface: surface area of pt's palm is roughly 1% TBSA, but less accurate for medium-sized burns
Wallace rules of nines: quick way to estimate large burns in adults, but not accurate in children
Lund and Browder chart: most accurate method, compensates for variation in body shape with age, and gives accurate assessment in children

Assessment and Resuscitation

Minor burn: TBSA < 15% in adults and < 10% in children warrant formal resuscitation
Parkland's formula: pure crystalloid formula, easy to calculate, and rate is titrated against urine output
Fluid resuscitation regimens: guidelines for probable amount of fluid required, continuously adjust according to urine output, pulse, BP, and RR
Regular investigations: plasma sodium, base excess, lactate, and packed cell volume

Transfer and Care

Who to transfer: adults with > 10% FT, > 20% deep partial, flexors, perineum, inhalation, head and neck, and children with > 5% FT, > 10% deep partial
When is care "futile": > 60% FT with inhalation, > 70% FT without inhalation, > 80% DP
Transfer wound coverage: Burnshield, Cling-wrap

In-hospital Care

Prevent sepsis
Cover with silver-containing cream
Debride blisters
Resuscitate
Early enteral feeding
Early excision and biological wound coverage

Skin Cover Options

Autologous split skin grafts
Living related donors
Cadaver skin
Synthetic analogues
Xenografts (pig and frog)
20% BSA per sitting
Tissue biopsy for MCS

Rehabilitation

Early chest physio
Early mobilisation
Post-graft splinting
ADL adaptation
Compression garments and dynamic hand splints
Social worker, psychologist, dietician, pastor/Imam/rabbi, family, and community involvement
Reconstructive (plastic) surgeon

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

Learn about the management of burns, including assessment, resuscitation, and rehabilitation. This quiz covers the causes of burns, initial assessment, and primary survey of a major burn.