Presentation on theme: "Christopher P. Brandt M.D. Associate Professor of Surgery Case Western Reserve University BURNS Initial Evaluation & Management."— Presentation transcript:
Christopher P. Brandt M.D. Associate Professor of Surgery Case Western Reserve University BURNS Initial Evaluation & Management
Joseph B. Your patient is brought to the E.D. by the EMS service. He is a 14 year-old male who was involved in a house fire
History What other points of history do you want to know? What other points of history do you want to know?
History, Joseph B. Neighbors heard an explosion Patient found confused, outside of the house Cannot remember what occurred Denies shortness of breath Transport time of twenty minutes PMH of ADHD Tetanus – up to date
Physical Examination What would you look for? What would you look for?
Physical Examination VS T=96.5 P=140 R=24 BP=90/60 Awake; No hoarseness or stridor Soot in mouth Clear breath sounds Burns involving face, neck, trunk, arms and upper legs (see photos) Doppler pulses in all extremities
Physical Examination How do you determine the extent and depth of the burn injuries? What findings suggest inhalation injury?
Interventions Why is fluid resuscitation important? How do you estimate fluid requirements? How do you monitor response to initial fluid therapy? What complications can occur from over- or under- resuscitation?
Fluid Management Edema formation Systemic inflammatory response Capillary leak/ Increased vascular permeability Loss of skin barrier Zones of injury Parkland formula Crystalloid 4 x %TBSA x wt (kg) ½ of total in first eight hours Goal of ½ - 1 cc/kg/hr U.O.
Studies What further studies/tests would you want at this time? What further studies/tests would you want at this time?
Management Low urine output Loss of Doppler signals in the hands Inadequate ventilation with high airway pressures? What would you do in the following scenarios?
Management What are the principles of management of the inhalation injury? What will be the basic strategies for management of the burn wounds?
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