1. Schedule Burns Hypothermia Anaphylaxis

2. You will need Paper Pen Coin MCQ card

3. Burns Dr. Stella Yiu Emergency Physician, TOH

4. LMCC objectives Determine severity and extent Diagnose Complications Institute initial management of burn trauma

5. 1. Severity & extent

7. Skin layer Image credit: Simon Yiu Derived from work by Persian Poet Gal at en.wikipedia [GFDL (http://www.gnu.org/copyleft/fdl.html) or CC-BY-3.0 (http://creativecommons.org/licenses/by/3.0)], from Wikimedia Commons

9. 1 st degree/Superficial

10. Superficial PT/2 nd degree Image credit: Simon Yiu Derived from work by Persian Poet Gal at en.wikipedia [GFDL (http://www.gnu.org/copyleft/fdl.html) or CC-BY-3.0 (http://creativecommons.org/licenses/by/3.0)], from Wikimedia Commons

11. Superficial PT/2 nd degree By Cjr80 (Own work) [CC-BY-SA-3.0 (http://creativecommons.org/licenses/by- sa/3.0)], via Wikimedia Commonshttp://creativecommons.org/licenses/by- sa/3.0

12. Deep PT/2 nd degree Image credit: Simon Yiu Derived from work by Persian Poet Gal at en.wikipedia [GFDL (http://www.gnu.org/copyleft/fdl.html) or CC-BY-3.0 (http://creativecommons.org/licenses/by/3.0)], from Wikimedia Commons

13. Deep PT/2 nd degree Photo credit: www.vicburns.org.auwww.vicburns.org.au The Victorian Adult Burns Service, Alfred Health, Melbourne, Australia

14. Full thickness/3 rd degree Image credit: Simon Yiu Derived from work by Persian Poet Gal at en.wikipedia [GFDL (http://www.gnu.org/copyleft/fdl.html) or CC-BY-3.0 (http://creativecommons.org/licenses/by/3.0)], from Wikimedia Commons

15. Photo credit: www.vicburns.org.auwww.vicburns.org.au The Victorian Adult Burns Service, Alfred Health, Melbourne, Australia Full thickness/3 rd degree

17. What body surface area?

19. Scattered areas Image credit: Simon Yiu

20. Knowing surface area -> who needs special burn unit care -> how much fluids to give

21. Photo credit: www.vicburns.org.auwww.vicburns.org.au The Victorian Adult Burns Service, Alfred Health, Melbourne, Australia MCQ 1: Calculate his area of burn: Anterior torso + Whole left arm A.18% B.27% C.31.5% D.36% E.45%

22. 2. Diagnose Complications

23. Burn: Cellular level ++ Inflammation Capillaries leak with fluids and proteins Edema and hypovolemia

24. Fluids Airway Edema Chemicals

25. Burn patients need ++ fluids

26. ++ Fluids Parkland Formula (1 st 24 hrs) 4cc x %BSA (2-3deg) x Wt (kg)

27. ++ Fluids 1 st half 8 hr from time 0 Time zero 8 hours

28. ++ Fluids 1 st half 8 hr from time 0 Time zero Hospital arrival time 8 hours

29. MCQ 2: 80kg, Ant + post torso, left arm. Presents 4 hr post. Rate of fluids/first hour? A.1800 cc/hr B.1500 cc/hr C.1000 cc/hr D.900 cc/hr E.700 cc/hr

30. Fluids Airway Edema Chemicals

31. Image credit: Patrick J. Lynch, medical illustrator; C. Carl Jaffe, MD, cardiologist. http://creativecommons.org/licenses/by/2.5/, via Wikimedia commons http://creativecommons.org/licenses/by/2.5/

32. Photo credit: www.vicburns.org.auwww.vicburns.org.au The Victorian Adult Burns Service, Alfred Health, Melbourne, Australia

33. Who is at risk for inhalation injury? Face burn Soot Voice

34. Photo credit: Dr. Mark Silverberg

35. Face burn: Singed brows Soot: Mouth, nose, sputum Voice: Hoarse, change Intubate early even if no airway compromise

36. Fluids Airway Edema Chemicals

37. Tight skin + Edema  Compartment syndrome

38. Escharotomy Photo credit: Drs. Mike Cadogan and Chris Nickson, lifeinthefastlane.com

39. Fluids Airway Edema Chemicals

40. Carbon Monoxide 200x Affinity to Hb

41. Carbon Monoxide is chased Atmos air T1/2 = 4 hours Atmos 100% Oxygen = 1 hour Hyperbaric oxygen = < 20 minutes

42. Cyanide chokes mitochondria

43. Photo credit: www.vicburns.org.auwww.vicburns.org.au The Victorian Adult Burns Service, Alfred Health, Melbourne, Australia 3. Patient now arrives, what to do?

44. CDMQ: Write nursing orders (6)

45. Iv Fluids Cardiac monitor (BP, HR, O2 sat) Pain control, Tetanus CBC, lytes, Cr, CO level, Lactate, Trop CXR

46. Who needs special care

47. Area Agent Vulnerable population

48. Area: 10% second or third (deep partial or full)

49. Area: Hands Perineum Face

50. Circumferential

51. Chemical burn

52. Electricity

53. Children

54. Burn unit

55. LMCC objectives Determine severity and extent Diagnose Complications Institute initial management of burn trauma