1. Burns Dr. Stella Yiu Emergency Physician, TOH

2. LMCC objectives Diagnose severity and extent Manage complications Institute initial management of burn trauma

3. 1. SEVERITY & EXTENT

5. Partial thicknessFull thickness SuperficialDeep

7. Skin intact

8. Skin broken, moistSkin intact

9. Skin broken, moist Charred, dry Skin intact

10. What body surface area?

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

14. WHO NEEDS SPECIAL CARE

15. Area Agent Vunerable population

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

17. Area: Hands Perineum Face 2/3 Degree

18. Area: Circumferential = compartment syndrome

19. Agent: Chemical burn = penetrate tissue

20. Agent: Electricity

21. Vulnerable population: children

22. Vulnerable population: Children

23. 2. MANAGE COMPLICATIONS

24. 3 big complications of burn Shock Infection High metabolic demands - DIC

25. Burn: Cellular level Local and systemic inflammatory response Capillaries permeable, fluids and proteins leak Edema and hypovolemia

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

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

28. ++ Fluids 1 st half 8 hr from time 0 Time zero Hospital arrival time 8 hours 1 st half of fluid to be given

29. Other associated injuries Chemical Thermal burn Other trauma

30. Chemical Carbon Monoxide Cyanide

31. Carbon Monoxide 200x Affinity to Hb

32. Carbon Monoxide

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

34. Cyanide Cyanide asphyxiates mitochondria Lactic acidosis

35. AIRWAY THERMAL BURN

36. Thermal burn Burn = Airway swelling

37. Minor burns Wash Debride open blisters Cover wound with topical antibiotic ointment Burn wound is tetanus prone!

38. 3. MAJOR BURN RESUSCITATION

39. Airway: Intubate early

40. Intubate early if airway injury -Singed nasal hairs -Facial or oral burns -Sooty sputum -Stridor -Grunting Can also use fiberoptic bronchoscopy

41. ++ Fluids Parkland Formula (1 st 24 hrs) 4cc x %BSA x Wt (kg) 1 st half 8 hr from time 0 Treat pain

42. Escharotomy if third degree (full thickness)

43. Investigations CBC, lytes CO level Lactate, ABG CXR

44. Burn unit

45. Electrical injury depends on entry and exit sites

46. Electrical burn CVS: VF or asystole Neurologic: confusion, LOC, seizure MSK: compartment snd, Renal: Rhabdo, renal failure Trauma: thrown