ACLS ( CH 9 ) - BURN 1

BURN , COLD INJURY

90-02-24


ACLS ( CH 9 ) - BURN 2
INJURY DUE TO
BURN AND COLD
ACLS ( CH 9 ) - BURN 3
OBJECTIVES
Estimate burn size, and determine
presence of associated injuries.
Outline innitial stabilization,
treatment measures, and
transfer criteria.
Identify special problems and
methods of treatment.
ACLS ( CH 9 ) - BURN 4
BURN / COLD INJURIES
Management Principles
Timely application
Maintain:
Airway
Hemodynamic stability
Fluid / electrolyte balance
Normal body temperature
Prevent complications
ACLS ( CH 9 ) - BURN 5
Injury Due To Burn
ACLS ( CH 9 ) - BURN 6
LIFE-SAVING MEASURES
Establish airway
Identify signs of distress
Initiate supportive measures
Obtain history
ACLS ( CH 9 ) - BURN 7
CLINICAL INDICATIONS
Carbonaceous sputum
Facial burns
Hair singeing
Carbon deposites
Inflamed oropharynx
History
Inhalation Injury
ACLS ( CH 9 ) - BURN 8
LIFE-SAVING MEASURES
Remove all:
Injurious material
Clothing, jewelry
Prevent hypothermia
Two, large-caliber Ivs
Ringers lactate
ACLS ( CH 9 ) - BURN 9
ASSESSMENT
History
Mechanism of ijury
Associated illness
Allergies
Tetanus status
ACLS ( CH 9 ) - BURN 10
Rule of Nines
ACLS ( CH 9 ) - BURN 11
ASSESSMENT
Estimate Burn Size
Surface of patients palm represents
1% body surface area
ACLS ( CH 9 ) - BURN 12
Second-degree Burn
ACLS ( CH 9 ) - BURN 13
Third-degree Burn
ACLS ( CH 9 ) - BURN 14
MANAGEMENT
Airway
Assess for injury
Establish and maintain patient
airway early
ACLS ( CH 9 ) - BURN 15
Inhalation Injury
Early Management
ACLS ( CH 9 ) - BURN 16
MANAGEMENT
Breathing
Assume CO exposure
Inhalation of toxic fumes or carbon
particles
Direct thermal injury
ACLS ( CH 9 ) - BURN 17
MANAGEMENT
Breathing
Oxygen / ventilate
Endotracheal intubation
ABGs
Carboxyhemoglobin levels
ACLS ( CH 9 ) - BURN 18
MANAGEMENT
Circulation
Monitor vital signs
Hourly urinary outputs
Adult: 30 50 mL / hr
Child: 1.0 mL / kg / hr
ACLS ( CH 9 ) - BURN 19
MANAGEMENT
Circulation Estimate of Fluid Needs
2 4 mL Ringers lactate / kg / % BSA
in first 24 hours
One-half in first 8 hours
One-half in next 16 hours
Based on time from injury
Monitor patient response
ACLS ( CH 9 ) - BURN 20
MANAGEMENT
Develop Treatment plan
Estimate burn size / depth
Identify associated injuries
Weigh patient
Baseline blood analyses
Chest films
Document on flow sheet
ACLS ( CH 9 ) - BURN 21
MANAGEMENT
Maintain Peripheral Circulation
Remove all connstricting devices
Assess distal circulation
Escharotomy surgical consultation
ACLS ( CH 9 ) - BURN 22
Escharotomy
Sites
ACLS ( CH 9 ) - BURN 23
Escharotomy
ACLS ( CH 9 ) - BURN 24
MANAGEMENT
Nasogastric Intubation
Nausea, vomiting, distention
Burn > 20% BSA
Medications
Narcotics Spare use, IV only
Antibiotics Not indicated early
ACLS ( CH 9 ) - BURN 25
MANAGEMENT
Wound Care
Cover with clean linen
Do not
Break blisters
Apply antiseptics
Apply cold water
ACLS ( CH 9 ) - BURN 26
MANAGEMENT
Acid / Alkali Burns
Duration, concentration, and amount
Flush with copious amount of water for
20 30 minutes
Brush away dry chemical before
irrigation
ACLS ( CH 9 ) - BURN 27
Chemical Burns
ACLS ( CH 9 ) - BURN 28

Fasciotomy Electrical Burn
Electrical burn
result in damage
to the fascia and
muscle, and may
spare the
overlying skin
ACLS ( CH 9 ) - BURN 29
MANAGEMENT
Electrical Burn
ABCs
Myoglobinuria
Fluid: 100 mL urine / hr
Mannitol: 25 g IV
Metabolic acidosis
Maintain adequate perfusion
Sodium Bicarbonate
ACLS ( CH 9 ) - BURN 30
TRANSFER CRITERIA
2nd, 3rd degree burns > 10% BSA
in age < 10 and > 50 years
2nd, 3rd degree burns > 20% BSA
2nd, 3rd degree burns to face, eyes,
ears, hands, feet, genitalia,
perineum, and major loints
ACLS ( CH 9 ) - BURN 31
TRANSFER CRITERIA
3rd degree burns > 5% BSA
Electrical and chemical burns
Inhalation injury
Pre-existing illness, associated injuries
Children
Special situations
ACLS ( CH 9 ) - BURN 32
TRANSFER PROCEDURE
Coordinate with burn-center physician
Transfer with all
Documentation / information
Laboratory results
ACLS ( CH 9 ) - BURN 33
Injury Due To Cold
ACLS ( CH 9 ) - BURN 34
COLD INJURY FACTORS
Temperature
Duration of exposure
Enviromental conditions
Immobilizzation
Moisture
Vascular disease
Open wounds
ACLS ( CH 9 ) - BURN 35
TISSUE-FREEZING INJURY
FROSTBITE
1st Degree: Hyperemia, edema
2nd Degree: Vesicles, parttial-thickness
skin necrosis
3rd Degree: Full-thickness skin necrosis
4th Degree: Skin, muscle, bone necrosis
ACLS ( CH 9 ) - BURN 36
Second-degree Frostbite
ACLS ( CH 9 ) - BURN 37
Fourth-degree Frostbite
ACLS ( CH 9 ) - BURN 38
MANAGEMENT
Do nor delay
Remove clothing
Warmed blankets
Rewarm frozen part
ACLS ( CH 9 ) - BURN 39
MANAGEMENT
Preserve damaged tissue
Prevent infection
Elevate and expose injured part
Analgesics / tetanus / antibiotics
ACLS ( CH 9 ) - BURN 40
HYPOTHERMIA
Core temperature < 35 degrees
Rapid / slow drop in core temperature
Elderly and children at greater risk
Low-range thermometer required
ACLS ( CH 9 ) - BURN 41
HYPOTHERMIA
Clinical Findings
Core temperature < 35 degrees
Depressed level of consciousness
Gray, cyanotic, variable vital signs
Absence of cardiorespiratory activity
ACLS ( CH 9 ) - BURN 42
MANAGEMENT
ABCs, IV access
Oxygenate and ventilate
Prevent heat loss and rewarm
Assess for associated disorders
Blood analyses
ACLS ( CH 9 ) - BURN 43
MANAGEMEN
Passive External Rewarming
Warm enviroment
Warmed blankets and IV fluids
Active Core Rewarming
Surgical rewarming techniques
Do not delay transfer
Not dead until warm and dead
ACLS ( CH 9 ) - BURN 44
ACLS ( CH 9 ) - BURN 45
SUMMARY
Burn Injury
Recognize inhalation injury
Establish airway
Fluid resuscitation
Rremove all clothing
ACLS ( CH 9 ) - BURN 46
SUMMARY
Burn Injury
Identify extend, depth of burn
Establish fluid guidelines
Initiate burn flow sheet
Obtain baseline lab / radiology
Maintain peripheral circulation
Identify burns requiring transfer
ACLS ( CH 9 ) - BURN 47
SUMMARY
Cold Injury
Diagnose type
History
Clinical finding
Measure core temperature
Rewarming techniques
Monitor and support vital signs