ACS

1
Injuries Due to
Burns and Cold
ACS
2
Objectives
Estimate size of injury and determine
associated injuries
Demonstrate measures of initial
stabilization and treatment
Identify special problems and methods of
treatment
Specify criteria for transfer of burn
patient
ACS
3
Burns / Cold Injuries
Management Principles
Establish / maintain
Airway
Normal perfusion
Fluid / electrolyte balance
Normal body temperature
ACS
4
Inhalation Injury
Clinical Indications
Carbonaceous sputum
Facial burns
Hair singeing
Carbon deposits
Inflamed oropharynx
History
CO Hgb >10%
ACS
5
Life Saving Burn Treatment
Remove all
Injurious material
Clothing jewelry
Prevent hypothermia
Establish 2 large caliber IVS
Initiate warmed Ringers lactate solution
ACS
6
Burn Assessment
History
Mechanism of injury
Associated illnesses
Allergies
Tetanus status
ACS
7
Rule of Nines
surface of patients
palm = 1% BSA
ACS
8
Second Degree Burn
ACS
9
Third Degree Burn

ACS
10
Burn Management
Airway
Assess for injury
Establish and maintain patent airway
early
ACS
11
Burns Management
Breathing
Assume CO exposure
Inhalation of toxic fumes, carbon
particles
Direct thermal injury
Oxygenate / ventilate
Endotracheal intubation
ABGs and CO levels
ACS
12
Burn Management
Circulation
Adequate venous access
Monitor vital signs
Hourly Urinary output
Adult : 30-50 mL/hour
Child : 1.0 ML/kg/hour
ACS
13
Burn Management
Circulation : Estimate Fluid Needs
2-4 ml warmed Ringers lactate
solution/kg/% BSA in 1st 24 hours
in first 8 hours
in next 16 hours
Based on time from injury
Monitor heart rate and urinary output
ACS
14
Burn Management
Develop Treatment Plan
Estimate burn size / depth
Identify associated injuries
Weigh patient
Baseline blood analyses and chest x-ray
Document on flow sheet
ACS
15
Burn Management
Maintain peripheral Circulation
Remove All constricting devices
Assess distal circulation
Escharotomy : Surgical consult
ACS
16
Burn Management
Gastric Intubation
Nausea vomiting , distention
Burns > 20% BSA
Medications
Narcotics : Minimal use, IV only
Antibiotics : Not indicated early
ACS
17
Burn Management
Wound Care
Cover with clean linens
Do not
Break blisters
Apply antiseptics
Apply cold water
ACS
18
Burn Management
Chemical Burns
Duration, amount,
and concentration
Brush away dry
chemicals
Flush with copious
amounts of water
for 20-30 minutes
Alkali Burn
ACS
19
Burn Management
Electrical Burn
Result in damage
to fascia and
muscle, and may
spare the overlying
skin

Fasciotomy
ACS
20
Burn Management
Electrical Burn
ABCDES
Myoglobinuria
Fluids : 100 ml urine / hour
Mannitol : 25 g IV
Metabolic acidosis
Maintain adequate perfusion
Sodium bicarbonate
ACS
21
Burn Transfer Criteria
2nd and 3rd Degree burn
>10% BSA in ages
<10 and > 50 years
>20% BSA
To :
Face
Eyes
Ears
Hand
Feet
Genitalia
Perineum
Major joints
ACS
22
Burn Transfer Criteria

3rd degree burn > 5% BSA
Electrical and chemical burns
Inhalation injury
Preexisting illnesses,associated injuries
Children
Special situations
ACS
23
Burn Transfer Prosedure
Coordinate with burn center doctor
Transfer with
Documentation / information
Laboratory results
ACS
24
Cold Injury Facture
Temperature
Duration of
exposure
Environmental
conditions
Immobilization
Moisture
Vascular disease
Open wounds

ACS
25
Cold Injury : Local Tissue
Frostnip
Frostbite
Nonfreezing
ACS
26
Cold Management
Do not delay
Remove clothing
Warmed blankets
Rewarm frozen
part
Preserve damaged
tissue
Prevent infection
Elevate exposed part
Analgesics, tetanus,
and antibiotics

ACS
27
Hypothermia : T
c
< 35 Degrees

Rapid / slow drop in core temperature
Elderly and Children at greater risk
Low-range thermometer required
Clinical findings
Depressed LOC
Gray, cyanotic, variable vital signs
Absence of cardiorespiratory activity
ACS
28
Hypothermia
Management
ABCDES, IV access
Oxygenate and ventilate
Prevent heat loss and rewarm
Assess for associated disorders
Blood analyses
ACS
29
Hypothermia
Management
Passive external rewarming : Warmed
environment, blankets, and IV fluids
Active core rewarming
Surgical rewarming techiniques
Do not delay transfer
Not dead until warm and dead
ACS
30
Question
ACS
31
Summary
Burn Injury
Recognize and treat inhalation injury
Fluid resuscitation
Identify burns requiring transfer
ACS
32
Summary
Cold injury
Diagnose type
History
Clinical findings
Measure core temperature
Rewarming techniques
Monitor and support vital functions