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I. Phatophysiology
A.
B.
C.
I. Pathophysiology (Contd)
D. Three areas of injury
1. Central zone of coagulation: Nonviable,
irreversibly injured tissue.
2. Middle zone of stasis: Initially characterized
by dilated blood vessels and capillary
diffusion. After 24 to 28 hours, dilated
capillaries become occluded, with resulting
conversion of this zone of tissue to
coagulation. Injury in this zone may be
reversible with appropriate treatment
(cooling, fluid resuscitation, critical care).
3. Outer zone of hyperemia: Composed
mostly of viable, edematous tissue.
I. Pathophysiology (Contd)
E.
History
1. Identity the source: Hot liquid,
chemicals, flame, superheated
air/steam, explosion, etc.
2. Duration and location of exposure:
Closed space; potential for smoke
inhalation
3. Concomitant drug or alcohol ingestion
4. Associated injury mechanism:
Esplosion, jump/fall, motor vehicle
crash, etc.
b.
c.
Circulation
1.
2.
Intravenous access: Ideally, several peripheral largebore intravenous lines should be place through
nonburned tissue. Central lines are the next best
option.
Intravenous fluid administration
a.
b.
D.
1.
a.
b.
2.
3.
4.
5.
6.
b.
c.
d.
e.
If 10 to 40 years old: Greater than 15% total body surface area (TBSA)
second-degree burns or greater than 3%. TBSA third-degree burns
should be treated on an inpatient basis.
If younger than 10 years or older than 40 years: Greater than 10% TBSA
second-or third-degree burns.
Burns involving the face, hands feet and/or perineum
Circumferential extremity burns.
Electrical burns
Etiology
1. Chemical irritants in smoke affect the distal
airways, resulting in an intense inflammatory
response, which can lead to adult respiratory
distress syndrome (ARDS) and/or systemic
inflammatory response syndrome (SIRS).
2. Direct thermal injury: inhalation of
superheated air or water vapor can cause a
thermal burn to the airway mucosa.
3. Oropharyngeal and supraglottic edema
caused by thermal injury can progress to
airway obstruction
Evaluation
c.
d.
Treatment
b.
1.
2.
a.
b.
c.
d.
e.
3.
CO level
a.
b.
c.
4.
Treatment
a.
b.
Area
1. Patients palm is approximately 1 %of
TBSA
2. Adult: Rule of 9s
a.
b.
d.
e.
Example: sunburn
Confined to the epidermis
Skin: Mildly erythematous
Pain: Resolves in 48 to 72 hours
No scarring
3.
b.
V. Fluid Resuscitation
A.
c.
D.
Infection
1. Bronchopneumonia is the leading
cause of death.
2. Burn wound sepsis, septic
thromboplebitis, and bacterial
endocarditis are also common
infections in the burn patient.
3. Pseudomonas, Enterococcus, and
methicillin-resistant staphylococus are
the main offending organisms.
c.
d.
e.
Widely available.
Broad gram-negative and gram-positive
coverage.
Moderate wound penetration
Can damage the cornea
May cause leukopenia
d.
e.
Broad-Spectrum coverage
Excellent wound penetration
The best topical agent for exposed
cartilage (e.g., the ear and nose).
Painful
Can cause acidosis due to carbonic
anhydrase inhibition. Its use should be
avoided in burns greater than 20% TBSA.
Broad-spectrum coverage.
Poor eschar penetration
Costly, messy
Can cause hyponatremia
b.
c.
1.
2.
a.
b.
c.
d.
b.
c.
b.
c.
d.
e.
f.
B.
C.
D.
1.
2.
3.
B.
C.
D.
E.
F.
G.
XI. Nutrition
A.
1.
2.
3.
4.
a.
b.
B.
C.
D.
B.
D.
c.
1.
Hydrofluoric acid
a.
b.
2.
Phenol
a.
b.
c.
d.
3.
White phosphorus
a.
b.
Pearls
1.
2.
3.
4.
5.