Burns, Burns Size, Criteria for admission to a Burn Centre, General Management,
Burns classification: There are 4 degrees - the 2nd degree divided into superficial and deep
- Epidermis, erythemia, blanching changes, Pain
- There are 2 subdivisions:
- Superficial - Epidermis and upper dermis, erythemia, blanching changes, Pain - Blisters and Hair Follicles present
- Deep - Epidermis and deeper dermis, erythemia, NO blanching changes, Limited Pain - Absent Blisters BUT SOME Hair Follicles present
- Full thickness burns, leathery eschar, NO PAIN, NUMB, NO HAIR
- Underlying Muscle and Bone, Leathery Eschar, NO PAIN, Numb no hair
Burn Size:
- Total Body Surface Area (TBSA) - affected by the second degree or third degree burn using the rule of NINE
- Full head - 9% TBSA
- Each full arm - 9% TBSA
- Each full leg - 18% TBSA
- Trunk anterior - 18% TBSA
- Trunk Posterior - 18% TBSA
- Groin is 1% TBSA
- For patchy burns the size of the PATIENTS palm is 1% (it would be a tragedy if you used your palm to measure 1% of an infant - duh)
- On second thoughts please use the Lund-Browder chart in children to estimate size
Criteria for admission to a Burns Centre
- 2nd and 3rd degree burns greater than 10% TBSA in patients that are <10y and >50y of age
- 2nd and 3rd degree burns greater than 20% - any age
- 2nd and 3rd degree burns with Cosmetic and functional impairment (face, hands, genitalia, perinium, major joints)
- 3rd degree burns greater than 5% TBSA
- Elecrical burns
- Chemical burns - threatening function or cosmetic impairment
- Inhalation injury
- Burns associated with major trauma
General management:
- 100% O2 by face mask for potential cabon monoxide poisoning - (a blood gas may be useful)
- Intubation for facial burns following inhalation injury, >40% TBSA burns, or smoke inhalation injury
- Asses for circumferential chest burns which may require escarectomy for respiratory distress
- Circulation - IVI Access - RL 700 ml Stat while assessing patient
- Asses limbs for circumferential burns for escarectomy
- Asses burn depth and size - degree and % TBSA
- Fluids -
- IVI RL 4cc/kg/% TBSA over 24 hours
- Divide over 24 hours - give 1/2 in first 8 hours and remainder given over the 16 hours
- Monitor resuscitation - Urine output - (30 to 55 cc/hr), MAP > 70, clear sensorium, pulse <120, HCO3 >18mmol/L, CO>3,1 L/sqm
- Wound debridement and wound closure
- Tetanus toxoid
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