Burns, Burns Size, Criteria for admission to a Burn Centre, General Management,

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Burns classification:  There are 4 degrees - the 2nd degree divided into superficial and deep

  1. Epidermis, erythemia, blanching changes, Pain
  2. 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
  3. Full thickness burns, leathery eschar, NO PAIN, NUMB, NO HAIR
  4. Underlying Muscle and Bone, Leathery Eschar, NO PAIN, Numb no hair
Burn Size:
  1. 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
  2. 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


Comments

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