traumaburns.ppt

Christopher P. Brandt M.D.
Associate Professor of Surgery
Case Western Reserve University
BURNS
Initial Evaluation & Management

Joseph B.
 Your patient is brought to the E.D. by the
EMS service.
 He is a 14 year-old male who was involved
in a house fire

History
What other points of history do you
want to know?

History, Joseph B.
 Neighbors heard an explosion
 Patient found confused, outside of the house
 Cannot remember what occurred
 Denies shortness of breath
 Transport time of twenty minutes
 PMH of ADHD
 Tetanus – up to date

Physical Examination
What would you look for?

 VS T=96.5 P=140 R=24 BP=90/60
 Awake; No hoarseness or stridor
 Soot in mouth
 Clear breath sounds
 Burns involving face, neck, trunk, arms and
upper legs (see photos)
 Doppler pulses in all extremities

 How do you determine the extent and
depth of the burn injuries?
 What findings suggest inhalation
injury?

1
8
Extent of burn
% total body
surface area

Burn Depth
 Color
 Moistness
 Capillary refill/Blanching
 Sensation
 Blistering

Superficial Second Degree
Deeper second degree
Third Degree

Inhalation injury
 Occurred in closed space
 Cough, dyspnea, wheezing, hoarseness,
stridor
 Facial burns / Singed facial hair
 Carbonaceous sputum
 Hypoxia
Indicators

Lab Results
 CBC - WBC-12.0 Hct-49%
 Electrolytes -Na-147 Cl-100 K-4.5 BUN-12
 ABG - 7.31/35/125 on 50%VM
 Carboxyhemoglobin- 21%
 Tox. Screen - Negative
 U/A - Normal

Interventions at this point?
Assess airway; Intubation ?
Oxygen
Fluid resuscitation
Foley Catheter
NG tube
Wound care
Pain medication

Interventions
Why is fluid resuscitation important?
How do you estimate fluid requirements?
How do you monitor response to initial fluid
therapy?
What complications can occur from over- or
under- resuscitation?

Fluid Management
Edema formation
 Systemic inflammatory response
 Capillary leak/ Increased vascular permeability
 Loss of skin barrier
Zones of injury
Parkland formula
 Crystalloid 4 x %TBSA x wt (kg)
 ½ of total in first eight hours
 Goal of ½ - 1 cc/kg/hr U.O.

Studies
What further studies/tests would you
want at this time?

Studies
 CXR – Basilar atelectasis
 EKG – Sinus tachycardia
 ? Bronchoscopy

Management
 Low urine output
 Loss of Doppler signals in the hands
 Inadequate ventilation with high airway
pressures?
What would you do in the following scenarios?

Management
 What are the principles of management of
the inhalation injury?
 What will be the basic strategies for
management of the burn wounds?

Acknowledgment
The preceding educational materials were made available through the
ASSOCIATION FOR SURGICAL EDUCATION
In order to improve our educational materials we
welcome your comments/ suggestions at:
feedbackPPTM@surgicaleducation.com

traumaburns.ppt

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