What is TBSA?
Total Body Surface Area
What is STSG?
Split Thickness Skin Graft
Are acid or alkali chemical burns more serious?
In general, alkali burns because the body cannot buffer the alkali, thus allowing them to burn for much longer
Why are electrical burns so dangerous?
Most of the destruction is internal because the route of least electrical resistance follows nerves, blood vessels, and fascia. Injury is usually worse than external burns at entrance and exit sites would indicate. Cardiac dysrhythmias, myoglobinuria, acidosis, and renal failure are common.
How is myoglobinuria treated?
HAM: Hydration with IVF Alkalization of urine with IV bicarbonate Mannitol diuresis
What is a first-degree burn?
What is a second-degree burn?
Epidermis and varying levels of dermis
What is a third-degree burn?
All layers of the skin including the entire dermis
What is a fourth-degree burn?
Burn injury into bone or muscle
How do first-degree burns present?
Painful, dry, red areas that do not form blisters
How do second-degree burns present?
Painful, hypersensitive, swollen, mottled areas with blisters and open weeping surfaces
How do third-degree burns present?
Painless, insensate, swollen, dry, mottled white, and charred areas. Often described as dried leather.
What is the major clinical difference between second-degree and third-degree burns?
Third-degree: Painless Second-degree: Painful
By which measure is burn severity determined?
Depth of burn and TBSA affected by second and third-degree burns. TBSA is calculated by the rule of 9s in adults and by a modified rule in children to account for the disproportionate size of the head and trunk.
What is the rule of 9s in burns?
In an adult, the TBSA that is burned can be estimated by the following: Each upper limb: 9% Each lower limb: 18% Anterior and posterior trunk: 18% each Head and neck: 9% Perineum and genitalia: 1%
What is the rule of the palm?
Surface area of the patient's palm is 1% of the TBSA used for estimating size of small burns
What is the burn center referral criteria?
1. Second degree > 20% TBSA 2. Second degree > 10% TBSA in children and elderly 3. Third degree > 5% TBSA 4. Any second- or third-degree burns involving the face, hands, feet or perineum 5. Any burns with inhalation 6. Any burns with associated trauma 7. Any electrical burns
What is the treatment for first-degree burns?
Keep clean, pain meds, +/- Neosporin
What is the treatment for second-degree burns?
Remove blisters; apply antibiotic ointment (usually Silvadene) and dressing; pain meds. Most second-degree burns do not require skin grafting.
What are some newer options for treating a second-degree burn?
1. Biobrane (temporary silicone artificial epidermis) 2. Silverlon (silver ion dressings)
What is the treatment of third-degree burns?
Early excision of eschar (within first week post-burn) and STSG
How can you decrease bleeding during excision of a third-degree burn?
Tourniquets if possible, topical epinephrine, topical thrombin
What is an autograft STSG?
STSG from the patient's own skin
What is an allograft STSG?
STSG from a cadaver (temporary coverage)
What thickness is the STSG?
10/1000 to 15/1000 of an inch (down to the dermal layer)
What prophylaxis should the burn patient get in the ER?
What is used to evaluate the eyes after a third-degree burn?
What principles guide the initial assessment and resuscitation of the burn patient?
ABCDEs, then urine output. Check for eschar and compartment syndromes.
What are the signs of smoke inhalation?
Smoke and soot in sputum/mouth/nose; nasal or facial hair burns; carboxyhemoglobin; throat or mouth erythema; history of LOC/explosion/fire in enclosed area; dyspnea; low O2 saturation; confusion; headache; coma
What diagnostic imaging is used for smoke inhalation?