by In honor of Thanksgiving Week this week’s Sunday Scaries is going to highlight burns.
Mostly because I so desperately want to deep fry a Turducken, hopefully without sinching my eyebrows!
THE CASE: 28M old came in for “second degree burn” after having climbed into the bathroom sink, burning the lateral aspect of her left leg down to the foot (looking almost like de-gloving of the skin). Aside from getting ACS involved (strange and extensive burns in children must be reported), the burn team was called for debridement and evaluation of the wound. It had me thinking of what could we do at Coney (since we have to transfer to a burn unit) while we are waiting for the transfer. So I was nosey and asked. She replied, you can do the debriding and pain control, unroof all blisters, and apply bandages, it doesn’t change our evaluation of BSA and management, and in little children please help us in addressing their pain early.
recommendations for treating burns–>use gauze in sterile water to lightly scrub peeled skin, use scissor in suture removal kit to unroof blisters, apply bacitracin and
vaseline gauze with bandage
Let’s Talk Their Lingo:
Review of Rules of 9’s (because we know this will be on inservice)
ike all traumas evaluate the ABCs
Intubate if:
-evidence of inhalation injury (DO NOT wait for stridor or respiratory difficulty) -full-thickness face or peri-oral burns
-Circumferential NECK burns
-Pt is tachypneic, hypoxic, hypoventilating or ALTERED AF
–> TBSA >60% will deteriorate quickly….intubate quicker
Parkland: 4mL x %burn x weight (kg) = fluids for the 1st 24hrs **Lactated Ringers**
–remember to use 3mL in children and add maintenance fluids (Add 5% dextrose in maintenance if <20kg) -only count 2nd n 3rd degree
-Give HALF over the first 8 hours BUT maintain urine output of 0.5-1mL/kg/hour
Don’t forget:
-drop the foley in adults with severe burns, wee need to monitor the urine output -UPDATE their tetanus
-labs: ABG, carboxyhemoglobin, cardiac enzymes and CXR
-Albuterol and pulmonary toilet for intubated burn patients
When do we transfer??
References: First Aid for EM Boards
- http://www.health.state.mn.us/oep/healthcare/burn/tbsa.pdf
- http://www.emdocs.net/modern-day-burn-resuscitation-moving-beyond-parkland-formula/
- http://ameriburn.org/public-resources/burn-center-referral-criteria/
