Burns
·
Caused by: thermal, electricity,
chemical, mechanical, radiation
·
History:
o Timing – start fluid maintenance calculations from time of injury not
time of presentation
o Circumstances – eg any risk of inhalational injury
o Tetanus immunisation
·
Classification:
o Assessing depth:
§ 1st degree burns: Erythema (like bad sunburn)
§ 2nd degree: Blistering
§ 3rd degree: skin goes like leather
§ Now classified as:
· Partial thickness burns (either 1st or 2nd degree): superficial heal in 2 – 3 weeks, deep need grafting
· Full thickness burn
o Body area covered: Rule of nines to estimate surface area burnt: head
9%, arms 9% each, thorax 18%, abdomen 18%, legs 18% each
·
Admit if:
o Major burn (>15% of adult, > 10% of child)
o Special areas (hands, face, over joints, etc)
o Circumferential – Require escharotomy to release pressure
o Other medical conditions, etc
·
Respiratory complications:
o Upper airway burns: watch for oedema and obstruction. Prophylactic intubation if severe
o Lower respiratory tract burns: Suspect if closed space fire, smoke
inhalation or upper RT burns.
o Treatment: humidified O2, PEEP, pulmonary toilet and physiotherapy. Avoid steroids
o Inhalational injury a big killer – eg chemicals from burning materials ® ARDS 24
hours later
·
Watch for:
o Hypovolaemia.
o Good nutrition critical: calorie and protein
requirements. Use NG tube
·
For minor burns:
o Analgesia
o Wash gently
o Dress with paraffin gauze and padding
o Tetanus jab
o Review in 3 – 4 days
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