Burns



Burns


Ryan M. Garcia

Michael S. Gart



INTRODUCTION



  • Demographics



    • 1 200 000 burn cases in the United States per year


    • Increased survival secondary to critical care measures has led to an increased need for reconstruction.


  • Criteria for patient transfer to a burn center based on guidelines from the American Burn Association



    • Any burn to the hands, feet, genitalia, perineum


    • Chemical or electric burns


    • Third-degree burns or second-degree burns of >10% total body surface area (TBSA)


    • Burns associated with additional trauma or associated medical comorbidities


    • Burns in children


  • Burn histology (moving from central area to the periphery)



    • Zone of coagulation—tissue necrosis, nonviable, requires excision and grafting


    • Zone of stasis—surrounds the zone of coagulation, viable, requires aggressive resuscitation to avoid transitioning to tissue necrosis


    • Zone of hyperemia—peripheral most zone, viable, preserved with resuscitation


EVALUATION



  • History



    • Timing of injury


    • Type of burn (chemical, electrical, flame, contact, etc.)



  • Physical examination



    • Airway assessment


    • TBSA burned


    • Depth of burn


    • Evaluate for compartment syndrome and for circumferential eschars that diminish limb perfusion



      • Consideration of deep compartment syndrome in electrical burn patients given the pathway of injury


  • Imaging



    • None indicated unless concomitant injuries are present


  • Classification of burns



    • Based on depth of penetration (superficial to deep penetration)



      • First degree



        • Epidermis only—behaves like a sunburn


        • Erythema, digital pressure leads to blanching, no blisters


      • Second degree (subclassified into superficial and deep)



        • Superficial



          • ▲ Papillary dermis involved


          • ▲ Skin appendages (ie, hair follicles) spared, blistering, sensate


        • Deep



          • ▲ Reticular dermis involved


          • ▲ White in color without capillary refill, blistering, diminished sensation


      • Third degree



        • Entire dermis involved



          • ▲ Insensate, black to brown in color, no blistering


ACUTE MANAGEMENT



  • Initial evaluation and management



    • Advanced trauma life support protocol


    • Airway management



      • Inhalation injury requires intubation and intensive care management



        • Carbonaceous material in the oral or nasal airway


        • Arterial blood gas/elevated carboxyhemoglobin


        • Diagnosis confirmed with bronchoscopy


    • Compartment syndrome



      • Tense/firm compartments


      • 5 “P”s evaluation (Pain with stretch and palpation, Pallor, Paresthesia, Pulselessness, Poikilothermic)



      • Clinical examination versus pressure monitoring



        • Difference of 30 mm Hg or less between compartment and diastolic blood pressure suggestive of compartment syndrome


    • Chemical burn antidotes

May 7, 2019 | Posted by in ORTHOPEDIC | Comments Off on Burns
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