J CM ER

#1 cause of burns

hot drinks

1st degree burn (superficial thickness) sx*

epidermis only

red burns that BLANCH, NO blisters

erythema, minor pain

tx of 1st degree burn*

aloe

benzocaine

pain = ibuprofen/acetaminophen

2nd degree burn (superficial partial thickness) burn findings*

superficial (papillary) dermis

blisters b/w epidermis and dermis that BLANCH with pressure, looks WET

clear fluid, pain, moist + weep

2nd degree burn (superficial partial thickness) tx*

drain large, floppy blisters

bacitracin/silvadene

sterile vaseline gauze

± topical anesthetic, ibuprofen, acetaminaphen

2nd degree burn (deep partial thickness) findings*

deep (reticular) dermis

easily unroofed blisters that do NOT blanch w pressure, WAXY appearance, DEC pain, hemorrhagic blisters

be concerned with hypothermia, water/electrolyte loss, infx

2nd degree burn (deep partial thickness) tx*

opioids

ibuprofen = anti-inflamm

tetanus prophylaxis

3rd degree burn (full thickness) findings*

dermis/muscle/bone (destroys dermis entirely)

waxy white/leathery gray, insensate**, hard eschar, charring

3rd degree burn (full thickness) tx*

cover w sterile vaseline gauze

skin grafting

biobrane/pig skin

narcotics/ketamine/sedatives/ibuprofen

tetanus prophylaxis

rule of 9’s (adult Lund and Browder chart)*

Head + neck = 9%

Chest + abdomen = 18%

Back + butt = 18%

1 entire arm = 9%

1 entire leg = 18%

special concerns for a burn victim*

1. any burn to face/hands/feet/genitalia/circum burn

2. 3rd degree or full thickness burns that covers large area

3. any burn that interferes w respiration

4. any burn to infant/elderly

5. any chemical/electrical burn (alkali** more caustic > acid)

why is circumferential burn a concern?

the healing process → compartment syndrome/compress on that body part (tourniquet)

sx that a burn is evidence of abuse*

pattern burns that suggest contact w/ object

cigarette burns

stocking/glove/circum burn

burns to genitalia/perineum

major factors involved in severity of electrical burn*

AMOUNT of shocking current through body

DURATION

PATH

immediate death with burns is the result of?*

coexisting trauma

airway compromise

NOT THE BURN ITSELF

remember to remove the person from the source of burn!

signs of inhalation injury*

carbonaceous sputum

singed facial / nasal hairs

facial burns

oropharyngeal edema

changes in voice

altered mental status

initial management of burns

1. ABC

2. stop burn process (remove clothing, cool tissures)

3. irrigate chemical burns for 15 mins

4. circumferential full thickness burns require escharotomy

5. AMPLE = allergies, meds, PMH, last meal, events leading to injury

6. IV access, labs, foley, abx, wound care, pain control

3 RF for death (with burns)*

1. >60 yo

2. more than 40% BSA burned

3. inhalation injury

ARDS

edema from leaky capillaries from traumatized lung

(inhalation injury)

what burn pts hospitalized vs. goes home?

admission:

• full thickness (3rd degree) >5% BSA

• partial thickness (2nd degree) >10% BSA

• any full thickness/partial thickness around critical areas (face, hands, feet, genitals, perineum, skin) → significant risk for fx problems

• circumferential burns (thorax/extremities)

• significant chemical injury, electrical burns, lightning injury, coexisting major trauma, significant comorbidities

• presence of inhalation injury

goes home

• first degree

_ venom is associated with neuromuscular paralysis

elapids

produces complex/mixed toxidromes (muscle/tissue destruction)

neurotoxic snake venoms cause _ paralysis

descending

diplopia, ptosis, dysphagia, dysarthria, muscle weakness,

characteristics of elapid bites

snake hangs on → multiple tiny bite wounds

^ higher risk of envenomation vs. crotalid bites

minimal pain, redness, swelling

systemic effects of elapid envenomation + tx

sx delayed several hours!

euphoria, local paresthesia, N/V, drowsiness, dysphagia

antivenom can PREVENT paralysis but can NOT REVERSE it

→ NO fasciotomy, MUST treat if no snake ID, tourniquets

viperidae is the subfamily of?

crotalidae (pit vipers) = venous members of this family

moveable anterior fangs

viperids venom + systemic effects

cytotoxic and myotoxic effects

possible sig dysregulation of coag

= soft tissue necrosis, rhabdo, DIC

hypotension, fasiculations, diaphoresis, N/V, coag

mixed toxidrome (“broken neck” syndrome)

sx of viperidae envenomation

metallic taste

perioral tingling

fang marks

vesicles, necrosis

local swelling/pain/ecchymosis/erythema

Which snake is responsible for the most fatalities in North America?

Rattlesnake

grading for viperidae (crotalidae) bites

None

Minimal

Moderate

Severe

Moderate + severe might require fasciotomy

non-venomous vs venomous snake bites

non-venomous: horseshoe

venomous: 2 fang marks