Burn and Wound Care

Mechanisms: flame, contact, scald, smoke, chemical, electrical, radiation

Any suspected smoke inhalation, no matter how stable the patient is, gets immediate intubation

• Being trapped in a house fire is a classic smoke inhalation injury

• Medical treatment is albuterol, N-acetylcysteine, and heparin

CO poisoning gets hyperbaric oxygen therapy

• Carboxyhemoglobin is checked

  • 10%+ automatically gets treated with hyperbaric oxygen therapy to reduce the risk of long-term neurological damage.

Cyanide inhalation will show elevated lactate, decreased arteriovenous oxygen difference, elevated venous oxygen

• Treat based on clinical suspicion

• Cyanide kit contains

  • Hydroxocobalamin: A chelating agent that binds cyanide.

  • Sodium thiosulfate: Helps convert cyanide to thiocyanate for safer excretion.

With chemical burns, do not neutralize; instead, flush the affected area with copious amounts of water for at least 20 minutes to dilute the chemical and reduce tissue damage.

• Hydrofluoric acid burns get calcium gluconate as well because HF acid will cause hypocalcemia

With chemical ingestion like bleach, do not induce vomiting; instead, give the patient water or milk to dilute the chemical and call poison control

• For lithium battery ingestion, extract ASAP; if past the pylorus, make sure the patient shits out the battery

Electrical injuries get immediate EKG, myoglobin, CK, and troponin

• They will need to stay inpatient for 24-48 hours

• Any electrical burn to face, neck, and mouth will require intubation

• People who are pulseless from electrical injuries get triaged first

The worse the burns are, the less they tend to hurt

Rule of 9s:

• For adults, the body is divided into sections, with each section representing approximately 9% of total body surface area (TBSA):

  • Head and Neck: 9%

  • Each Arm: 9%

  • Each Leg: 18%

  • Anterior Trunk: 18%

  • Posterior Trunk: 18%

  • Perineum: 1%

    • Face and perineal/genital area are critical areas which will require transfer to burn center

2 cc/kg/% burn for adults; 3 cc/kg/% burn for kids; 4 cc/kg/% burn for electrical

• A 50 kg adult with 20% body surface area burn

  • 2×50×20 =2,000 cc

    • 1000/8 = 125 cc; give this amount over the next 8 hours

    • 2000 - 125 =1,875 cc; give this amount over the next 16 hours

The rate should attain a urine output of 0.5 to 1.0 cc/kg/hr

Eschars are big scabs that can constrict the skin and underlying tissues, potentially leading to complications such as impaired circulation and further tissue damage.

• If it looks circumferential and tight, get on it right away

The 5 Ps of compartment syndrome (pain, pallor, paresthesia, paralysis, pulseless)

• You only need to have one of those to go straight to fasciotomy before it gets to all 5

• If it feels tight, go to fasciotomy

Superficial burns get treated with cool compresses and antibiotic ointments to prevent infection and promote healing.

Full thickness and deep partial thickness burns get exicision

• Smaller wounds get full excision

• Larger wounds keep getting tangential excision until getting to viable tissue and then covered with graft from the patient's own skin or from a suitable donor site, ensuring optimal healing and reducing the risk of complications.

Topical antibiotic → non-stick gauze → ACE compression bandage

Remember the caloric requirements for these patients are much higher