Burns 101 Initial Management Video Lecture | Introduction to Burn Care: Medical Treatment - Health & Fitness

management of the burn patient breaks
down the same way you'd manage any other
patient airway breathing and circulation
remember that your burn patient may have
traumatic injuries or medical problems
that are related to or associated with
the burn itself you have to remember to
treat those problems too there's some
particulars about the way we manage
airway breathing and circulation and
burn patients so let's review those
first any burn that occurs in an
enclosed area burns from explosions
burns to the face and upper torso or
burn in which the patient was
unconscious should make you consider the
possibility of inhalation injury even
patients who present with a Payton
airway can lose it quickly as an airway
irritated by thermal or chemical injury
begins to swell patients with blisters
or suit in the hypopharynx on exam
should be assumed to have an inhalation
injury singed nasal and facial hairs on
the other hand do not necessarily equate
to inhalation injury unfortunately it's
not always easy to tell if an airway has
been burned
if you suspect an inhalation injury
intubate early before swelling
associated with the burn and
resuscitation set in it's much easier to
extubate down the line than it is to
intubate too late remember that
hoarseness and Strider are late signs of
an inhalation injury not early signs
when in doubt intubate early smoke
inhalation is very common and very
serious the mortality rate for any given
burn will double if the patient has
smoke inhalation smoke inhalation is not
limited to breathing physical products
of combustion in fact the most serious
effects of smoke inhalation come from
carbon monoxide which is odorless
colorless and not necessarily
accompanied by visible smoke even if
there are no physical signs of smoke
inhalation or inhalation injury all
patients who are exposed to fires and
enclosed spaces should have a
carboxyhemoglobin level checked and
received 100% oxygen until it's proved
that they don't have an elevated carbon
monoxide level patients with a smoke
inhalation injury pattern a combination
of carboxyhemoglobin of 10% at the time
of rescue a closed space fire and
carbonaceous sputum have a 90% chance of
needing intubation and ventilatory
support so be ready to intubate early
all patients with a question of smoke
inhalation need a chest x-ray on arrival
to the emergency room
although early chest x-rays will be
normal even with inhalation injury the
burn patient has by definition lost some
of his or her skin integrity and with it
their primary way of maintaining fluid
homeostasis compounding this effect
patients with burns over 20% or more
develop a systemic capillary leak that
further depletes intravascular volume
patients with serious burns will lose
fluid at an alarming rate an adequate
fluid resuscitation is absolutely vital
in serious burns having adequate IV
access is essential at all times the
current consensus formula for
resuscitation of large burns meaning
greater than 20% in adults are greater
than 15% in children is two to four
milliliters per kilogram per percent
body surface area at our institution we
begin with lactated ringers at 3
milliliters per kilogram per TBSA and
deliver half over the first eight hours
and the next half over the subsequent 16
hours oh is titrating - urine output
this estimate is a good place to start
we titrate to 0.5 milliliters per
kilogram per hour or 30 to 50
milliliters per hour of urine output in
adults place it fully to guide your
resuscitation be careful to avoid over
resuscitation and remember that
estimates are only a starting point
patients with facial burns should have a
Woods lamp exam if a Woods lamp is
available an ophthalmology consult is
indicated if corneal abrasions are
detected all burn patients should
receive a tetanus shot unless they can
provide a reliable history of having had
one within the past 12 months burned
extremities should be assessed for
neurovascular status and elevated above
the level of the heart to reduce
swelling for circumferential full
thickness burns you should consider
performing an escharotomy burn patients
lose heat quickly so active warming is
essential some ICUs have heat shields to
provide active warming in the ICU