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AcuteBurnsM ang ement Consultant Burns & Plastic Surgeon Queen Victoria Hospital East Grinstead, England Summary • Focus on major burns • Ongoing treatment • Initial management • Special types of burn • ABCD • Infection • Burn Assessment • Psychological support • Initial Urgent Treatment • Fluids • Inhalation • Urgent Surgery F irstAid • 20 minutes of tepid running water • Within 3 hours • Same for chemical burns • Wet soaks • Cover (cling film) • Special case: Hydrofluoric acid Interburns essential reading • interburns.org/training • comprehensive • aimed at LMIC • widely recognised • FREE! InitialCar e • ABCD • Airway (cervical spine) • Breathing • Circulation • Disability • ANALGESIA InitialCar e • ABCD • Airway (cervical spine) • Breathing • Circulation • Disability • Secondary survey Depth • Erythema • Superficial Partial • Deep Partial (dermal) • Full thickness • Very often mixed • Change in first 48 hours Depth • Erythema • Superficial Partial • Deep Partial (dermal) • Full thickness • Very often mixed • Change in first 48 hours Depth • Erythema • Superficial Partial • Deep Partial (dermal) • Full thickness • Very often mixed • Change in first 48 hours Siz e • Adults vs children • 1% = palm • Rule of 9s • Halving/quartering • Charts or apps • Fluids, surgical planning FluidR esuscitation • 20% adults 15% children • 15 and 10 if any concern • Parkland (2ml/kg/%burn) • 24 hours (1st half in 8 hours) • Crystalloid (avoid N/Saline) • Regular observations • Urine output 0.5ml/kg (1 in children) Inhalation • Airway, lung, systemic • Blood gases • CO, cyanide • Change over time • Signs of worsening • Intubation, bronchoscopy • Drug treatment (salbutamol, N acetyl cysteine, heparin Inhalation • Airway, lung, systemic • Blood gases • CO, cyanide • Change over time • Signs of worsening • Intubation, bronchoscopy • Drug treatment (salbutamol, N acetyl cysteine, heparinSummaryofEarlyCare Ur gentSur gery • Surgical Airway • Escharotomy • Chest • Limbs • Fasciotomy Ur gentSur gery • Surgical Airway • Escharotomy • Chest • Limbs • Fasciotomy Ur gentSur gery • Surgical Airway • Escharotomy • Chest • Limbs • Fasciotomy W oundCar e • ANALGESIA • Remove blisters • Clean • Dress • non adherent layer • absorbent layer • securing layer • Change if wet through W oundCar e • ANALGESIA • Remove blisters • Clean • Dress • non adherent layer • absorbent layer • securing layer • Change if wet through Nutrition • Start ASAP • Nasogastric or jejunal feeding • Oral if possible • High protein, high calorie • Milk, eggs, meat, beans, rice • 50% carbs, 30% protein, 20% fat • Weigh regularly Ph ysicalTher ap y • Movement • on the ward • in theatre • routine • Splintage • resting • post op Sur gery • Limit blood loss • Keep warm • Debride to healthy tissue • shave • fascial excision Sur gery • Any site possible inc. head • Limit blood loss • Guarded knife (powered) • Meshing • Securing • Dressing Sur gery • Any site possible inc. head • Limit blood loss • Guarded knife (powered) • Meshing • Securing • Dressing • (Splinting) ChemicalBurns • First aid • Alkali often deeper • Hydrofluoric acid • Look in eyes - priority • Often require surgery • Accidental/assault ElectricalBurns • Low vs high voltage • ECG/cardiac • Skin vs deep injury • Compartment syndrome • Haemochromogenuria • “Progressive loss” • Amputation Inf ection • Chest • Lines • Burn • Staph early, gram negative late • Early recognition hard • High risk of resistance • Wound management • AntibioticsNonSurviv ableBurns • Understand what is possible • Make a decision early • Get experienced opinion • May need to make late decisions • Involve family Ps y chology • Important • Scared, anxious • Traumatised • Family support • Trust • Slow processTPlease feel free to ask questions