Burns

Abdullah Shamsah

Suzan Schneeweiss

Amina Lalani

Introduction

Burn injuries are commonly seen in the emergency department
Scald injuries are more common in young children
Older children are more likely to suffer from flame injuries
Burn severity and depth may not be obvious on initial assessment
Common to see different depths of injury in a burn; center usually demonstrates deeper burn
Superficial burns may progress to deeper burns over the first 24 hrs
Burns are classified as superficial, partial thickness, or full thickness
Old terminology classified burns as first, second, third, or fourth degree

Table 53.1 Assessment of Burn Severity

Superficial (first degree)	Erythema, dry, epidermal sloughing, painful Blanches with pressure Heal without scarring in 4-5 days Not included in calculation of total burn surface area (TBSA) Example: sunburn
Partial thickness (second degree) 1. Superficial partial thickness: < 50% of dermis	Red or mottled, epidermal sloughing or blisters, moist, and painful Healing with minimal scarring in 7-10 days
2. Deep partial thickness: > 50% of dermis	Usually less painful as nerve fibers destroyed White, pale appearance Requires 2-3 weeks or more to heal May be difficult to distinguish from full thickness burn Scarring is common Skin grafting is often necessary Refer to plastic surgeon if burn does not heal within 7-10 days
Full thickness (third degree)	Involves full dermis White, leathery, waxy, dry, painless Does not bleed, no capillary refill High risk for infection and fluid loss Cannot re-epithelialize; heals from periphery Takes several weeks to heal Refer to plastic surgery immediately Most require skin grafting
Fourth degree	Involve underlying fascia, muscle, and bone Seen with severe electrical burns Requires immediate plastic surgery consult

First Aid

Stop the burn and help dissipate heat
Run cool water or use saline-soaked gauze
- Caution with large burns as risk of hypothermia
- Avoid ice or submersion of wound in ice water
For large burns: cover with clean sheet during initial assessment of patient to provide pain control

Initial Assessment

Airway and Breathing

100% oxygen
Look for signs of compromise: singed nasal hairs, eyebrows, or eyelashes; hoarse voice; stridor; carbonaceous sputum; perioral or perinasal burns
Secure airway with intubation if any of above signs present
Edema of airway may be delayed up to 48 hrs
Delay in securing airway until signs of respiratory distress are present can lead to inability to secure airway and dismal outcome
Do not rely on chest X-ray as it may be normal
Consider bronchoscopy or laryngoscopy for direct visualization of airway

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Jun 22, 2016 | Posted by drzezo in EMERGENCY MEDICINE | Comments Off

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