For example, although deep thermal burns are operated on immediately, the same approach would be an error in frostbite, in which the therapy of choice is moist rewarming, possible thrombolysis and watchful waiting. The particular cause of a burn injury determines the treatment approach. These mechanisms lead not only to skin necrosis but also to deep tissue damage 3. Frostbite is caused by a number of mechanisms including direct cellular injury from crystallization of water in tissue and indirect injury from ischaemia and reperfusion. Thermal injury can also occur through cold. Electrical injuries are entirely different because they can cause deep tissue damage that is greater than the visible skin injury tissue damage in electrical injuries is correlated with the electric field strength (amperes and resistance of the tissue), although for ease of comprehension the voltage is often used to describe the circumstances of injury 2. Alkaline chemicals cause colliquative necrosis (whereby the tissue is transformed into a liquid, viscous mass), whereas acidic burn causes a coagulation necrosis (whereby the architecture of the dead tissue can be preserved). For example, a flame or hot grease can cause an immediate deep burn, whereas scald injuries (that is, from hot liquids or steam) tend to appear more superficial initially, due to rapid dilution of the source and energy. Although all burn injuries involve tissue destruction due to energy transfer, different causes can be associated with different physiological and pathophysiological responses. The injuries can be caused by friction, cold, heat, radiation, chemical or electric sources, but the majority of burn injuries are caused by heat from hot liquids, solids or fire 1. The aim of this Primer is not only to give an overview and update about burn care, but also to raise awareness of the ongoing challenges and stigmata associated with burn injuries.īurn injuries are an under-appreciated trauma that can affect anyone, anytime and anywhere. Burn care providers are, therefore, faced with a plethora of challenges including acute and critical care management, long-term care and rehabilitation. Accordingly, patients with burn injury cannot be considered recovered when the wounds have healed instead, burn injury leads to long-term profound alterations that must be addressed to optimize quality of life. Of great importance is that the injury affects not only the physical health, but also the mental health and quality of life of the patient. Burn injuries, particularly severe burns, are accompanied by an immune and inflammatory response, metabolic changes and distributive shock that can be challenging to manage and can lead to multiple organ failure. Cyanide poisoning can also occur from smoke inhalation and can be treated with hydroxocobalamin (see Inhalation Injury chapter).Burn injuries are under-appreciated injuries that are associated with substantial morbidity and mortality. If carbon monoxide poisoning is confirmed, continue treatment with high-flow oxygen and consider hyperbaric oxygen in select cases (see Hyperbaric, Carbon Monoxide Toxicity chapter). In patients with moderate to severe flame burns and with suspicion for inhalation injury, carboxyhemoglobin levels should be checked, and patients should be placed on high flow oxygen until carbon monoxide poisoning is ruled out. Remember that the fluid resuscitation formula for burns is only an estimate and the patient may need more or less fluid based on vital signs, urine output, other injuries or other medical conditions (see Burns, Resuscitation, and Management for discussion of the management of severely burned patients). For example, if a 70 kg patient has a 30% TBSA partial thickness burn they will need 8400 mL Lactated Ringer solution in the first 24 hours with 4200 mL of that total in the first 8 hours. Half of the calculated amount is administered during the first eight hours beginning when the patient was initially burned. The total amount of fluid to be given during the initial 24 hours = 4 ml of LR × patient’s weight (kg) × % TBSA. One commonly used fluid resuscitation formula is the Parkland formula. Splints can also provide support and comfort for certain burned areas.įor burns classified as severe (> 20% TBSA), fluid resuscitation should be initiated to maintain urine output > 0.5 mL/kg/hour. Comfort – Over-the-counter pain medications or prescription pain medications when needed.
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