Transcript Burn 2 - HKCEM

HKCEM College Tutorial
Burn 2
DR. AXIEL YC SIU
REVISED BY
DR. CHAN MING YIN
JULY, 2013
Ambulance information
▪A 45 year old man was found
unconscious while working with
electric drill
History
▪ A 45 year-old man was found unconscious on
ground.
▪ He was using a electric hand drill before.
▪ No convulsion was noticed by his colleagues.
▪ No period of cardiac arrest was documented.
▪ He regained consciousness in ambulance.
What are the possible differential diagnoses?
Differential diagnosis
▪ CVS
▪ Cardiac arrhythmia
▪ Ischaemic heart
disease
▪ CNS
▪ Syncope
▪ Epilepsy
▪ Endocrine
▪ Hypoglycaemia
▪ Electrolyte disturbance
▪ Addison’s disease
▪ Others
▪ Electrocution
▪ Drug effect
▪ Substance abuse
Vital Signs
• Alert (GCS:15/15)
• BP: 140/89 mmHg
• Pulse: 84/min (Regular)
• SpO2: 100% (Room Air)
History
▪ A 45 year-old man was found unconscious on
ground.
▪ He was using a electric hand drill before.
▪ No convulsion was noticed by his colleagues.
▪ No period of cardiac arrest was documented.
▪ He regained consciousness in ambulance.
Assessment
▪ Charred mark was noted at
right palm
▪ No other external wound
▪ Heart sound was normal
▪ No neurological deficit was
noted
▪ Mild tenderness was noted
over both loin region
What is the most likely diagnosis?
WHAT IS YOUR MANAGEMENT PRIORITY?
Electrical Injury
WHAT IS YOUR MANAGEMENT PRIORITY?
Management Priority
▪ Airway with cervical protection
▪ Breathing
▪ Circulation
▪ Deficit and Disability
▪ Exposure
▪ Fluid Management and Foley
▪ Gastric tube (if indicated)
What Investigations will you order?
Baseline Investigations
▪ Chest X-ray
▪ Electrocardiogram
▪ CBP, electrolytes, CPK, troponin I
What additional test you would like
to order to guide your fluid management?
Myoglobinuria
▪ Urine for myoglobin
▪ The fluid regime should be
adjusted so that the urine output
is maintained at least 100mL per
hour
▪ Mannitol 25g ivi may be
considered if the urine output is
still not satisfactory
How is the electrical burn wound
different from other burn wound?
Electrical Burn
▪ Deep muscle necrosis and rhabdomyolysis causing acute renal
failure may occur in relatively normal looking skin.
▪ Severe electric shock may cause fatal dysrhythmia
▪ 110V AC can produce ventricular fibrillation
▪ Involuntary muscle contractions forceful to cause fractures or joint
dislocations
▪ Can induce respiratory arrest and seizures
Lightning injury
▪ >10,000,000V DC in 1-3ms
▪ Mainly involve skin giving rise to Lichtenberg figures
▪ Neurologically
▪ unconscious/ paralysis/ paraesthesia/ seizure
▪ Auditory
▪ tinnitus/vertigo/TM rupture
▪ Cardiac
▪ ECG arrhythmia/MI like pattern
Wound Management
▪ Fluid inside blister is sterile
▪ It will be re-absorbed by body
with time
▪ Aspirate blister if it is too
tense or too large
▪ Do not deroof the blister
Wound Management
▪ Promote wound healing
▪ Keep clean
▪ Prevent infection
▪ Keep dry but not too dry
▪ Minimize pain ( each time of change dressing)
Wound Management
▪ 1st degree burn -> lotion would be enough
▪ Superficial partial thickness
▪ Simple wound dressing or various dressing materials
▪ Possible dressing methods:
▪ Daily OPD dressing till fully granulated
▪ No topical agent is required
▪ Special dressing e.g. Hydrocolloid dressing
▪ Keep intact and renew every 2 to 3 days
Dressing materials
Dressing materials
▪ Some dressing aim to keep the wound intact till totally
healed
▪ Some allow exudate to be absorbed without change of
dressing
▪ Some aim to keep wound dry and inhibit bacterial growth
▪ Silver sulphadiazine is out of favor nowadays
▪ Most burn wound do not require antibiotic
Wound Management
▪ For deep partial thickness
▪ May need excision and skin graft / flap over functionally
or cosmetically important area
▪ 3rd/4th degree burn
▪ Skin graft
▪ Skin flap
▪ Reconstruction surgery
Thank you