Transcript Burns & Escharotomy - Donald Hudson Home

Burns & Escharotomy
By
Don Hudson, D.O.
FACEP/ACOEP
LifeFlight Medical Director
Burns
In the USA over 2.2 million/year
Major burns have a significant risk of
morbidity & death.
The pre-hospital care is a major
contributor to patients final out come.
Burns
The skin is the largest organ in the body
It provides Thermal regulation &
prevention of fluid loss by evaporation.
Hermetic barrier to infection.
Contains sensory receptors that provide
information about the environment.
Skin Anatomy
The skin is divided into 3 layers
Epidermis- outer layer of cornified
epithelial cells.
Dermis- the middle layer, mostly
connective tissue. Contains capillaries,
nerve endings, & hair follicles.
Hypodermis- a layer of fat & connective
tissue between skin & underlying tissue
Approach to Burn Patient
Age
History
Duration of exposure
Type of fire
Tetanus status
Consider Abuse in pediatrics
Determine depth, type & extent of injury
For Review
Consider Abuse
Important Points
A- Allergies
M- Medications even OTC
P- Past medical Hx/previous illness
L- Last meal or fluids consumed
E- Events leading up to injury/Hx present
illness
Burn Patients
Burn patients need lots of medical skill
You must identify the amount of burn
You must define degree of burn
You must identify associated injuries
You must establish events preceding the
injury
Establish basic care first
Airway, Fluids & Urine
Treatment
Airway- establish early
Fluids- Two (2) big bore IV’s
Consider Foley for fluid management
Protect from further injury
Consult
Notify dispatch of findings
Arrange appropriate referral &/or treatment
Studies Needed
CBS & Chemistry profile
ABG
CO level
Coagulation profile
UA
Type & screen
CPK & urine myoglobin (especially in electrical
injuries)
CXR
Fluids
(4 ml crystalloid) X (% BSA burn) X (body wt in Kg)
Ex a man weighting 70 Kg with 30% BSA would
require (30) X (4ml) X 70 = 8400 ml in 1st 24 hr.
Half of the fluid is given in the first 8 hr. with the
balance given in the next 16 hr.
Maintain urine output at 1 ml/kg/hour
Escharotomy
Needed when there is a full thickness burn
involving the extremities or chest.
The eschar acts like a tourniquet.
Edema forming in the middle layer pushes
out ward & the eschar restricts further
motion.
This compromises the vascular flow
Procedure
Perform along lateral aspect of extremity
Incision should go completely through the
eschar.
Be prepared for the subq fat to bubble up
through the incision
Once the incision is made some bleeding
will occur.
Incision Lines
Procedure
Do not forget chest, it may also need a
procedure
Don’t forget PAIN MEDS
Don’t forget, clean, bandage, Universal
Precautions about blood products &
potential for hypothermia
Visuals
Review
Anatomy
First Degree
Second Degree
Second & Third Degree
One Hour Difference
30 Min After Procedure
Note: Chest Incisions
Fat Bulging
Chest
Foot
Leg
REMEMBER
Be early
Be aggressive in Tx
Airway Control
IV’s, adequate fluids
Foley
Consider other injuries
Splints
Escharotomy
Temperature control
THE END