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__NOTOC__ | __NOTOC__ | ||
{{Burn}} | {{Burn}} | ||
{{CMG}}{{EAM}} | {{CMG}}; {{AE}} {{EAM}} | ||
==Overview== | |||
==Medical Therapy== | ==Medical Therapy== | ||
The American Burn Association recommends burn center referrals for patients with: | The [[American Burn Association]] recommends [[burn]] center referrals for patients with: | ||
*partial thickness burns greater than 10% total body surface area or:<ref name="pmid9115481">{{cite journal| author=Mertens DM, Jenkins ME, Warden GD| title=Outpatient burn management. | journal=Nurs Clin North Am | year= 1997 | volume= 32 | issue= 2 | pages= 343-64 | pmid=9115481 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9115481 }}</ref><ref name="pmid8222354">{{cite journal| author=Baxter CR| title=Management of burn wounds. | journal=Dermatol Clin | year= 1993 | volume= 11 | issue= 4 | pages= 709-14 | pmid=8222354 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8222354 }}</ref> | *[[partial thickness burns]] greater than 10% [[total body surface area]] or:<ref name="pmid9115481">{{cite journal| author=Mertens DM, Jenkins ME, Warden GD| title=Outpatient burn management. | journal=Nurs Clin North Am | year= 1997 | volume= 32 | issue= 2 | pages= 343-64 | pmid=9115481 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9115481 }}</ref><ref name="pmid8222354">{{cite journal| author=Baxter CR| title=Management of burn wounds. | journal=Dermatol Clin | year= 1993 | volume= 11 | issue= 4 | pages= 709-14 | pmid=8222354 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8222354 }}</ref> | ||
**Partial-thickness burns <10 percent TBSA in patients 10 to 50 years old | **[[Partial-thickness burns]] <10 percent [[TBSA]] in patients 10 to 50 years old | ||
**Partial-thickness burns <5 percent TBSA in patients under 10 or over 50 years old | **[[Partial-thickness burns]] <5 percent TBSA in patients under 10 or over 50 years old | ||
**Full-thickness burns <2 percent TBSA in any patient without other injury | **Full-thickness burns <2 percent TBSA in any patient without other injury | ||
*full thickness burns | *full thickness [[burns]] | ||
*burns of the face, hands, feet, genitalia, or major joints | *[[burns]] of the [[face]], [[hands]], [[feet]], [[genitalia]], or [[major joints]] | ||
*chemical burns, electrical, or lighting strike injuries | *[[chemical burns]], [[electrical]], or [[lighting strike injuries]] | ||
*significant inhalation injuries | *significant [[inhalation]] injuries | ||
*burns in patients with multiple medical disorders | *[[burns]] in patients with multiple medical [[disorders]] | ||
*burns in patients with associated traumatic injuries | *[[burns]] in [[patients]] with associated traumatic injuries | ||
Patients being transferred to burn centers do not need extensive debridement or topical antibiotics before transfer. Whether transferring or referring to a burn center, you should contact them before | [[Patients]] being transferred to [[burn]] centers do not need extensive [[debridement]] or topical [[antibiotics]] before transfer. Whether transferring or referring to a [[burn]] center, you should contact them before. | ||
If burns classified as severe (> 20% TBSA), fluid resuscitation should be initiated to maintain urine output > 0.5 mL/kg/hour. One commonly used fluid resuscitation formula is the Parkland formula. The total amount of fluid to be given during the initial 24 hours = 4 ml of LR × patient’s weight (kg) × % TBSA. Half of the calculated amount is administered during the first eight hours beginning when the patient was initially burned. 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 [(4 mL) × (70 kg) × (30% TBSA) = 8,400 mL LR]. 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). | If [[burns]] classified as severe (> 20% TBSA), fluid resuscitation should be initiated to maintain [[urine output]] > 0.5 mL/kg/hour. One commonly used fluid resuscitation formula is the Parkland formula. The total amount of fluid to be given during the initial 24 hours = 4 ml of LR × patient’s weight (kg) × % TBSA. Half of the calculated amount is administered during the first eight hours beginning when the patient was initially [[burned]]. For example, if a 70 kg patient has a 30% TBSA partial thickness burn they will need 8400 mL Lactated [[Ringer's lactate|Ringer]] solution in the first 24 hours with 4200 mL of that total in the first 8 hours [(4 mL) × (70 kg) × (30% TBSA) = 8,400 mL LR]. 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). | ||
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. 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). Cyanide poisoning can also occur from smoke inhalation and can be treated with hydroxocobalamin (see Inhalation Injury chapter).<ref name="pmidPMID: 30480960">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume= | issue= | pages= | pmid=PMID: 30480960 | doi= | pmc= | url= }}</ref><ref name="pmid30440148">Burn and Trauma Branch of Chinese Geriatrics Society. Ming J, Lei P, Duan JL, Tan JH, Lou HP | display-authors=etal (2018) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=30440148 [National experts consensus on tracheotomy and intubation for burn patients (2018 version)].] ''Zhonghua Shao Shang Za Zhi'' 34 (11):E006. [http://dx.doi.org/10.3760/cma.j.issn.1009-2587.2018.11.E006 DOI:10.3760/cma.j.issn.1009-2587.2018.11.E006] PMID: [https://pubmed.gov/PMID: 30440148 PMID: 30440148]</ref> | 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. If [[carbon monoxide poisoning]] is confirmed, continue [[treatment]] with high-flow [[oxygen]] and consider [[hyperbaric oxygen]] in select cases (see [[Hyperbaric]], [[Carbon monoxide|Carbon Monoxide]] Toxicity chapter). [[Cyanide]] poisoning can also occur from [[smoke inhalation]] and can be treated with [[hydroxocobalamin]] (see [[Inhalation]] Injury chapter).<ref name="pmidPMID: 30480960">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume= | issue= | pages= | pmid=PMID: 30480960 | doi= | pmc= | url= }}</ref><ref name="pmid30440148">Burn and Trauma Branch of Chinese Geriatrics Society. Ming J, Lei P, Duan JL, Tan JH, Lou HP | display-authors=etal (2018) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=30440148 [National experts consensus on tracheotomy and intubation for burn patients (2018 version)].] ''Zhonghua Shao Shang Za Zhi'' 34 (11):E006. [http://dx.doi.org/10.3760/cma.j.issn.1009-2587.2018.11.E006 DOI:10.3760/cma.j.issn.1009-2587.2018.11.E006] PMID: [https://pubmed.gov/PMID: 30440148 PMID: 30440148]</ref> | ||
A [[local anesthetic]] is usually sufficient in managing [[pain]] of minor first-degree and second-degree [[burns]]. However, systemic [[Anti-inflammatory medication|anti-inflammatory]] drugs such as [[naproxen]] may be effective in mitigating [[pain]] and [[swelling]]. Additionally, [[topical]] [[antibiotics]] such as Mycitracin are useful in preventing [[infection]] to the damaged area<ref> Minor Burns [http://quickcare.org/skin/burns.html quickcare.org] Accessed February 25, 2008</ref>. [[Lidocaine]] can be administered to the spot of [[injury]] and will generally negate most of the [[pain]]. Regardless of the cause, the first step in managing a person with a [[burn]] is to stop the burning process at the source. For instance, with dry powder [[burns]], the powder should be brushed off first. With other burns, such as those caused by exposure to [[chemicals]], the affected area should be rinsed throughly with a large amount of clean water to remove the caustic agent and any [[foreign body|foreign bodies]]. Cold water should not be applied to a person with extensive [[burns]], however, as it may compromise the [[Burn (injury)|burn]] victim's [[temperature]] status. | A [[local anesthetic]] is usually sufficient in managing [[pain]] of minor first-degree and second-degree [[burns]]. However, systemic [[Anti-inflammatory medication|anti-inflammatory]] drugs such as [[naproxen]] may be effective in mitigating [[pain]] and [[swelling]]. Additionally, [[topical]] [[antibiotics]] such as Mycitracin are useful in preventing [[infection]] to the damaged area<ref> Minor Burns [http://quickcare.org/skin/burns.html quickcare.org] Accessed February 25, 2008</ref>. [[Lidocaine]] can be administered to the spot of [[injury]] and will generally negate most of the [[pain]]. Regardless of the cause, the first step in managing a person with a [[burn]] is to stop the burning process at the source. For instance, with dry powder [[burns]], the powder should be brushed off first. With other burns, such as those caused by exposure to [[chemicals]], the affected area should be rinsed throughly with a large amount of clean water to remove the caustic agent and any [[foreign body|foreign bodies]]. Cold water should not be applied to a person with extensive [[burns]], however, as it may compromise the [[Burn (injury)|burn]] victim's [[temperature]] status. | ||
| Line 29: | Line 34: | ||
===Treatment of Low Grade Burns(minor thermal burns)=== | ===Treatment of Low Grade Burns(minor thermal burns)=== | ||
The majority are minor and can be managed on an outpatient basis without the need for burn specialist consultation.<ref name="pmid8675512">{{cite journal| author=Brigham PA, McLoughlin E| title=Burn incidence and medical care use in the United States: estimates, trends, and data sources. | journal=J Burn Care Rehabil | year= 1996 | volume= 17 | issue= 2 | pages= 95-107 | pmid=8675512 | doi=10.1097/00004630-199603000-00003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8675512 }}</ref> | The majority are minor burn and can be managed on an outpatient basis without the need for [[burn]] specialist consultation.<ref name="pmid8675512">{{cite journal| author=Brigham PA, McLoughlin E| title=Burn incidence and medical care use in the United States: estimates, trends, and data sources. | journal=J Burn Care Rehabil | year= 1996 | volume= 17 | issue= 2 | pages= 95-107 | pmid=8675512 | doi=10.1097/00004630-199603000-00003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8675512 }}</ref> | ||
To be considered minor, burns must also generally meet the following criteria: | To be considered minor, [[burns]] must also generally meet the following criteria: | ||
*Isolated [[injury]] (ie, no suspicion of inhalation or high-voltage injury) | |||
*Does not involve face, hands, perineum, or feet | |||
*Does not cross major joints | |||
*Is not circumferential | |||
A [[local anesthetic]] is usually sufficient in managing pain of smaller first-degree and second-degree [[burns]]. [[Lidocaine]] can be administered to the spot of [[injury]] and will generally negate most [[pain]]. | A [[local anesthetic]] is usually sufficient in managing pain of smaller first-degree and second-degree [[burns]]. [[Lidocaine]] can be administered to the spot of [[injury]] and will generally negate most [[pain]]. | ||
==TREATMENT== | ==TREATMENT== | ||
*[[Cooling bath|Cooling]] | |||
*[[Pain management]] | |||
*[[Cleaning Pages|Cleaning]]<ref name="pmid11896770">{{cite journal| author=Balin AK, Pratt L| title=Dilute povidone-iodine solutions inhibit human skin fibroblast growth. | journal=Dermatol Surg | year= 2002 | volume= 28 | issue= 3 | pages= 210-4 | pmid=11896770 | doi=10.1046/j.1524-4725.2002.01161.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11896770 }}</ref><ref name="pmid91154812">{{cite journal| author=Mertens DM, Jenkins ME, Warden GD| title=Outpatient burn management. | journal=Nurs Clin North Am | year= 1997 | volume= 32 | issue= 2 | pages= 343-64 | pmid=9115481 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9115481 }}</ref><ref name="pmid82223542">{{cite journal| author=Baxter CR| title=Management of burn wounds. | journal=Dermatol Clin | year= 1993 | volume= 11 | issue= 4 | pages= 709-14 | pmid=8222354 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8222354 }}</ref><ref name="pmid8268745">{{cite journal| author=Waitzman AA, Neligan PC| title=How to manage burns in primary care. | journal=Can Fam Physician | year= 1993 | volume= 39 | issue= | pages= 2394-400 | pmid=8268745 | doi= | pmc=2379923 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8268745 }}</ref><ref name="pmid9060321">{{cite journal| author=Hill MG, Bowen CC| title=The treatment of minor burns in rural Alabama emergency departments. | journal=J Emerg Nurs | year= 1996 | volume= 22 | issue= 6 | pages= 570-6; quiz 576-8 | pmid=9060321 | doi=10.1016/s0099-1767(96)80214-5 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9060321 }}</ref><ref name="pmid8695324">{{cite journal| author=Greenhalgh DG| title=The healing of burn wounds. | journal=Dermatol Nurs | year= 1996 | volume= 8 | issue= 1 | pages= 13-23, 66; quiz 24-5 | pmid=8695324 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8695324 }}</ref> | |||
*[[Debridement]] | |||
*[[Chemoprophylaxis]] | |||
*Dressings Basic dressing, dry, nonstick gauze only, Biologic and synthetic dressings | |||
Several case reports describe epiglottitis caused by thermal injury after an oral scald burn | Oral [[Burn (injury)|burn]]<nowiki/>s :Minor oral mucosal [[Burn|burns]] typically require no specific [[treatment]] other than saline rinses and basic [[oral hygiene]]. Alcohol-based mouth rinses should be avoided as they can irritate wounds and increase [[pain]]. | ||
Several case reports describe [[epiglottitis]] caused by [[thermal injury]] after an [[oral]] scald [[burn]]. Close attention should be paid to young children with [[oral scald burns]] as their [[airway structures]] are narrower and are more prone to obstruction with smaller degrees of [[Inflammation|inflammatio]]<nowiki/>n and [[swelling]]. If there is any concern for airway compromise or about the extent of [[injury]], the patient is best evaluated in the ED, where a more in-depth inspection of the [[epiglottis]] and [[airway]] can be performed<ref name="pmid2373837">{{cite journal| author=Goldberg RM, Lee S, Line WS| title=Laryngeal burns secondary to the ingestion of microwave-heated food. | journal=J Emerg Med | year= 1990 | volume= 8 | issue= 3 | pages= 281-3 | pmid=2373837 | doi=10.1016/0736-4679(90)90006-h | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2373837 }}</ref><ref name="pmid24797620">{{cite journal| author=Kannan S, Chandrasekaran B, Muthusamy S, Sidhu P, Suresh N| title=Thermal burn of palate in an elderly diabetic patient. | journal=Gerodontology | year= 2014 | volume= 31 | issue= 2 | pages= 149-52 | pmid=24797620 | doi=10.1111/ger.12010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24797620 }}</ref><ref name="pmid8572457">{{cite journal| author=Sheridan RL| title=Recognition and management of hot liquid aspiration in children. | journal=Ann Emerg Med | year= 1996 | volume= 27 | issue= 1 | pages= 89-91 | pmid=8572457 | doi=10.1016/s0196-0644(96)70302-5 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8572457 }}</ref><ref name="pmid24113478">{{cite journal| author=Kudchadkar SR, Hamrick JT, Mai CL, Berkowitz I, Tunkel D| title=The heat is on... thermal epiglottitis as a late presentation of airway steam injury. | journal=J Emerg Med | year= 2014 | volume= 46 | issue= 2 | pages= e43-6 | pmid=24113478 | doi=10.1016/j.jemermed.2013.08.033 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24113478 }}</ref><ref name="pmid17427650">{{cite journal| author=Go H, Yang HW, Jung SH, Park YA, Lee JY, Kim SH | display-authors=etal| title=Esophageal thermal injury by hot adlay tea. | journal=Korean J Intern Med | year= 2007 | volume= 22 | issue= 1 | pages= 59-62 | pmid=17427650 | doi=10.3904/kjim.2007.22.1.59 | pmc=2687594 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17427650 }}</ref><ref name="pmid8909764">{{cite journal| author=Watts AM, McCallum MI| title=Acute airway obstruction following facial scalding: differential diagnosis between a thermal and infective cause. | journal=Burns | year= 1996 | volume= 22 | issue= 7 | pages= 570-3 | pmid=8909764 | doi=10.1016/0305-4179(96)00032-0 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8909764 }}</ref>. | |||
====Contraindicated medications==== | ====Contraindicated medications==== | ||
| Line 67: | Line 73: | ||
|MedCond = Severe burns with hyperkalemia|Potassium chloride}} | |MedCond = Severe burns with hyperkalemia|Potassium chloride}} | ||
==Reference== | |||
<br /> | <br /> | ||
{{Reflist|2}} | {{Reflist|2}} | ||
{{WikiDoc Help Menu}} | {{WikiDoc Help Menu}} | ||
Latest revision as of 09:19, 15 January 2021
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American Roentgen Ray Society Images of Burn medical therapy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Eman Alademi, M.D.[2]
Overview
Medical Therapy
The American Burn Association recommends burn center referrals for patients with:
- partial thickness burns greater than 10% total body surface area or:[1][2]
- Partial-thickness burns <10 percent TBSA in patients 10 to 50 years old
- Partial-thickness burns <5 percent TBSA in patients under 10 or over 50 years old
- Full-thickness burns <2 percent TBSA in any patient without other injury
- full thickness burns
- burns of the face, hands, feet, genitalia, or major joints
- chemical burns, electrical, or lighting strike injuries
- significant inhalation injuries
- burns in patients with multiple medical disorders
- burns in patients with associated traumatic injuries
Patients being transferred to burn centers do not need extensive debridement or topical antibiotics before transfer. Whether transferring or referring to a burn center, you should contact them before.
If burns classified as severe (> 20% TBSA), fluid resuscitation should be initiated to maintain urine output > 0.5 mL/kg/hour. One commonly used fluid resuscitation formula is the Parkland formula. The total amount of fluid to be given during the initial 24 hours = 4 ml of LR × patient’s weight (kg) × % TBSA. Half of the calculated amount is administered during the first eight hours beginning when the patient was initially burned. 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 [(4 mL) × (70 kg) × (30% TBSA) = 8,400 mL LR]. 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).
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. 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). Cyanide poisoning can also occur from smoke inhalation and can be treated with hydroxocobalamin (see Inhalation Injury chapter).[3][4]
A local anesthetic is usually sufficient in managing pain of minor first-degree and second-degree burns. However, systemic anti-inflammatory drugs such as naproxen may be effective in mitigating pain and swelling. Additionally, topical antibiotics such as Mycitracin are useful in preventing infection to the damaged area[5]. Lidocaine can be administered to the spot of injury and will generally negate most of the pain. Regardless of the cause, the first step in managing a person with a burn is to stop the burning process at the source. For instance, with dry powder burns, the powder should be brushed off first. With other burns, such as those caused by exposure to chemicals, the affected area should be rinsed throughly with a large amount of clean water to remove the caustic agent and any foreign bodies. Cold water should not be applied to a person with extensive burns, however, as it may compromise the burn victim's temperature status.
If the patient was involved in a fire accident, then it must be assumed that he or she has sustained inhalation injury until proven otherwise, and treatment should be managed accordingly. At this stage of management, it is also critical to assess the airway status. Any hint of burn injury to the lungs (e.g. through smoke inhalation) is considered a medical emergency. Survival and outcome of severe burn injuries is remarkably improved if the patient is treated in a specialized burn center/unit rather than a hospital. Serious burns, especially if they cover large areas of the body, can result in death.
Once the burning process has been stopped, the patient should be volume resuscitated according to the Parkland formula, since such injuries can disturb a person's osmotic balance. This formula dictates the amount of Lactated Ringer's solution to deliver in the first twenty four hours after time of injury. This formula excludes first and most second degree burns. Half of the fluid should be given in the first eight hours post injury and the rest in the subsequent sixteen hours. The formula is a guide only and infusions must be tailored to the urine output and central venous pressure. Inadequate fluid resuscitation causes renal failure and death.
Treatment of Low Grade Burns(minor thermal burns)
The majority are minor burn and can be managed on an outpatient basis without the need for burn specialist consultation.[6]
To be considered minor, burns must also generally meet the following criteria:
- Isolated injury (ie, no suspicion of inhalation or high-voltage injury)
- Does not involve face, hands, perineum, or feet
- Does not cross major joints
- Is not circumferential
A local anesthetic is usually sufficient in managing pain of smaller first-degree and second-degree burns. Lidocaine can be administered to the spot of injury and will generally negate most pain.
TREATMENT
- Dressings Basic dressing, dry, nonstick gauze only, Biologic and synthetic dressings
Oral burns :Minor oral mucosal burns typically require no specific treatment other than saline rinses and basic oral hygiene. Alcohol-based mouth rinses should be avoided as they can irritate wounds and increase pain.
Several case reports describe epiglottitis caused by thermal injury after an oral scald burn. Close attention should be paid to young children with oral scald burns as their airway structures are narrower and are more prone to obstruction with smaller degrees of inflammation and swelling. If there is any concern for airway compromise or about the extent of injury, the patient is best evaluated in the ED, where a more in-depth inspection of the epiglottis and airway can be performed[13][14][15][16][17][18].
Contraindicated medications
Severe burns with hyperkalemia is considered a relative contraindication to the use of the following medications:
Reference
- ↑ Mertens DM, Jenkins ME, Warden GD (1997). "Outpatient burn management". Nurs Clin North Am. 32 (2): 343–64. PMID 9115481.
- ↑ Baxter CR (1993). "Management of burn wounds". Dermatol Clin. 11 (4): 709–14. PMID 8222354.
- ↑ "StatPearls". 2020. PMID 30480960 PMID: 30480960 Check
|pmid=value (help). - ↑ Burn and Trauma Branch of Chinese Geriatrics Society. Ming J, Lei P, Duan JL, Tan JH, Lou HP | display-authors=etal (2018) [National experts consensus on tracheotomy and intubation for burn patients (2018 version).] Zhonghua Shao Shang Za Zhi 34 (11):E006. DOI:10.3760/cma.j.issn.1009-2587.2018.11.E006 PMID: 30440148 PMID: 30440148
- ↑ Minor Burns quickcare.org Accessed February 25, 2008
- ↑ Brigham PA, McLoughlin E (1996). "Burn incidence and medical care use in the United States: estimates, trends, and data sources". J Burn Care Rehabil. 17 (2): 95–107. doi:10.1097/00004630-199603000-00003. PMID 8675512.
- ↑ Balin AK, Pratt L (2002). "Dilute povidone-iodine solutions inhibit human skin fibroblast growth". Dermatol Surg. 28 (3): 210–4. doi:10.1046/j.1524-4725.2002.01161.x. PMID 11896770.
- ↑ Mertens DM, Jenkins ME, Warden GD (1997). "Outpatient burn management". Nurs Clin North Am. 32 (2): 343–64. PMID 9115481.
- ↑ Baxter CR (1993). "Management of burn wounds". Dermatol Clin. 11 (4): 709–14. PMID 8222354.
- ↑ Waitzman AA, Neligan PC (1993). "How to manage burns in primary care". Can Fam Physician. 39: 2394–400. PMC 2379923. PMID 8268745.
- ↑ Hill MG, Bowen CC (1996). "The treatment of minor burns in rural Alabama emergency departments". J Emerg Nurs. 22 (6): 570–6, quiz 576-8. doi:10.1016/s0099-1767(96)80214-5. PMID 9060321.
- ↑ Greenhalgh DG (1996). "The healing of burn wounds". Dermatol Nurs. 8 (1): 13–23, 66, quiz 24-5. PMID 8695324.
- ↑ Goldberg RM, Lee S, Line WS (1990). "Laryngeal burns secondary to the ingestion of microwave-heated food". J Emerg Med. 8 (3): 281–3. doi:10.1016/0736-4679(90)90006-h. PMID 2373837.
- ↑ Kannan S, Chandrasekaran B, Muthusamy S, Sidhu P, Suresh N (2014). "Thermal burn of palate in an elderly diabetic patient". Gerodontology. 31 (2): 149–52. doi:10.1111/ger.12010. PMID 24797620.
- ↑ Sheridan RL (1996). "Recognition and management of hot liquid aspiration in children". Ann Emerg Med. 27 (1): 89–91. doi:10.1016/s0196-0644(96)70302-5. PMID 8572457.
- ↑ Kudchadkar SR, Hamrick JT, Mai CL, Berkowitz I, Tunkel D (2014). "The heat is on... thermal epiglottitis as a late presentation of airway steam injury". J Emerg Med. 46 (2): e43–6. doi:10.1016/j.jemermed.2013.08.033. PMID 24113478.
- ↑ Go H, Yang HW, Jung SH, Park YA, Lee JY, Kim SH; et al. (2007). "Esophageal thermal injury by hot adlay tea". Korean J Intern Med. 22 (1): 59–62. doi:10.3904/kjim.2007.22.1.59. PMC 2687594. PMID 17427650.
- ↑ Watts AM, McCallum MI (1996). "Acute airway obstruction following facial scalding: differential diagnosis between a thermal and infective cause". Burns. 22 (7): 570–3. doi:10.1016/0305-4179(96)00032-0. PMID 8909764.