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When should you transfer a burn patient to a designated burn center? A few words on steroids and antibiotics — Today there is no data to support steroid administration in the setting of inhalation injury. Great overview! FYI, the Cyanokit only contains hydroxycobalmin. Your email address will not be published. Save my name, email, and website in this browser for the next time I comment. Notify me of follow-up comments by email. Notify me of new posts by email. We are actively recruiting both new topics and authors. This project is rolling and you can submit an idea or write-up at any time!

Contact us at editors emdocs. Algorithm for Transfusion Reactions. Powered by Gomalthemes. Toggle navigation. Menu All Content. Previous Post. Next Post. Mental Road Map To adequately manage the burn victim, the emergency medicine physician must remember three key guidelines: The burn patient is a special type of trauma patient.

Modern-Day Burn Resuscitation: Moving Beyond the Parkland Formula

The burn patient may be a toxicological patient. The burn patient requires comprehensive evaluation and management, and is best served by transferring to a burn center in accordance with ABA American Burn Association guidelines. If the airway is not protected: intubate. Signs of impending airway compromise include: stridor, wheezing, subjective dyspnea, and a hoarse voice.

Remember that full-thickness burns to the chest wall may lead to mechanical restriction of ventilation: consider escharotomy. Obtain IO access if unable to obtain IV access.


Central lines equipped with invasive monitoring devices may provide useful volume-status metrics to guide resuscitation. The What, When, and How Much of Fluids In order to determine the volume of fluid resuscitation required for a burn patient, the Rule of Nines for adults and the Lund and Browder chart for children should be utilized Figures 1 and 2 below.

Rule of Nines Reference 5 Figure 2. It is important to note that this formula is not universally accepted. Current trends in burn management literature emphasize a clinical assessment of volume status as essential in guiding fluid administration. The placement of a radial or femoral catheter is advised. The burn does not heal by itself. Extent of burns surface area involved Wallace's rule of nines A quick but reliable method for estimating the surface area covered by burns in the case of adults. The rule of nines is unreliable among children.

Clinical features of shock e. Remove any burnt clothing Cool the burnt area with cool running water or saline-soaked gauzes. Do NOT use ice or ice water!

What’s New in Trauma? (ATLS 10th Edition Updates) - Medical Exam Prep

Cover the wound with a sterile dressing. If burn wound infection or sepsis occurs, empirically treat for MRSA until ruled out e. Management based on degree 1 st and 2 nd -degree burns Irrigation Topical moisturizers e. Options include: Free skin grafts split-thickness or full-thickness Flap reconstruction with free or pedicled flaps. Topical antibiotics e. Chemical burns: specific measures Immediate, copious irrigation of all areas of exposure with water, prior to or on the way to the hospital. Once in the hospital, irrigation should be continued until the pH normalizes References: [6] [9] [10].

Curling's ulcers see stress ulcers Keloid formation, contractures Marjolin's ulcer : squamous cell carcinoma that develops in a burn scar Complications of chemical burns Cataracts or vision loss if burn involved eyes Esophageal strictures if burn involved esophagus Systemic poisoning Complications of electrical burns: arrhythmias , trauma References: [6] [4] We list the most important complications.

Prepare and succeed on your medical exams. Find hundreds of Learning Cards covering all clinical subjects Practice answering thousands of USMLE-formatted multiple choice questions in the Qbank Explore concepts in depth with interactive images, videos and charts Fill knowledge gaps with the help of supportive features and an analysis of your progress.

It appears that JavaScript is disabled in your browser. Superficial layers of the epidermis. Pain Erythema Swelling The burn wound blanches on applying pressure and refills rapidly.

What’s New in Trauma? (ATLS 10th Edition Updates)

Healing within 3—6 days without scarring. Head The secondary survey begins with evaluating the head to identify all related neurologic injuries and any other significant injuries. The entire scalp and head should be examined for lacerations, contusions, and evidence of fractures. See Chapter 6: Head Trauma.

Ocular mobility should be evaluated to exclude entrapment of extraocular muscles due to orbital fractures. These procedures frequently identify ocular injuries that are not otherwise apparent. Appendix A: Ocular Trauma provides additional detailed information about ocular injuries. Maxillofacial Structures Examination of the face should include palpation of all bony structures, assessment of occlusion, intraoral examination, and assessment of soft tissues.

Maxillofacial trauma that is not associated with airway obstruction or major bleeding should be treated only after the patient is stabilized and life-threatening injuries have been managed. At the discretion of appropriate specialists, definitive management may be safely delayed without compromising care.

Patients with fractures of the midface may also have a fracture of the cribriform plate. For these patients, gastric intubation should be performed via the oral route.