Burns and their management

0
175

Primary Survey:

Initial Assessment:

 

Mechanism of injury, inhalational injury; CO poisoning, associated injuries, patient’s age, and previous state of health, pre-hospital treatment.

Physical examination:

 

  1. Airway, Breathing, Circulation.
  2. Removal of all clothing, jewelry and rings.
  3. Assess depth of burn.  Partial thickness, or full thickness.
  4. Quick assessment of burn area by “Rule of Nine”.

Management:

Criteria for Admission

 

  1. Patients under 10 years or over 50 years old, sustaining partial or full thickness burn to over 10% body surface area (BSA).
  2. Burns over 20% BSA in any age groups.
  3. Burns of special regions like joints, perineum, genitalia, hands, feet, face, eyes and ears.
  4. Full thickness burns to over 5% BSA.
  5. Significant inhalation, chemical or electrical injury.
  6. Burn in combination with significant associated or pre-existing medical problems.
  7. Patient requiring specialized rehabilitation, psychological support or social services.

 

Resuscitation

  1. 100% oxygen, 2-6 liter/minutes.
  2. Maintain I/V line with 16 or 18G branula.
  3. Calculate fluid requirement for patients with over 20% burn by “Parkland Formula”.
  4. Fluid in 1st 24 hours = 4 ml x weight of patient x % BSA burnt.
  • 1st 8 hours = half of calculated fluid.
  • 2nd 8 hours = half of remaining fluid.
  • 3rd 8 hours = remaining fluid.
  1. Start I/V Ringer’s Lactate
  2. Catheterize the patient with Foley catheter #16 in adults.
  3. Inj. Tetavax 0.5 ml I/M stat.
  4. Inj. Nalbufin 10mg I./V stat.
  5. Start I/V antibiotics:  Inj. Ampiclox 500 mg ATD I/V.
  6. Inj. ranitidine 50 mg I/V 8 hourly for stress ulcer prophylaxis.
  7. Take blood sample for Hb%, blood group & cross match, Pregnancy test in women, urea, creatinine, and electrolytes.
  8. Pass N/G tube #16 in adults with burns over 30% BSA.

Secondary Survey:

 

  1. Detailed history.
  2. Physical examination from head to toe.
  3. Photograph or make a diagram showing %age of body surface area burnt for Medico-legal purpose and discussion with other specialists involved in patient care.
  4. Early irrigation and debridement of burn area.
  5. Topical anti microbial ointment: silver sulphadiazine except face where Polyfax be applied
  6. Moist dressing for partial thickness burns.
  7. Consider escherotomy or fasciotomy for circumferential burns.
  8. Consider tracheotomy in patients with respiratory distress.

Medico-Legal Aspects

 

  1. Every burn patient must be considered and documented as a medicolegal case.
  2. Keep record of treatment chart and progress notes of burn patient in the medico legal register.
  3. Dead body of burn patient should be handed over to CMO and not to patient’s relatives.