Mechanism |
· Chemical · Electrical · Flame · Hot liquid |
Surface area |
· Rule of 9s for adults · Rule of 7s for babies · 1% = palm |
Thickness |
· Less deep: red, blanching, painful · More deep: white, non-blanching, painless |
Location |
· Airway? · Lungs? · Chest wall? |
As for trauma, right?
1.Team leader |
· Allocate roles · Observe · Co-ordinate |
2.Airway + breathing |
· Observe · Intubate early if airway burn |
3.Circulation |
3a. Access: · 2 x big PIVC wherever possible · Urinary catheter 3b. Fluid: · Parkland resus: 2-4mL/kg/%BSA, ½ first 8 hours, ½ next 16 hours · Titrate against urine output + lactate |
4.Surgery |
· Assessment · Dressings · Debridement (A&E vs OR) |
Multi-organ dysfunction |
· CVS: ↑cardiac output, ↓SVR (except very beginning) · Resp: early APO, later restrictive · Metab: severe catabolic state, elec derangement, risk of rhabdo · Haem: risk of DIC · Immune: risk of sepsis |
Difficult monitoring |
· Sats probe · BP cuff vs arterial line · ECG dots |
Difficult procedures |
· Airway · Vascular access |
Difficult homeostasis |
· Feeding · Hydration · Normothermia · Analgesia |
Traumatic event |
· Patient suffering +++ · Parental guilt +++ |
Goals |
· Facilitate surgery · Seek homeostasis · Minimise suffering |
Referrals |
· Burns unit · ICU post-op · Acute pain service |
Airway |
· Modified rapid sequence induction (avoid sux) · Video laryngoscope first line |
Breathing |
· Consider lung-protective ventilation |
Circulation |
Access: · Peripheral IV · +/- Central IV · +/- Arterial line Fluids: · Observe Parkland formula · Titrate against urine output, lactate |
Drugs |
Analgesics: · Titrate to effect, often large dose · Consider transfer to ICU anaesthetized and intubated · Paracetamol · Ketamine infusion · Opioid infusion · Acute pain service Other: · Avoid sux except on day 1 |
Exposure |
· Warmed theatre · Warmed table · Warmed fluid |