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Thermal injury management

Immediate rescue action


What’s the priority?
• Airway control
• Stop the burning process
• IV line access
Airway
How to identify inhalation injury?
Clinical indication of inhalation injury
• Burns at face and/or neck
• Singed nasal hairs and eyebrows
• Soot and acute inflammation signs of oropharynx
• Carbonaceous sputum production
• Changes in voice
• History of chewing disorder and/or smoke
exposure in a closed space
• Burns on head and body in an explosion
• Carboxyhemoglobin level more than 10% after
burns
Inhalation injury most likely happen if
one of the situation above was found

It needs definitive therapy

Airway exemption
IMPORTANT
• Inhalation injury is an indication of referring
the patient to burn center
• Before referring the patient to far distance
center, intubation should be done

• Presence of stridor Indication of


• Encircle burns on neck early
intubation
Stop the burning process
• Remove any clothing immediately
• Wash the body surface with clean water
• Give the patient warm, dry, and clean cloth
blanket
IV line
• Fluid resuscitation was given to any patient
with > 20% Total Body Surface Area (TBSA)
burn
• IV catheter (minimal #16) on peripheral vein
on area without burn (or burn area if must)
• Upper extremity vein was preferred to avoid
complication
Burn patients assessment
• Anamnesis
• Determine the percentage area of burn
• Determine the depth of burn
Burn patients assessment

Determine the
percentage area of
burn
Burn patients assessment
Determine the depth of burn
Burn patients assessment
Determine the depth of burn
Primary survey and resuscitation
• Airway
• Breathing
• Circulation
– Grade II and III burns need 2-4 ml/kg/%TBSA of
Ringer Lactate in 24 hours (since the trauma)
– 50%  8 hours
– 50%  16 hours
– Asses  urine output and vital sign
Secondary survey
• Physical examination
• Medical records
• Supporting examination
– Blood test
– Blood type and cross match
– Carboxyhemoglobin level
– Blood glucose
– Electrolyte
– Blood gas analysis
– Thorax roentgen
Secondary survey
• Peripheral circulation
• Nasogastric tube
• Narcotics, analgesics, and sedative
• Wound care
• Antibiotics
• Tetanus
Referred criteria
• Grade II and III burns > 10% TBSA on patient
age < 10 years old or > 50 years old
• Grade II and III burns > 20% TBSA on other age
• Grade II and III burns on face, eye, ears, hand,
leg, genitalia, and joint
• Grade III burns > 5% TBSA at all age
• Electrical burn
• Chemical burn
Referred criteria
• Inhalation injury
• Burns on patient with other disease that can
complicate the handling, extend the recovery
time, or can caused death
• Burns with accompanying injury
• Burns children at hospital without sufficient
equipment and staff
• Burns patient who need special handling
(social problem)
Referred procedure
• Prepare the patient
• Coordination
• Medical records

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