Description
La plupart des brûlures légères peuvent être traitées efficacement en ambulatoire et guérissent sans intervention. Une classification précise des brûlures est essentielle pour garantir des soins appropriés. Les brûlures thermiques sont des lésions cutanées provoquées par une chaleur extrême, généralement due au contact avec des objets chauds, des liquides, de la vapeur ou des flammes. La plupart des brûlures sont bénignes et les patients peuvent être pris en charge dans les hôpitaux proches ou en ambulatoire. Les centres spécialisés pour brûlés traitent environ 6,5 % des cas de brûlures. La surface corporelle brûlée, la gravité des brûlures et les caractéristiques uniques de chaque patient, telles que l'âge, les antécédents de blessures ou d'autres problèmes médicaux, sont prises en compte lors de la décision de transférer et de traiter un patient dans un centre pour brûlés.
Résumé
- The speaker discusses common pitfalls in emergency department care for burn patients, highlighting the need for accurate burn size assessment, early intubation considerations, and appropriate fluid resuscitation volumes. They emphasize the importance of managing core temperature to prevent hypothermia, adequate analgesia, proper dressing techniques, and considering associated trauma in burn patients.
- The presentation covers different types of burns, including thermal, chemical, electrical, cold, and radiation burns. A case study involving a child with burns is presented, emphasizing the need to differentiate between accidental and non-accidental trauma, potentially indicating child abuse. First aid measures, particularly washing burns with cool running water for 20 minutes, are recommended, cautioning against the use of ice and domestic remedies like toothpaste.
- Hospital management of burns includes primary evaluation focusing on ABC (airway, breathing, circulation), detailed incident history, co-morbidities, medication review, and identifying associated injuries. Airway management, breathing support with supplemental oxygen, and circulation management with fluid resuscitation are prioritized. Diagnostic investigations like CBC, kidney and liver function tests, and coagulation profiles are essential.
- Fluid resuscitation should be based on the percentage of body surface area burned, using ringer lactate as the preferred solution. Over and under-hydration must be avoided to prevent complications like compartment syndrome or acute kidney injury. Fluid formulas like Parkland are starting points, requiring adjustment based on urine output monitoring.
- The speaker stresses the significance of pain management, suggesting a combination of acetaminophen, NSAIDs, and opioids, including fentanyl or ketamine. Proper wound care is emphasized, maintaining a moist environment with non-adherent dressings, and using antibiotic-based dressings. Blisters should generally not be debrided, and dressing changes should be frequent enough to manage exudate without interfering with healing.
- Electrical burns present unique challenges due to potential internal injuries and muscle necrosis. Fluid resuscitation for electrical burns requires a higher volume, and urine alkalization might be necessary to prevent acute kidney injury caused by myoglobinuria. Hospital admission or referral to a burn center is required for significant burns based on percentage of body surface area affected and location of burn.
Exemple de certificat
À propos des intervenants
Dr Anurag Aggarwal
Directeur et chef de service - Médecine d'urgence et traumatologie, hôpital Fortis, Noida
Divulgation financière
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