विवरण
The majority of small burns can be effectively treated in an outpatient setting and recover with no need for intervention. A precise classification of burns is essential to ensuring appropriate care. Thermal burns are injuries to the skin brought on by extreme heat, usually from coming into touch with hot objects, liquids, steam, or flames. The majority of burns are not severe, and patients can receive care at nearby hospitals or as outpatients. Specialized burn centers treat about 6.5 percent of all burn cases. The amount of burned body surface area, the degree of the burns, and the unique characteristics of each patient—such as age, previous injuries, or other medical issues—are taken into consideration when deciding whether to transfer and treat a patient at a burn center.
सारांश
- 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.
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