Burn
❤️Surgical Care of the Burned Patient 🩺🔥
🌹 Background
Burn care = now a specialized, interdisciplinary field (surgeons, nurses, therapists,
specialists).
Mass casualty events → general surgeons may have to step in, so they need comfort
with burn care.
History:
o Old days = poor prognosis.
o Advances that improved survival:
💧 Fluid resuscitation.
✂️Early excision of burn wound.
o Now: survival is expected even in severe burns.
o New focus = function + psychological recovery, not just survival.
American Burn Association (ABA):
o Promotes referral to specialized burn centers.
o Created standards + verification system.
o Specific referral criteria guide transfer.
Patients often transferred long distances → 🚑 data show transport times (even hours) do
not worsen outcomes.
🌹 Initial Evaluation (Burn = Trauma Patient)
Follow ATLS principles 📋
🔑 Four crucial first assessments:
1. Airway 🫁
o Smoke/thermal injury → rapid swelling = lethal.
o 🚩 Warning signs: hoarseness, wheezing, stridor, dyspnea.
o Management:
Early elective intubation = safest.
Orotracheal intubation = preferred.
Nasotracheal only if facial trauma & skilled hands.
Perioral burns & singed nasal hairs = not diagnostic, but require close look
at pharynx.
2. Other injuries 🩸
, o Treat patient as polytrauma until proven otherwise.
o Look for falls/jumps in house fires, motor vehicle trauma, etc.
3. Burn size estimation (%TBSA) 🔥
o Rule of Nines (adult):
Head = 9%
Each arm = 9%
Each leg = 18%
Front torso = 18%
Back torso = 18%
o Children (<3 yrs) → head proportionally larger.
o “Rule of the palm” (palm incl. fingers = 1%).
o Lund & Browder chart = most accurate (esp. in kids).
o ❌ Don’t include first-degree burns.
o Always clean soot/debris before assessing.
o ⚠️Inexperienced docs → overestimate small burns, underestimate large ones →
bad resuscitation.
4. CO & cyanide poisoning ☠️
o Must always be suspected in smoke inhalation.
💧 Fluid resuscitation
Access:
o ≥40% TBSA = 2 large-bore IVs.
o Peripheral IV through burned skin = ✅ safe.
o If hard → central line or intraosseous (IO).
<15% burns: usually oral fluids are fine (except kids).
Pediatrics with >15% → may need IO if no IV access.
🌹 Other Key Points
Hypothermia prevention 🧣
o Wrap in blankets during transport.
o ❌ Avoid cooling >20% TBSA burns (worsens resuscitation).
No prophylactic antibiotics 🚫💊
o Promotes fungal infection & resistance → abandoned since 1980s.
Tetanus booster 💉
Pain & anxiety management:
o Multimodal pain plan; avoid overuse of opioids.
o Benzodiazepines sparingly (reduce delirium risk).
o Always set clear expectations with patients.
, 🌸 Memory Tricks
Airway Danger Signs = "Hot SWaD":
o Stridor
o Wheezing
o a (dyspnea)
o Dysphonia (hoarseness)
Burn size rule = "9’s in Adults, Big Head in Kids."
Don’t Forget Burn ABCs = Airway • Breathing • Circulation • Size (TBSA)
🌹 High-Yield Recall Questions
1. Which two interventions revolutionized burn survival?
2. What are the four initial priorities when evaluating a burn patient?
3. Why are prophylactic antibiotics avoided in burns?
4. Which chart gives the most accurate burn size calculation in children?
5. List two signs that indicate urgent intubation in a burn patient
❤️ABA Guidelines for Referral to a Burn
Center 🩺🌹
🌸 Criteria 💡 Explanation / Notes
🔥 Partial-thickness burns >10% Even if not deep, large surface = needs specialized
TBSA care.
🌹 Burns of face, hands, feet, Critical for function + cosmesis (appearance).
genitalia, perineum, major joints
🩸 Third-degree burns (any % in Always need advanced intervention (e.g., grafting).
any age)
⚡ Electrical burns (incl. lightning) Risk of deep tissue/muscle/heart injury → often
underestimated.
☠️Chemical burns Require expertise for neutralization +
decontamination.
🌫️Inhalation injury Airway compromise risk, high mortality.
🏥 Burn + complicated preexisting e.g., diabetes, cardiac disease → higher morbidity.
medical disorder
🚑 Burn + trauma If burn = main risk → transfer. If trauma > burn
→ stabilize trauma first, then transfer.
❤️Surgical Care of the Burned Patient 🩺🔥
🌹 Background
Burn care = now a specialized, interdisciplinary field (surgeons, nurses, therapists,
specialists).
Mass casualty events → general surgeons may have to step in, so they need comfort
with burn care.
History:
o Old days = poor prognosis.
o Advances that improved survival:
💧 Fluid resuscitation.
✂️Early excision of burn wound.
o Now: survival is expected even in severe burns.
o New focus = function + psychological recovery, not just survival.
American Burn Association (ABA):
o Promotes referral to specialized burn centers.
o Created standards + verification system.
o Specific referral criteria guide transfer.
Patients often transferred long distances → 🚑 data show transport times (even hours) do
not worsen outcomes.
🌹 Initial Evaluation (Burn = Trauma Patient)
Follow ATLS principles 📋
🔑 Four crucial first assessments:
1. Airway 🫁
o Smoke/thermal injury → rapid swelling = lethal.
o 🚩 Warning signs: hoarseness, wheezing, stridor, dyspnea.
o Management:
Early elective intubation = safest.
Orotracheal intubation = preferred.
Nasotracheal only if facial trauma & skilled hands.
Perioral burns & singed nasal hairs = not diagnostic, but require close look
at pharynx.
2. Other injuries 🩸
, o Treat patient as polytrauma until proven otherwise.
o Look for falls/jumps in house fires, motor vehicle trauma, etc.
3. Burn size estimation (%TBSA) 🔥
o Rule of Nines (adult):
Head = 9%
Each arm = 9%
Each leg = 18%
Front torso = 18%
Back torso = 18%
o Children (<3 yrs) → head proportionally larger.
o “Rule of the palm” (palm incl. fingers = 1%).
o Lund & Browder chart = most accurate (esp. in kids).
o ❌ Don’t include first-degree burns.
o Always clean soot/debris before assessing.
o ⚠️Inexperienced docs → overestimate small burns, underestimate large ones →
bad resuscitation.
4. CO & cyanide poisoning ☠️
o Must always be suspected in smoke inhalation.
💧 Fluid resuscitation
Access:
o ≥40% TBSA = 2 large-bore IVs.
o Peripheral IV through burned skin = ✅ safe.
o If hard → central line or intraosseous (IO).
<15% burns: usually oral fluids are fine (except kids).
Pediatrics with >15% → may need IO if no IV access.
🌹 Other Key Points
Hypothermia prevention 🧣
o Wrap in blankets during transport.
o ❌ Avoid cooling >20% TBSA burns (worsens resuscitation).
No prophylactic antibiotics 🚫💊
o Promotes fungal infection & resistance → abandoned since 1980s.
Tetanus booster 💉
Pain & anxiety management:
o Multimodal pain plan; avoid overuse of opioids.
o Benzodiazepines sparingly (reduce delirium risk).
o Always set clear expectations with patients.
, 🌸 Memory Tricks
Airway Danger Signs = "Hot SWaD":
o Stridor
o Wheezing
o a (dyspnea)
o Dysphonia (hoarseness)
Burn size rule = "9’s in Adults, Big Head in Kids."
Don’t Forget Burn ABCs = Airway • Breathing • Circulation • Size (TBSA)
🌹 High-Yield Recall Questions
1. Which two interventions revolutionized burn survival?
2. What are the four initial priorities when evaluating a burn patient?
3. Why are prophylactic antibiotics avoided in burns?
4. Which chart gives the most accurate burn size calculation in children?
5. List two signs that indicate urgent intubation in a burn patient
❤️ABA Guidelines for Referral to a Burn
Center 🩺🌹
🌸 Criteria 💡 Explanation / Notes
🔥 Partial-thickness burns >10% Even if not deep, large surface = needs specialized
TBSA care.
🌹 Burns of face, hands, feet, Critical for function + cosmesis (appearance).
genitalia, perineum, major joints
🩸 Third-degree burns (any % in Always need advanced intervention (e.g., grafting).
any age)
⚡ Electrical burns (incl. lightning) Risk of deep tissue/muscle/heart injury → often
underestimated.
☠️Chemical burns Require expertise for neutralization +
decontamination.
🌫️Inhalation injury Airway compromise risk, high mortality.
🏥 Burn + complicated preexisting e.g., diabetes, cardiac disease → higher morbidity.
medical disorder
🚑 Burn + trauma If burn = main risk → transfer. If trauma > burn
→ stabilize trauma first, then transfer.
