Other than the specific complications we’ve discussed,
there’s some general principles we should always follow for burn care.
Obviously, you wanna get any kind of garments and jewelry off of affected areas,
especially, circumferential jewelry like rings or bracelets
that might potentially cause constriction as the patient swells.
We wanna clean all of the burn wounds.
Any tense large blisters we wanna aspirate
and we wanna gently debride them or remove the necrotic tissue from the service
because that can serve as a nidus of infection.
We wanna apply wound dressings.
This is impart to protect the burns from any kind of further mechanical trauma or infection.
It’s also in part for the patient’s comfort
because you can imagine if you’ve got a lot of open burn wounds
and they’re just there open to the air, any kind of touch,
any kind of brush of bed clothing or anything like that is gonna cause a lot of pain.
So this is both for patient comfort as well as prevention of infection and further trauma.
Burns are very painful.
Every patient with significant burns needs pain control.
This is not a two Tylenol kind of situation.
These patients will typically need opioids,
and we wanna be sure that we adequately control pain
especially during dressing changes which are very painful procedures for burn patients.
Lastly, burns can become infected with Clostridium tetani,
so we wanna make sure that every patient is up to date on their Tetanus prophylaxis.
So we’ve covered a lot of stuff about burns here today.
We wanna classify severity based on both patient characteristics
as well as burn characteristics, and once you’ve decided your severity,
that’s gonna help you know whether your patient’s gonna be treated as an out-patient,
in-patient, or in a specialty burn unit.
We wanna always remember ABC’s.
So we wanna assess the airway very carefully
and intubate if we’re concerned in any way about airway compromise.
We wanna be sure to provide aggressive respiratory support with oxygen,
and we wanna provide mechanical ventilation as needed.
Always think about carbon monoxide and measure your carboxyhemoglobin.
Again, carbon monoxide poisoning is usually treatable with regular old oxygen,
but you can think about hyperbarics in extreme cases.
You wanna make sure you have adequate IV access
and after you’ve estimated the total body surface area burned,
you’re gonna use that information to calculate how much fluid your patient needs
and carefully titrate it according to their urine output.
Remember, escharotomy is for circumferential burns, and remember cyanide.
It’s a lethal complication in closed-space house fires and it’s not one that you wanna miss.
Thank you very much. This has been my discussion of burns.