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Rule of Nines
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Aetiology
- Thermal
- Flame
- Chemical
- Electrical
- Radiation
- Friction
Assessment
Type of burn
- Partial thickness
- Blistered
- Painful
- Red
- Superficial
- Deep Dermal
- Full thickness
- No blisters
- No sensation
- Grey/white
Area
Indication of inhalational injury
- Burns to face
- Soot in mouth
- Laryngeal/pharyngeal oedema
- Burnt Nostril Hairs
- Respiratory depression
Management
Admit if >10% child or >15% adult
- Airway
- Circumferential burns leading to strangulation
- Breathing
- Circulation
- Assess burn surface area
- Formal fluid resuscitation
- Catheterise
- Escharotomies - to bleeding tissue
- Investigations
- FBC
- HCT
- U&Es
- Arterial Blood Gas
- Carboxyhaemoglobin
- Cultures
- Tetanus, Ranitidine, NG feed
- Debridement of dead tissue
- Graft
Fluid Resuscitation
Muir & Barcley
- Per period
- mls of crystalloid/period =( %suface area of burn x weight (Kg)) / 2
- +100ml colloid
- Administer over 6 periods
- Periods 1,2 and 3 are 4 hours long
- Periods 4&5 are 6 hours long
- Period 6 is 12 hours long
- Periods are from the time of the burn so if resuscitation starts late must
catch up
- e.g if 4 hours from burn (and patient still alive!) then fluid for
period 1 must be administered as fast as possible and fluid for period 2
must be administered over the next 4 hours,
- On top of this you must add on normal daily
fluid balance
- Reassess at end of each period
- Hb
- U&E's
- HCT
- Urine Output
Dressings
- Face, Perineum - open
- Hands - plastic bags (not clingfilm!)
- Jelonet
- Inadine
- Mepitil
- NA Ultra
- Release
- Duoderm - Not for infected
Complications
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