Episode 915: Severe Burn Injuries

Contributor: Megan Hurley, MD

Educational Pearls:

• Initial assessment of patients with severe burn injuries begins with ABCs 

• Airway: consider inhalation injury

• Breathing: circumferential burns of the trunk region can reduce respiratory muscle movement

• Circulation: circumferential burns compromise circulation

• Exposure: Important to assess the affected surface area

• Escharotomy: emergency procedure to release the tourniquet-ing effects of the eschar 

• Differs from a fasciotomy in that it does not breach the deep fascial layer

• PEEP = positive end-expiratory pressure

• The positive pressure remaining in the airway after exhalation

• Keeps airway pressure higher than atmospheric pressure

• Common formulas for initial fluid rate in burn shock resuscitation

• Parkland formula: 4 mL/kg body weight/% TBSA burns (lactated Ringer's solution)

• Modified Brooke formula: 2 mL/kg/% (also lactated Ringer's solution)

• Less fluid = lower risk of intra-abdominal compartment syndrome

• Lactated Ringer's solution is preferred over normal saline in burn injuries

• Normal saline is avoided in large quantities due to the possibility of it leading to hyperchloremic acidosis

References

1. Acosta P, Santisbon E, Varon J. "The Use of Positive End-Expiratory Pressure in Mechanical Ventilation." Critical Care Clinics. 2007;23(2):251-261. doi:10.1016/j.ccc.2006.12.012 

2. Orgill DP, Piccolo N. Escharotomy and decompressive therapies in burns. J Burn Care Res. 2009;30(5):759-768. doi:10.1097/BCR.0b013e3181b47cd3 

3. Snell JA, Loh NH, Mahambrey T, Shokrollahi K. Clinical review: the critical care management of the burn patient. Crit Care. 2013;17(5):241. Published 2013 Oct 7. doi:10.1186/cc12706

Summarized by Meg Joyce, MS1 | Edited by Meg Joyce & Jorge Chalit

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