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