Traumatic Conditions
Burns injury
In a burn, there is local response with progressive tissue loss and
release of inflammatory cytokines
– Loss of capillary membrane integrity leads to fluid leading into
interstitial space, leading to hypovolemic shock
– There is increased risk of bacterial infections (S. Aureus), acute
peptic stress ulcers and lung injury
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Before treating the burn, it is essential to measure
the&extentand&depthof the burn
Extent –Measured by Wallace’s Rule of Nines, divided body into 11
sections each measuring 9% surface area
– Used to generate burn measurement quantified by the total body
surface area (TBSA)
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Depth– This is measured by the depth it penetrates through the
dermis
– 1st degree –> this is confined to the epidermis and is likely to be red
and tender
– 2nd degree –>This is where the burn penetrates the dermis layer
giving blisters and reducing feeling
– 3rd degree –> This is where the burn penetrates the full thickness of
the skin. It will appear brown/black
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Management– Perform first aid (Airway, breathing, circulation)
i) Immediate fluid resuscitation using Hartman’s solution if TBSA >15%
– Uses the Parkland formula:
– Total fluid in 24 hours = 4ml x total burn surface area (%) x body
weight (kg)
– 50% given in first 8 hours, and 50% given in next 16 hours
– Give fluids till urine output 0.5-1ml/kg/hr (insert urinary catheter)
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ii) Maintenance fluids – After 24 hours, colloid infusion at 0.5ml x total
burn surface area (%) x body weight (kg)
– Crystalloid (dextrose-saline) at 1.5ml x total burn surface area (%) x
body weight (kg)
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iii) Refer to hospital if: 2nd/3rd degree burn, deep dermal burns>5%
TBSA (adults), electrical/chemical burn
Pressure Sores
