ERDN
Emergency - serious, unexpected, and often dangerous situation (Life threatening) requiring
immediate action
Disaster - sudden event, such as accident or natural catastrophe, man made catastrophe that
causes great damage or loss of life.
Burns: Fluid shifting (from intravascular/ blood vessel (functional) - to the interstitial space/third
space - edema, ascites, anasarca (non functional)
* uid loss - albumin loss ( major protein in the body) - dec. oncotic pressure- allows third
spacing.
What is the priority with burns? Fluid REPLACEMENT (PLR/LACTATED RINGERS) = volume
expander (MANAGE SHOCK), ALSO CONTAINS SODIUM BICARBONATE ( Alka- Metabolic
acidosis)
*Burn - Hyperkalemia - meta acidosis - cardiac arrest
Degree Depth Layer pain Edema Char
rst Super cial/ Epidermis Yes No-no third Red blanching
super cial spacing * not included in the
partial No uid losses parkland formula
Second Deep partial Dermis Yes Yes - Third Red, blisters, weeping
partial spacing - Fluid mottled
thickness losses *included in the PF
Third Full thickness Epidermis, No Yes Red , yellow(fat),
burn dermis, sq. brown(Muscle), white.
Muscles, Black charred leathery
bones *Included in the PF
PARKLAND FORMULA - total ML to be replaced in the rst
24HRS (4ml x TBSA X BW (KG))
First 8hrs = 50%
Last 16 hrs = 50%
Example: patient 100lbs sustained 36% of burn. Total Ml in the rst 8hrs?
45.45kg x 36 x 4ml = 6544.8 ml -> 1st 8hrs -> divide by 2 = 3, 272.4 ml
RULES OF 9’S
ADULT INFANT
HEAD AND NECK - 9 = 18
anterior - 4.5 , post 4.5 9,9
TRUNK - 36
anterior trunk - 18 ( chest 9 and abdomen 9)
posterior trunk - 18
ARM - 9
anterior 4.5, posterior 4.5
upper arm 4.5, forearm 4.5
LEG - 18 (anterior 9 , post 9) 14 (7,7
PERINEUM - 1 0
fifl fl fifi fi fi
, Phases of Burn injury
-> First Phase
Emergent/ shock/ resuscitative - 24 to 48 hrs. Problem: FLuid De cit
-> Second Phase
Acute/ diuretic - post 48 hrs to 5 days - risk for infections
-> Third Phase
Recovery - > 5 days - restore optimal Function
EMERGENT PHASE (First phase)
SX: DEC. BP, inc. HR, RR (COMPENSATORY MECH.) DEC. UO, INC HCT - Dehydrated -
concentrated blood - Hyperkalemia, hyponatremia = meta acidosis
URINE OUTPUT - best assessment (VITAL SIGN 2ND)
HEMATOCRIT- best lab. (Male: 42-52% Female: 37-47%)
*situational: present inhalation burn (dob, soot, facial hair, bronchospasm facial burn) = airway
Summary of management
1) uid situational : airway
2) Severe pain: opioid analgesic (morphine, demerol, fentanyl)
3) WOF: Curling ulcer (stress ulcer related to burn) - management: h2 blocker, PPI, Bismuth
salts, to dec. hydrochloric acid
ACUTE/ DIURETIC PHASE (2nd Phase)
SX: INC BP, INC HR RR ( VASCULAR RESISTANCE), INC UO
DEC. HCT - DILUTED BLOOD - OVER HYDRATED
HYPOKALEMIA, DILUTIONAL HYPONATREMIA
Priority
1) Risk for infection (sterile techniques, prevent infection)
fl fi
Emergency - serious, unexpected, and often dangerous situation (Life threatening) requiring
immediate action
Disaster - sudden event, such as accident or natural catastrophe, man made catastrophe that
causes great damage or loss of life.
Burns: Fluid shifting (from intravascular/ blood vessel (functional) - to the interstitial space/third
space - edema, ascites, anasarca (non functional)
* uid loss - albumin loss ( major protein in the body) - dec. oncotic pressure- allows third
spacing.
What is the priority with burns? Fluid REPLACEMENT (PLR/LACTATED RINGERS) = volume
expander (MANAGE SHOCK), ALSO CONTAINS SODIUM BICARBONATE ( Alka- Metabolic
acidosis)
*Burn - Hyperkalemia - meta acidosis - cardiac arrest
Degree Depth Layer pain Edema Char
rst Super cial/ Epidermis Yes No-no third Red blanching
super cial spacing * not included in the
partial No uid losses parkland formula
Second Deep partial Dermis Yes Yes - Third Red, blisters, weeping
partial spacing - Fluid mottled
thickness losses *included in the PF
Third Full thickness Epidermis, No Yes Red , yellow(fat),
burn dermis, sq. brown(Muscle), white.
Muscles, Black charred leathery
bones *Included in the PF
PARKLAND FORMULA - total ML to be replaced in the rst
24HRS (4ml x TBSA X BW (KG))
First 8hrs = 50%
Last 16 hrs = 50%
Example: patient 100lbs sustained 36% of burn. Total Ml in the rst 8hrs?
45.45kg x 36 x 4ml = 6544.8 ml -> 1st 8hrs -> divide by 2 = 3, 272.4 ml
RULES OF 9’S
ADULT INFANT
HEAD AND NECK - 9 = 18
anterior - 4.5 , post 4.5 9,9
TRUNK - 36
anterior trunk - 18 ( chest 9 and abdomen 9)
posterior trunk - 18
ARM - 9
anterior 4.5, posterior 4.5
upper arm 4.5, forearm 4.5
LEG - 18 (anterior 9 , post 9) 14 (7,7
PERINEUM - 1 0
fifl fl fifi fi fi
, Phases of Burn injury
-> First Phase
Emergent/ shock/ resuscitative - 24 to 48 hrs. Problem: FLuid De cit
-> Second Phase
Acute/ diuretic - post 48 hrs to 5 days - risk for infections
-> Third Phase
Recovery - > 5 days - restore optimal Function
EMERGENT PHASE (First phase)
SX: DEC. BP, inc. HR, RR (COMPENSATORY MECH.) DEC. UO, INC HCT - Dehydrated -
concentrated blood - Hyperkalemia, hyponatremia = meta acidosis
URINE OUTPUT - best assessment (VITAL SIGN 2ND)
HEMATOCRIT- best lab. (Male: 42-52% Female: 37-47%)
*situational: present inhalation burn (dob, soot, facial hair, bronchospasm facial burn) = airway
Summary of management
1) uid situational : airway
2) Severe pain: opioid analgesic (morphine, demerol, fentanyl)
3) WOF: Curling ulcer (stress ulcer related to burn) - management: h2 blocker, PPI, Bismuth
salts, to dec. hydrochloric acid
ACUTE/ DIURETIC PHASE (2nd Phase)
SX: INC BP, INC HR RR ( VASCULAR RESISTANCE), INC UO
DEC. HCT - DILUTED BLOOD - OVER HYDRATED
HYPOKALEMIA, DILUTIONAL HYPONATREMIA
Priority
1) Risk for infection (sterile techniques, prevent infection)
fl fi
