Emergency Medicine Pearls, Burn
Management, Shock, and Surgical Airway
Protocols.
Glasgow
Coma
Scale
Chance fracture
Transverse fracture through vertebra.
In children usually associated with enterc disruption. Seen in motor vehicle accidents involving only lap
belt.
May be associated with retroperitoneal and Abdominal visceral injuries.
Anterior hip dislocation
Flexed, abducted, externally rotated.
Burst fracture
Associated with vertebral-axial compression injuries
Posterior hip dislocation
Flexed, aDDucted, internally rotated
Anterior shoulder dislocation
Squared off appearance
Posterior shoulder dislocation
Lock in internal rotation.
Ankle dislocation
Most are Externally rotated, with a prominent medial malleolus.
FULL thickness (3rd degree) burn
Dark or white and leathery. Translucent white as well. Painless and generally "dry" Does not blanch with
pressure. Very little swelling of burned tissue.
Principle Life saving measures for patients with burn injuries include
, -Establishing airway control
-Stopping the burning. process
-Intravenous access
Factors that increase the risk for upper AIRWAY OBSTRUCTION in burns include:
-Burns to the head and face
-Burn size and depth
-Burns inside the mouth
Partial thickness burn
Red remodeled appearance with associated swelling and blister formation. May have weeping or wet
appearance and is painfully hypersensitive even to air current.
Signs and symptoms and history that suggest INHALATION INJURY include:
These patients should be intubated. Inhalation injury is an indication for transfer to a burn center.
Rule of nines - adult
The palm represents 1% of the body total surface area.
Symptoms of carbon monoxide poisoning and respective levels
PaO2 does not reliably predict carbon monoxide poisoning because a CO partial pressure of only 1 mmm
Hg results in a hemoglobin CO level of 40% or greater.
Carbon monoxide has how many times greater affinity for hemoglobin than oxygen
240 times.
It displaces the oxyhemoglobin desaturated curve to the LEFT.
Two criteria required for the diagnosis of smoke inhalation injury
-Exposure to a combustible agent
-Signs of exposure to smoke in the lower airway, below the vocal cords, by bronchoscopy.
Performing this action will help reduce neck and chest wall edema in patients with burn and
inhalation injury.
Elevation of the head and chest by 30 degrees.
IV fluid administration formula for burn victims
Indicated in burns involving over 20% of the body surface area.
*(2-4 mL/kg of LR/NS) (weight in kg) (% area of burn); give 1/2 of this volume in first 8 hours. Remainder
in over 16 hours.