![]() 100% oxygen until CO levels are systolic pressure).Patient color ("cherry red" with poisoning).Oximeter (difference in oxy- and deoxyhemoglobin).PaO 2 (partial pressure of O 2 dissolved in serum).Binds hemoglobin with 200 times the affinity of oxygen.Fire consumes oxygen so people may suffer from hypoxia as a result of flame injuries.Remember: Intubation can lead to complications, so do not intubate if not needed.Tracheostomies not needed during resuscitation period.If any concerns about the airway, it is safer to intubate earlier than when the patient is decompensating.Intubate if patients require prolonged transport and any concern with potential for obstruction.Intubate early if massive burn or signs of obstruction.Elderly may die from small (35-40% TBSA should be endotracheally intubated.Children require more fluid per TBSA burns.Children/young adults can survive massive burns.Mortality for any given burn size increases with age.Deep burns usually need skin grafts to optimize results and lead to hypertrophic (raised) scars if not grafted.Need specialized care (grafts will not work).Heal by contraction and scar deposition (no epithelium left in middle of wound).Any color (white, black, red, brown), dry, less painful (dermal plexus of nerves destroyed). ![]() Entire thickness of skin destroyed (into fat).Heal by scar deposition, contraction and limited re-epithelialization.Deep second-degree burns (deep partial-thickness).Deep burns (deep second-degree to fourth-degree burns).Superficial burns heal by re-epithelialization and usually do not scar if healed within 2 weeks.Moist, red, blanching, blisters, extremely painful.The deeper the second-degree burn, the slower the healing (fewer adnexa for re-epithelialization).Heal by re-epithelialization from skin adnexa.Skin adnexa (hair follicles, oil glands, etc,) remain.Superficial burns (first-degree and superficial second-degree burns).Depth of burn injury (deeper burns are more severe).(Adapted from The Treatment of Burns, edition 2, Artz CP and Moncrief JA, Philadelphia, WB Saunders Company, 1969) (B) Lund-Browder diagram for estimating extent of burns Palmar hand surface is approximately 1% TBSAĮstimating Percent Total Body Surface Area in Children Affected by Burns.Lund-Browder diagrams improve the accuracy of the % TBSA for children.In children, adjust percents because they have proportionally larger heads (up to 20%) and smaller legs (13% in infants) than adults.Rule of Nines for Establishing Extent of Body Surface Burned Anatomic Surface In adults: "Rule of Nines" is used as a rough indicator of % TBSA.Burns >30-40% TBSA may be fatal without treatment.Burns >20-25% TBSA require IV fluid resuscitation.Percent total body surface area (TBSA) involvement.Definition: A burn is the partial or complete destruction of skin caused by some form of energy, usually thermal energy.Consultation with American Burn Association Verified Burn Centers is recommended.Health care providers with burn expertise are needed to optimize burn care.Burns complicating physical injury and/or chemical injury decrease the likelihood of survival.Burn therapy adds significant logistical requirements and complexity to the medical response in a chemical mass casualty incident.After a chemical mass casualty incident, trauma with or without burns is expected to be common.American Burn Association Burn Unit Referral Criteria.Burn Triage and Treatment - Thermal Injuries
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