🔥 Chapter 118: Burn Injuries

Parkland formula · Inhalational injury · Burn shock · Escharotomy · Topical antimicrobials · Hypermetabolism · Lund-Browder chart · Carbon monoxide poisoning

🔍 Core Concepts: Burn Injuries

📌 Burn centre transfer criteria (ABA)
>10% TBSA partial thickness, any full thickness, burns to face/hands/genitals, inhalation injury, electrical/chemical, paediatric without capability.
🧴 Parkland formula
4 mL/kg/%TBSA in first 24h (crystalloid: RL). Half in first 8h from burn time. Children also require maintenance fluids. Titrate to urine output 0.5-1 mL/kg/h.
🫁 Inhalational injury
Suspected if closed space, facial burns, soot, stridor, hoarseness. Early intubation before oedema. 100% O2 for CO poisoning. Lung-protective ventilation.
🩸 Burn shock
Hypovolemic + distributive + cardiogenic. Capillary leak → third spacing. Fluid creep: avoid over-resuscitation (compartment syndrome).
🛡️ Topical antimicrobials
Silver sulfadiazine (broad, painless, transient leukopenia), mafenide (penetrates eschar, painful, acidosis). Early excision reduces infection.
🍽️ Nutrition & hypermetabolism
Early enteral feeding (within 24h). Oxandrolone (anabolic steroid), propranolol (β-blocker) to reduce hypermetabolism.
⚠️ Compartment syndromes
Circumferential burns → escharotomy (extremity) or decompressive laparotomy (abdominal compartment syndrome). Bladder pressure monitoring.

🩺 Stepwise Management of Major Burns

1
Primary survey (ABCDE) with burn-specific modifications
Airway: suspect inhalation injury (stridor, soot, facial burns, closed space) → early intubation. 100% oxygen. C-spine immobilization if trauma.
2
Estimate burn size (Lund-Browder chart, rule of nines modified)
Do not include first-degree burns. For children, adjust for larger head and smaller legs. Calculate %TBSA.
3
Fluid resuscitation: Parkland formula + maintenance
4 mL RL/kg/%TBSA over 24h. Half given in first 8h from burn time. Target urine output 0.5-1 mL/kg/h. Avoid fluid creep.
4
Inhalational injury & CO poisoning
100% O2 until carboxyhemoglobin <5%. Consider hyperbaric oxygen for severe CO poisoning. Lung-protective ventilation if ARDS.
5
Wound care & infection prevention
Topical antimicrobials (silver sulfadiazine, mafenide). Early excision and grafting. Surveillance cultures. Systemic antibiotics only for infection, not prophylaxis.
6
Compartment syndrome monitoring
Circumferential burns: check distal pulses, sensation, compartment pressures. Escharotomy if signs of ischemia. Measure bladder pressure for abdominal compartment syndrome.
7
Hypermetabolism & nutrition
Early enteral feeding (within 24h). High protein. Consider oxandrolone and propranolol in severe burns (>30% TBSA).