Morning Report: 4/11/2014

by Jay Khadpe MD • April 11, 2014 • Comments Off

Thanks to Dr. Ozaki for today’s Morning Report!

Burns

Classification of burns:

	Appearance	Surface	Sensation	Time to healing
First Degree	Pink or red	Dry	Painful	Days
Second Degree	Pink, clear blisters	Moist	Painful	14-21 days
Deep Second Degree	Pink, hemorrhagic blisters, red	Moist	Painfl	Weeks, may progress to 3^rd-degree burn and require graft
Third Degree	White, brown	Dry, Leathery	Insensate	Requires excision
Fourth Degree	Brown, charred	Dry	Insensate	Requires excision

Depth	Appearance	Sensation	Healing time
Superficial	-Dry, red -Blanches with pressure	Painful	3-6 days
Superficial partial-thickness	-Blisters -Moist, red, weeping -Blanches with pressure	Painful to temperature and air	7-21 days
Deep partial-thickness	-Blisters (easily unroofed) -Wet or waxy dry -Variable color (patchy to cheesy white to red) -Does not blanch with pressure	Perceptive of pressure only	>21 days, usually requires surgical treatment
Full-thickness	-Waxy white to leathery gray to charred and black -Dry and inelastic -No blanching with pressure	Deep pressure only	Rare, unless surgically treated
Fourth degree	-Extends in to fascia and/or muscle	Deep pressure	Never, unless surgically treated

Burn Severity and Disposition

	Mild	Moderate	Severe
Children	<5% TBSA	5-10% TBSA	>10% TBSAS
Adult	<10% TBSA	10-20% TBSA	>20% TBSA
Elderly	<5% TBSA	5-10% TBSA	>10% TBSA
All	<2% full thickness	2-5% full thickness, high voltage, inhalation, circumferential, comorbid disease	>5% full thickness, high voltage, significant burn to face, eyes, ears, genitalia, joints, significant associated trauma
Disposition	Outpatient	Admission	Burn Unit

Total body surface area affected:

-Rule of nines: each arm 9%, each leg 18%, anterior trunk 18%, posterior truck 18%, head 9%, groin 1%

-Should not be used in children

-Lund-Browder chart to estimate burns in children

-Patient’s hand, including fingers, represents 1% of BSA in children and adults

Management:

-ABCs: important to assess for any inhalation injury

-Indications for intubation: upper airway obstruction, inability to handle secretions

Burn Centers in NYC

-Jacobi Medical Center

-New York-Presbyterian Hospital

-Staten Island University Hospital

The views expressed on this blog are the author's own and do not reflect the views of their employer. Please read our full disclaimer here. Any references to clinical cases refer to patients treated at a virtual hospital, Janus General Hospital.

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Jay Khadpe MD

Editor in Chief of "The Original Kings of County" Assistant Professor of Emergency Medicine Assistant Residency Director SUNY Downstate / Kings County Hospital