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ddxof: An Algorithm for Managing Severe Burns

Fadial, Tom MD

doi: 10.1097/01.EEM.0000512466.76417.4c
ddxof

Dr. Fadialis a chief resident (PGY-3) in emergency medicine at Harbor-UCLA in Torrance, CA. He graduated from the David Geffen School of Medicine at UCLA in 2014. He is the author ofhttp://ddxof.com/, a compilation of cases based on real patients, each inspiring a systematic approach to the evaluation and management of their chief complaint or diagnosis. His other medical education projects can be found athttp://fadial.com/.

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A 34-year-old woman with no reported medical history was brought in by ambulance with severe burns after a house fire. She was hypoxic, stridorous, and unable to provide history. She was intubated for airway protection with some difficulty. An examination revealed deep partial and full-thickness burns to 70 percent of her total body surface area including circumferential burns to bilateral upper extremities and extensive neck and anterior chest involvement.

Table A

Table A

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Figure

Initial fluid resuscitation and warming measures were instituted. Emergent bedside bronchoscopy revealed copious carbonaceous material throughout, with attempts at lavage. Urine output was minimal despite aggressive resuscitation. Critical care transport to local burn facility was arranged where the patient ultimately expired.

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Figure

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Burn Transfer Criteria

  • Partial thickness > 20% TBSA
  • Partial thickness > 10% TBSA for extremes of age (<10 or >50 years old)
  • Any full thickness
  • Burns involving face, hands, feet, genitalia, major joints
  • Electrical/chemical
  • Inhalation injury
  • Medical comorbidities impacting management/healing
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Suggested Reading

1. Monafo WW. Initial management of burns. N Engl J Med 1996;335(21):1581.
2. Hettiaratchy S, Papini R. Initial management of a major burn: I–overview. BMJ. 2004;328(7455):1555.
3. Singer AJ, Della-Giustina D. Thermal Burns: Rapid Assessment and Treatment. Emergency Medicine Practice; 2000.
    4. Rice PL. Emergency care of moderate and severe thermal burns in adults. In: UpToDate, Moreira ME (Ed), UpToDate, Waltham, MA. (Accessed on March 29, 2016.)
      5. Gauglitz GG. Overview of the management of the severely burned patient. In: UpToDate, Jeschke MG (Ed), UpToDate, Waltham, MA. (Accessed on March 29, 2016.)
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