Burns%20-%20initial%20management Diagnosis

Diagnosis

Degree of Burns

First-Degree Burns or Superficial Burns

Appearance: Similar to sunburn – painful, dry, swollen, erythematous without blisters & involves only the epidermis
Not included in estimates for fluid resuscitation
Hospitalization not required; pain resolves in 48-72 hours, peels off without residual scarring in 2-5 days

Second-Degree Burns or Partial-Thickness Burns

Appearance: Moist blebs, formation of vesicle & blister; underlying tissue is mottled pink & white with good capillary refill; this involves the entire epidermis & a variable portion of the dermal layer
Considered significant burns & are counted in burn size estimates
Subclassification
- Superficial:
  - Extreme pain attributed to a large number of remaining viable nerve endings exposed
  - Re-epithelialize in 7-14 days in the absence of infection
- Deep
  - Pain is less because fewer nerve endings remain viable; fluid losses & metabolic effects are similar to those of third-degree burn
  - Heals in 21-35 days if without infection; converts to full thickness burns if with wound infection, some may require grafting

Third-Degree Burns or Full-Thickness Burns

Appearance: Dry, leathery eschar, mixed white waxy, khaki, mahogany, soot-stained
Involves the entire epidermis & dermis, leaving no residual epidermis cells, may include fat, subcutaneous tissue, fascia, muscle & bone
No pain sensation & capillary filling
Wound cannot epithelialize, heals only by wound contracture or skin grafting
The difference in the growth rate of the head & extremities throughout childhood makes it necessary to use surface area charts
- The “rule of nines” used in adults is applicable only to children >14 year or as a very rough estimate to initiate therapy before transfer to a burn unit
In small burns <10%, the “rule of palm” (area from the wrist crease to finger crease in the child) may be used
- This equals 1% of the child’s body surface area (BSA)
Calculation of the fluid for resuscitation depends on the total BSA involved in the burn injury

Classification

Lund & Browder Classification

Relative percentage of body surface area affected by growth

	0 years	1 year	5 years	10 years	>15 years
A = one-half of head	9.5%	8.5%	6.5%	5.5%	4.5%
B = one-half of one thigh	2.75%	3.25%	4%	4.5%	4.5%
C = one-half of one lower leg	2.5%	2.5%	2.75%	3%	3.25%

Evaluation

A brief, accurate history must be obtained from guardian upon presentation of the patient
- Determine the time of injury, causative agent & type of burn, any first aid measures done, patient’s associated medical problems, & vaccination status
Stop the burning process by applying cold water on burned area & removing smoldering clothing or clothing saturated with hot liquid or chemicals
Assess degree, site & extent of burn

Laboratory Tests

All trauma patients will have their own specific radiologic & laboratory examinations depending on the involved organ during the injury

Routine examinations in the emergency department

General
- Complete blood count (CBC)
- Serum electrolytes
- Blood glucose
- Blood urea nitrogen (BUN)
- Creatinine (Cr)
- Clotting factor tests
- Blood typing & cross-matching
- Urinalysis
- Arterial blood gas (ABG)
Inhalational injuries
- Chest X-ray
- Carboxyhemoglobin levels
Inhalational injuries
- 12-lead electrocardiography (ECG)
- Cardiac enzymes

Spotlight on multidrug-resistant gram-negative infections: New developments for an old problem

Dr. Hsu Li Yang, Dr. Tan Thuan Tong, Dr. Andrea Kwa, 08 Jan 2021

Antimicrobial resistance has become increasingly dire as the rapid emergence of drug resistance, especially gram-negative pathogens, has outpaced the development of new antibiotics. At a recent virtual symposium, Dr Hsu Li Yang, Vice Dean (Global Health) and Programme Leader (Infectious Diseases), NUS Saw Swee Hock School of Public Health, presented epidemiological data on multidrug-resistant (MDR) gram-negative bacteria (GNB) in Asia, while Dr Tan Thuan Tong, Head and Senior Consultant, Department of Infectious Diseases, Singapore General Hospital (SGH), focused on the role of ceftazidime-avibactam in MDR GNB infections. Dr Andrea Kwa, Assistant Director of Research, Department of Pharmacy, SGH, joined the panel in an interactive fireside chat, to discuss challenges, practical considerations, and solutions in MDR gram-negative infections. This Pfizer-sponsored symposium was chaired by Dr Ng Shin Yi, Head and Senior Consultant of Surgical Intensive Care, SGH.