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Emergency Department Management of Patients With Thermal Burns (Trauma CME)

Emergency Department Management of Patients With Thermal Burns (Trauma CME)

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  Issue Info

Author: Juliana Tolles, MD, MHS

Peer Reviewers: Boyd Burns, DO; Christopher Palmer, MD

Publication Date: February 1, 2018

CME Expiration Date: February 1, 2021

CME Credits: 4 AMA PRA Category 1 CreditsTM, 4 ACEP Category I Credits, 4 AAFP Prescribed Credits, 4 AOA Category 2A or 2B Credits. Included as part of the 4 credits, this CME activitiy is eligible for 4 Trauma Credits.

PubMed ID: 29369586

  About this Issue

Classifying and measuring thermal burns in the ED will dictate all of the treatment decisions that follow:

  • First-degree, second-degree, third-degree burns: How can you tell?
  • How should you calculate the total body surface area of burns?
  • IV fluids: what kind and how much? How can you tell when you've given the right amount?
  • Wound care: when should you debride blisters, and should you use silver dressings?
  • Escharotomy: when must it be done?
  • Was it really an accident or was it abuse?
  • Referral: How do you know when to refer a patient to a burn center? 
  Issue Features
  Table of Contents
  1. Abstract
  2. Case Presentations
  3. Introduction
  4. Critical Appraisal of the Literature
  5. Etiology and Pathophysiology
  6. Differential Diagnosis
  7. Prehospital Care
    1. Prehospital Administration of Hydroxocobalamin
    2. Prehospital Cooling
    3. Prehospital Pain Management
  8. Emergency Department Evaluation
    1. History
    2. Physical Examination
  9. Diagnostic Studies
    1. Laboratory Testing
      1. Chemistry Panel
      2. Complete Blood Cell Count
      3. Arterial Blood Gas With CO-Oximetry Testing
      4. Lactate Level
      5. Cyanide Level
      6. Type and Screen
      7. Urine Pregnancy Testing
    2. Imaging
      1. Chest X-Ray
      2. Computed Tomography
      3. Bronchoscopy
  10. Treatment
    1. Airway Management
      1. Managing Inhalation Injury
      2. Carbon Monoxide and Cyanide Toxicity
    2. Cooling
    3. Intravenous Fluid Resuscitation
      1. Choosing Resuscitation Fluids
      2. Fluid Volume Resuscitation Formulas
      3. Monitoring Fluid Resuscitation
      4. Blood Transfusion
    4. Wound Care
      1. Unroofing, Debridement, and Surgical Excision
      2. Escharotomy
      3. Ocular Burns
    5. Antibiotics
    6. Pain Control
    7. Tetanus Prophylaxis
  11. Special Populations
    1. Pediatric Patients
    2. Pregnant Patients
  12. Controversies and Cutting Edge
    1. Analgesia
    2. Wound Care Controversies
    3. Assessment of Burn Depth With Laser Doppler Imaging
  13. Disposition
  14. Summary
  15. Risk Management Pitfalls for Management of Burn Patients in the Emergency Department
  16. Time- and Cost-Effective Strategies
  17. Case Conclusions
  18. Key Points
  19. Clinical Pathway for Management of Burns in the Emergency Department
  20. Tables and Figures
    1. Table 1. Classification of Burns by Depth
    2. Table 2. Physical Examination of Burn Patients
    3. Table 3. Common Intravenous Resuscitation Formulas for Adult Burn Patients
    4. Table 4. Occlusive Dressings for Partial-Thickness Burns
    5. Table 5. Topical Therapies for Partial-Thickness Burns
    6. Table 6. Centers for Disease Control and Prevention Guidelines for Tetanus Wound Management
    7. Table 7. American Burn Association Burn Center Referral Criteria
    8. Figure 1. Zones of Burn
    9. Figure 2. Illustration of Burn Depth Classifications
    10. Figure 3. Lund and Browder Chart
    11. Figure 4. Rule of Nines
    12. Figure 5. Escharotomy
    13. Figure 6. Accidental Versus Intentional Scald
  21. References


  CME Information

Accreditation: EB Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. This activity has been planned and implemented in accordance with the accreditation requirements and policies of the ACCME.

Credit Designation: EB Medicine designates this enduring material for a maximum of 4 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Specialty CME: Included as part of the 4 credits, this CME activity is eligible for 4 Trauma CME credits, subject to your state and institutional approval.

Faculty Disclosures: It is the policy of EB Medicine to ensure objectivity, balance, independence, transparency, and scientific rigor in all CME-sponsored educational activities. All faculty participating in the planning or implementation of a sponsored activity are expected to disclose to the audience any relevant financial relationships and to assist in resolving any conflict of interest that may arise from the relationship. In compliance with all ACCME Essentials, Standards, and Guidelines, all faculty for this CME activity were asked to complete a full disclosure statement. The information received is as follows: Dr. Tolles, Dr. Burns, Dr. Palmer, Dr. Mishler, Dr. Toscano, and their related parties report no significant financial interest or other relationship with the manufacturer(s) of any commercial product(s) discussed in this educational presentation.Dr. Jagoda made the following disclosures: Consultant, Daiichi Sankyo Inc; Consultant, Pfizer Inc; Consultant, Banyan Biomarkers Inc; Consulting fees, EB Medicine.

Commercial Support: This issue of Emergency Medicine Practice did not receive any commercial support.

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Last Modified: 07/19/2018
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