Case 49 Acute Burn Injury



Charles C. Jehle and Albert S. Woo

Case 49 Acute Burn Injury

Case 49 A 25-year-old male presents to critical care bay of emergency department after sustaining burns from a house fire. Burn injury is partially shown here and additionally involves the face, back, and both arms. In children, the head is proportionately larger and receives double the surface area of an adult.



49.1 Description




  • Acute burn injury to portions of the face, chest, back, abdomen, bilateral arms and legs, and groin




    • Superficial and deep partial-thickness burns



    • Approximately 65% of body surface area



    • Possible circumferential involvement of the forearms



  • Concern for inhalation injury



49.2 Work-Up



49.2.1 History and Physical Examination




  • Trauma evaluation




    • ABCs (airway, breathing, circulation): Assess for critical injuries during the primary survey



  • Mechanism of injury




    • Flame: Most common; can lead to superficial to deep burns, depending on degree of exposure



    • Oil or grease burns: Must be careful not to underestimate the severity of such burns; oil will continue to burn over longer period of time if not washed off immediately



    • Electrical (high or low voltage): Raises concern for deeper injury to underlying structures




      • There is a greater concern for compartment syndrome and rhabdomyolysis (see Chapter 50)



  • Inhalation injury




    • Examine for singed facial hair and/or soot in the airway



    • History of asthma or chronic obstructive pulmonary disease (COPD) can compromise oxygenation



    • Have a low threshold to intubate patients with any evidence of inhalation injury



  • Extent of burn




    • Rule of Nines: Calculation of extent in percentage of total body surface area (%TBSA) based on second- and third-degree burns; does not include first-degree burns (see Fig. 49-1)



    • Assess depth of burn: Partial (superficial or deep) versus full thickness



    • If electrical: Identify entry and exit wounds; determine path of injury



  • Extremities involved




    • Circumferential burns: Assess need for escharotomies or fasciotomies




      • Escharotomies for superficial burns to release tight, leathery burned skin



      • Fasciotomies when injuries are deep (as in electrical burns); fascial release to prevent necrosis of deeper structures



    • Compartment syndrome




      • Compartmental pressures may be measured with STIC pressure monitor (Stryker; Kalamazoo, MI)



      • Concern if pressures are>30mmHg



  • Face involved




    • Eyes: Consider consulting ophthalmology



    • Cartilage exposure: Assess for presence of exposed tissues

      Fig. 49.1 Rule of nines for estimation of burn injury in adults: Head (9%), Arm (9%), Trunk (18% front, 18% back), Leg (9% front, 9% back), Groin (1%).

Only gold members can continue reading. Log In or Register to continue

Stay updated, free articles. Join our Telegram channel

Jul 17, 2021 | Posted by in General Surgery | Comments Off on Case 49 Acute Burn Injury

Full access? Get Clinical Tree

Get Clinical Tree app for offline access