Case 51 Upper Extremity Burns

W. Kelsey Snapp, Albert S. Woo, and Adnan Prsic

Case 51 Upper Extremity Burns

Case 51 A 1-year-old boy presents with burns to the left upper extremity after dipping his hand in a pot of boiling water.

51.1 Description

  • Circumferential burns of variable thickness to the left upper extremity in a pediatric patient

  • Blistering suggestive of second degree burn, with the possibility of third degree injury

  • Burn of this variety in 1-year-old patient suspicious for abuse or neglect

51.2 Work-Up

51.2.1 History

  • Age, gender, handedness, and occupation of the patient

  • Timing and mechanism of burn injury

    • Thermal: Type of burn (flame, contact, scald, steam, or grease); associated injuries; suspicion of abuse (especially in elderly and children)

    • Chemical: Type of chemical (alkali, acid, or organic compound); any attempts at neutralization

    • Electrical: Type of current (alternating current [AC] or direct current [DC]), voltage, and location of initial contact

  • Past medical and surgical history

  • Social history, including tobacco, alcohol, and substance abuse

51.2.2 Physical Examination

  • Primary survey: Advanced Trauma Life Support (ATLS) protocol and ABCDs.

  • Hand is scrubbed of any soot, dirt, or debris

    • Potentially constricting clothing, jewelry, and watches are removed

  • Acute injury

    • Location and total body surface area of burn injury (see Chapter 49)

    • Depth of burn injury: First degree, superficial or deep second degree, or third degree; note exposure of deep structures

    • Perfusion of upper extremity, hands and fingers

    • Motor and sensory function

    • Compartment syndrome: Limb-threatening condition

      • Circumferential burns; associated crush injury or trauma

      • Pain out of proportion with movement (finger extension, flexion)

      • Five P’s (late signs): Pain, pallor, paresthesias, paralysis, and pulselessness

      • Intracompartmental pressures >30 mmHg require intervention

  • Secondary reconstruction

    • Status of soft-tissue coverage (thickness, durability, sensibility, and elasticity)

    • Contractures, and active and passive range of motion (ROM) of each joint

51.2.3 Pertinent Imaging or Diagnostic Studies

  • Standard radiography (three views) of the hand, elbow, and humerus

  • Bloodwork: Complete blood count (CBC), electrolytes, blood urea nitrogen (BUN), creatinine, international normalized ratio (INR), partial thromboplastin time (PTT), glucose, and blood type

  • Consider arterial blood gases for associated inhalational injuries or certain chemicals

  • Cardiac enzymes, urine myoglobin, creatine kinase, and 12-lead electrocardiography (hyper K+, electrical burns)

51.3 Consultations

  • Indications for referral to a burn center (see Table 50.1)

  • General surgery or critical care team if burns are extensive

  • Poison control center if chemical is involved and management is unclear

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Jul 17, 2021 | Posted by in General Surgery | Comments Off on Case 51 Upper Extremity Burns
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