Editing Burns (section)

== Unique burns ==

* Electrical
** Clenched hand with small entrance point means a likely extensive deep injury
** ECG and monitoring esp if >1000 volts ('high voltage')
** Consider rhabdo - ?dark red urine - IV fluid stat
** Consider spinal injury
** Resus
*** ABCD
*** Full spinal immobilisation
*** Define path of current through body - locate contact points
*** Check ECG, troponins, consider TTE (if no arrhythmia in ED, no need for 24 hour monitoring)
*** Consider compartment syndromes
*** Fluid resus if rhabdo is a possibility
*** Wounds often devolve over time, so serial debridement with VAC is often used
*** Consider cataract and tympanic exam
* Frostbite
** Produced by freezing temperatures
** Grading
*** First-degree: hyperaemia and oedema, no necrosis. Heals spontaneously in 1-2 weeks.
*** Second: large clear vesicle formation, partial-thickness necrosis, numbness, oedema. Heals in 2-4 weeks. Can heal as thin, atrophic skin if deeper injury.
*** Third: Full thickness and subcutaneous necrosis, haemorrhagic vesicles. Reactive hyperaemia for first 48-72 hours followed by a black eschar that separates slowly in 1-3 months unless infection occurs.
*** Fourth: Full thickness, including muscle and bone. Black, mummified tissues are present at first. If the mummified area becomes infected, it softens and becomes swollen and macerated at the margin with viable tissue.
*** Final surgical management depends on eventual level of demarcation
** Initial management:
*** Warm - ideally circulating water at 40 degrees until pink colour and perfusion return (normally 20-30 mins)
*** Watch for rewarming syndrome (acidosis, hyperkalaemia, local swelling)
**
* Trench foot
** Produced by prolonged exposure to above-freezing temperatures, along with the presence of moisture
* Immersion hand and foot
** Prolonged exposure to cold but not freezing water
** Can be a/w major nerve paralysis, in addition to chronic vasospastic cold sensitivity and pain
* Chilblains
** Mildest form of cold injury, with prolonged exposure
** Burning, itching, mild dermatitis
** Can see vesicles and haemorrhagic lesions
** Does not produce tissue loss
* Chemical
* Toxic epidermal necrolysis, Stevens-Johnson Syndrome, etc
** Usually superficial partial-thickness injuries
** Sulfa drugs, anti-epileptic drugs and allopurinol
** Need to examine eye