Burns, part 2


     - Circulatory or ventilatory compromise 

     - Circumferential burns of extremities, neck/chest → may require fasciotomy 

     - Rhabdomyolysis 

     - Infection 

     - ARDS 

     - Renal failure 


Inhalation injury

     - consider if facial burns, singed nasal hairs, soot in nose or mouth, hoarseness, wheezing, full thickness face or peri-oral burns, circumferential neck burns, respiratory distress, altered mental status 

     - Can look for supraglottic edema on NPL or bronchoscopy if unsure 

            - Early intubation if suspected 


Carbon monoxide exposure 

     - Order carboxyhemoglobin level, place on NRB while awaiting results 

     - Consult hyperbarics if carboxyhemoglobin >25% (>15% if pregnant), associated neurologic symptoms or myocardial ischemia 


Cyanide toxicity 

     - can occur from combustion of nitrogen-containing polymers such as wool, silk, plastic (furniture)

     - Suspect if lactate >10 (can also see elevated lactate in CO poisoning however)

     - no rapid direct test for level 

     - Classically bitter almond smell and can cause cherry red skin - rarely seen clinically 

     - Treatment: 

            - Hydroxycobalamin - note red and will interfere with lab interpretation 

            - Sodium or amyl nitrite followed by sodium thiosulfate 


Concomitant traumatic injuries - complete full trauma primary and secondary surveys 



Guthrie, A. Minor Burn Management. Life in the Fastlane. https://litfl.com/ 


Tintinalli, Judith E. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 8th Edition. Ch 204, 216, 222.  

Tolles, Juliana. “Emergency Department Management of Patients with Thermal Burns.” Emergency medicine practice (Online) : an evidence-based approach to emergency medicine. 20.2 (2018): 1–24. Print. 

Volino, A. An Interesting Case of Smoke Inhalation. EM Daily. https://emdaily.cooperhealth.org/content/interesting-case-smoke-inhalation