0071643192.pdf

High-Pressure Injection Injuries

■ Tend to have a benign appearance but high morbidity.

■ Must be referred to hand specialist or plastic surgeon immediately for

debridement.

■ Give prophylactic Abx, update Td, and elevate and splint extremity.

■ Plain film X-ray may show widespread radiopaque material and air.

■ Do not perform a digital block as this may increase compartment pressure.

BURNS

Thermal Burns

Burns are described according to depth, with superficial burns involving only

the epidermis, partial-thickness burns involving both the epidermis and part

of the dermis, full-thickness burns destroying the entire epidermis and dermis,

and subdermal burns involving the subdermal tissues (see Table 3.11).

SYMPTOMS/EXAM

■ Evaluation of burns involves five main components:

■ Evaluation of airway and breathing

■ Consideration of possible carbon monoxide and cyanide exposure

■ Estimation of involved TBSA

■ Determination of depth of burned skin (see Table 3.12)

■ Evaluate for involvement of critical parts and for circumferential burns.

■ Signs of inhalational injury:

■ Fire in enclosed space

■ Facial burns or singed nasal hair

■ Carbonaceous sputum, soot in mouth or nose

■ Hoarseness, stridor, expiratory wheezing

■ To estimate involved TBSA in adults, the Rule of Nines is commonly used

(see Figure 3.19):

■ 9 for each upper extremity

■ 18 for each lower extremity

■ 18 each for front and back of torso

■ 9 for the head

TRAUMA ■ 1 for perineum

TABLE 3.11. Burn Classifications

NEWTERMINOLOGY OLDTERMINOLOGY DEPTH

Superficial First-degree Epidermal layer only

Partial-thickness Second-degree Epidermis and superficial dermis

Superficial

Deep Epidermis to deep dermis, including

hair follicles and sweat/sebaceous glands

Full-thickness Third-degree Epidermis and dermis (all structures)

Subdermal Fourth-degree Subdermal structures (muscles, nerves, bone)

High-pressure injection

injuries require immediate

surgical consultation.

5 mm of healthy nail bed is

required for nail adherence.

The more proximal the

amputation, the less ischemia

time it can tolerate.

Thermal injury below vocal

cords only occurs with steam

inhalation.