Outpatient Burn Care for Primary Care: Who needs a referral?
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1 Outpatient Burn Care for Primary Care: Who needs a referral? J. Kevin Bailey, MD Associate Professor Department of Surgery Division of Trauma, Critical Care and Burn The Ohio State University Wexner Medical Center Does this patient need a specialist? ABA Referral Criteria 1. Partial thickness burns >10% TBSA (Wound - big) 2. Burns of face, hands, feet, genitalia, perineum, or major joints (Wound -Function/ Hard to dress) 3. Third degree burns of any age group (Wound -will heal with scars) 4. Electrical burns, including lightning (Mechanism - tip of iceberg) 5. Chemical burns (Mechanism-tip of the iceberg) 6. Inhalation injury (Mechanism- tip of the iceberg) 7. Burn injury in patients with preexisting medical disorders that could complicate management, prolong recovery, or affect mortality (Host factor) 8. Any patient with burns and trauma (Host factor) 9. Burned children in non-pediatric hospital (potential resource need) 10. Burn injury in patient who will require special social, emotional, or rehabilitative intervention (potential resource need). 1
2 Does this patient need a specialist? ABA Referral Criteria 1. Partial thickness burns >10% TBSA (Wound - big) 2. Burns of face, hands, feet, genitalia, perineum, or major joints (Wound -Function/ Hard to dress) 3. Third degree burns of any age group (Wound -will heal with scars) 4. Electrical burns, including lightning (Mechanism - tip of iceberg) 5. Chemical burns (Mechanism-tip of the iceberg) 6. Inhalation injury (Mechanism- tip of the iceberg) 7. Burn injury in patients with preexisting medical disorders that could complicate management, prolong recovery, or affect mortality (Host factor) 8. Any patient with burns and trauma (Host factor) 9. Burned children in non-pediatric hospital (potential resource need) 10. Burn injury in patient who will require special social, emotional, or rehabilitative intervention (potential resource need). Rule of Palms 2
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5 Does this patient need a specialist? ABA Referral Criteria 1. Partial thickness burns >10% TBSA (Wound - big) 2. Burns of face, hands, feet, genitalia, perineum, or major joints (Wound -Function/ Hard to dress) 3. Third degree burns of any age group (Wound -will heal with scars) 4. Electrical burns, including lightning (Mechanism - tip of iceberg) 5. Chemical burns (Mechanism-tip of the iceberg) 6. Inhalation injury (Mechanism- tip of the iceberg) 7. Burn injury in patients with preexisting medical disorders that could complicate management, prolong recovery, or affect mortality (Host factor) 8. Any patient with burns and trauma (Host factor) 9. Burned children in non-pediatric hospital (potential resource need) 10. Burn injury in patient who will require special social, emotional, or rehabilitative intervention (potential resource need). 5
6 Electrophoresis injury Excision to Achilles Tendon 6
7 Does this patient need a specialist? ABA Referral Criteria 1. Partial thickness burns >10% TBSA (Wound - big) 2. Burns of face, hands, feet, genitalia, perineum, or major joints (Wound -Function/ Hard to dress) 3. Third degree burns of any age group (Wound -will heal with scars) 4. Electrical burns, including lightning (Mechanism - tip of iceberg) 5. Chemical burns (Mechanism-tip of the iceberg) 6. Inhalation injury (Mechanism- tip of the iceberg) 7. Burn injury in patients with preexisting medical disorders that could complicate management, prolong recovery, or affect mortality (Host factor) 8. Any patient with burns and trauma (Host factor) 9. Burned children in non-pediatric hospital (potential resource need) 10. Burn injury in patient who will require special social, emotional, or rehabilitative intervention (potential resource need). 7
8 Does this patient need a specialist? ABA Referral Criteria 1. Partial thickness burns >10% TBSA (Wound - big) 2. Burns of face, hands, feet, genitalia, perineum, or major joints (Wound -Function/ Hard to dress) 3. Third degree burns of any age group (Wound -will heal with scars) 4. Electrical burns, including lightning (Mechanism - tip of iceberg) 5. Chemical burns (Mechanism-tip of the iceberg) 6. Inhalation injury (Mechanism- tip of the iceberg) 7. Burn injury in patients with preexisting medical disorders that could complicate management, prolong recovery, or affect mortality (Host factor) 8. Any patient with burns and trauma (Host factor) 9. Burned children in non-pediatric hospital (potential resource need) 10. Burn injury in patient who will require special social, emotional, or rehabilitative intervention (potential resource need). 8
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13 Burn Clinic BURN Case #1 45-year old woman No medical problems 1 day earlier had hot cooking oil splatter on her arm 6 cm weeping, erythematous areas with early blistering on left arm 13
14 Case #2 65-year old man with COPD Smoking while wearing nasal cannula oxygen Flaming incident from burning cigarette Coughing with nasal erythema and soot in nares Case #3 25-year old man extracted from burning house Found unconscious In the ER, confused with erythematous hands 14
15 Case #4 50-year old woman Intoxicated and passed out on a heating pad 1 day later, presents with rectangularshaped erythematous pattern on her back Case #5 19-year old college student Struck by lightning at a bus stop Received bystander CPR and resuscitated Now presents to the ER for evaluation 15
16 Case #6 15-year old girl 2 days previously, ate hot pizza and got cheese stuck to roof of her mouth Ulcerated area on hard palate Case #7 55-year old man Earlier that day, grabbed the handle of a hot cast iron skillet Erythema over the palm and fingers 16
17 Case #8 50-year old farmer with diminished range of motion in right shoulder & arm Last year, he pulled cattle out of a burning barn and had burns to the right axilla and chest Self-treated with veterinary silver sulfadiazine Now has taught scar in right axilla 17
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Infants and Children From Bradys Emergency Care 10 th Edition. 2. Why should moist dressings be used sparingly in a pediatric burn patient?
Infants and Children From Bradys Emergency Care 10 th Edition 1. Which is the most frequent sign of head injury in a child? A.) Nausea B.) Vomiting C.) Altered mental status D.) Shock 2. Why should moist
CPR: Frequently asked questions
CPR: Frequently asked questions General What is a cardiac arrest? During a cardiac arrest, a person s heart stops pumping blood around their body and to their brain. It causes the person to fall unconscious
Dual Wavelength Phototherapy System
Dual Wavelength Phototherapy System The AKLARUS Blue and Red Combination System is an effective, drugfree alternative for treating acne & photodamaged skin. The non-invasive Aklarus treatment has been