Burns with Dr Dennis Djogovic

Join us as we discuss early burns resuscitation with Dr. Dennis Djogovic. 

Dennis Djogovic is an emergency physician, trauma team leader and intensivist at the University of Alberta Hospital in Edmonton Alberta. He is the medical director for the HOPE organ donation organization, medical director for the Garner King General Systems Intensive Care Unit, and medical director for the Biggs and Allen Neurosciences Intensive Care Unit. The Garner King GSICU also incorporates the Edmonton Firefighters Burn Treatment unit, an American Burn Association verified burn centre and is a major burn referral centre in Western Canada, where Dennis is an instructor and course director for the Advanced Burn Life Support course.

The following make up the major learning points in this episode:

1. Ignore the burn. Burns patients are trauma patients with thermal traumas. Primary survey first!

2. Early on, only note extent as more than, or less than 20% BSA. 

3. Airway decompensation is usually slow. Outward appearance may not indicate the presence of an airway injury, if in doubt, intubate.  

4. If you are unsure of the exact extent of burns, start with Ringers Lactate at 500cc per hour for all patients who have more than 20% BSA burns and who are older than 14 years of age. If you are sure of extent, use the ABLS formula in place of the traditional (and old) Parkland formula, which is 2cc/kg/BSA divided by 2 and then by 8 for the first hour's starting rate. Changes to fluid administration rate then gets made in accordance to urine output and hemodynamic parameters. 

5. Hypotension in the burns patient, especially early on, is usually not due to the burn. Seek other etiologies to explain hypotension early on. 

6. Referral criteria include: More than 10% BSA involvement, involvement of special areas like hand, genitals and face, all pediatric burns, burns involving the joints and patients with major comorbidities. 

Further reading:

State of the Art: An Update on Adult Burn Resuscitation. Causbie, J.M.; Sattler, L.A.; Basel, A.P.; Britton, G.W.; Cancio, L.C. . Eur. Burn J. 2021, 2, 152–167. https://doi.org/10.3390/ ebj2030012. Here

Nebulized heparin for inhalation injury in burn patients: a systematic review and meta-analysis Xiaodong Lan1, Zhiyong Huang, Ziming Tan, Zhenjia Huang1, Dehuai Wang, and Yuesheng Huang. Here

The Physiologic Basis of Burn Shock and the Need for Aggressive Fluid Resuscitation Lisa Rae, Philip Fidler, Nicole Gibran. Here