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UNIVERSITY of TEXAS MEDICAL BRANCH
 

BLOCKER BURN UNIT
 

• Burn patients of all ages may be admitted to the University of Texas
  
  Medical Branch.  For transfer and admission information:
  
   
• Transfers for inpatient services:  Referring physicians will be
  
  directly connected to a faculty hospitalist physician by calling:

  1 (800) 962-3648 - The Transfer Center

   

  Or Direct:  UTMB Blocker Burn Unit
  
  John Sealy Hospital, 8th and Market St.; (409) 772-2023
   

A Patient Referral Form will need to be filled out.
 

Resources:  Burn Diagram (Preliminary)

                      Burn Diagram (72 hour)

                      Nomogram

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Burn Unit Referral Criteria

Burn injuries that should be referred to a burn unit include the following:

• Partial thickness burns greater than 10% total body surface area (TBSA).
• Burns that involve the face, hands, feet, genitalia, perineum, or major joints.
• Third-degree burns in any age group.
• Electrical burns, including lightning injury.
• Chemical burns.
• Inhalation injury.
• Burn injury in patients with preexisting medical disorders that could complicate management, prolong recovery, or affect mortality.
• Any patients with burns and concomitant trauma (such as fractures) in which the burn injury poses the greatest risk of morbidity or mortality.  In such cases, if the trauma poses the greater immediate risk, the patient may be initially stabilized in a trauma center before being transferred to a burn unit.  Physician judgment will be necessary in such situations and should be in concert with the regional medical control plan and triage protocols.
• Burned children that are in hospitals without qualified personnel or equipment for the care of children.
• Burn injury in patients who will require special social, emotional, or long-term rehabilitative intervention.
   

Hospital Emergency Care

• Assessment
  • Airway:  Support or provide airway and provide cervical spine protection.
  • Breathing:  Assess breathing and ventilation.  Provide assistance as necessary.  Monitor chest movement with deep burns of the trunk.  Administer oxygen at a high flow.
  • Circulation:  Assess vital signs.  Assess circulatory status of burned extremities by monitoring distal pulses.  Start IV access. 
  • Disability:  Assess orientation and neurological status, associated injuries, hypoxia.
  • Exposure:  Keep patient warm.
  • Medical History and Head to Toe Physical Exam with x-rays and laboratory assessment.

• Assess Burn
  • Assess type of burn and circumstances of injury.
  • Percent of burn injury (% Total Body Surface Area Burn)
    • The Burn Diagram  can be used to calculate burn size.  Children are different than adults.
    • The outline of the patient’s hand and fingers is equal to 1% of the body surface area and can be used to calculate burn size.  (An area the size of 2 of the patient’s hands would be a 2% burn.)
    • Body Surface Area nomogram:  A patient’s height and weight are used to measure Total Body Surface Area in centimeters squared.
  • Burn Depth
    • 1^st Degree Burn
    • 2^nd Degree Burn
    • 3^rd Degree Burn
    • 4^th Degree Burn
       

• Fluid Resuscitation
  • The most important aspect of early clinical management of the burn victim is fluid resuscitation beginning within the first couple hours of burn injury. 
  • Adult resuscitation:
    • Ringers Lactate 2-4 ml / kg / %TBSA burned.
    • Give ½ of total volume over the first 8 hours from time of burn injury.
    • Give second ½ of total volume over the following 16 hours.
    • Example
    • Titrate to maintain blood pressure and urine output of at least 30 cc/hr.
  • Pediatric resuscitation:
    • Ringers Lactate 5000 ml / TBSA burn (m²) + 2000 ml / TBSA (m²).
    • Give ½ of total volume over the first 8 hours from time of burn injury.
    • Give second ½ of total volume over the following 16 hours.
    • Example
    • Titrate to maintain blood pressure and urine output of at least 1 cc/kg/hr.

• Wound Care for Emergency care and transport
  • No ice or cold water soaks, no wet dressings or sheets.
  • Cover with clean dry cloth.
  • Keep patient warm.
  • For delayed transfer - 
    • Wash wounds and débride loose tissue.
    • Topical Antimicrobial (Silver Sulfadiazine) and gauze wrap.
    • Monitor need for escharotomies.

In this section:
Blocker Burn Unit Contacts
Burn Unit Referral Criteria
Hospital Emergency Care

Blocker Burn Unit Staff

"OLD RED"
The Ashbel Smith Building