Rapid Clinical Updates: Management of Burns and Carbon Monoxide Toxicity for Hospitalists-Handout

Handout

Pdf Summary

This document outlines current and advanced practices in disaster preparedness for burn care, inhalational injury, and carbon monoxide (CO) exposure. <br /><br />Initial burn management emphasizes aggressive fluid resuscitation using the Parkland Formula to estimate fluid needs, such as administering 4 liters in the first 8 hours for a 100 kg patient with 10% body burns. After initial stabilization, fluid therapy is adjusted to maintain urine output at least 0.5 mL/kg/hr. Optimal care involves a multidisciplinary team including hospitalists, surgeons (for debridement and grafting), therapists (to prevent joint contractures), nutritionists, and wound care specialists. Since specialized burn centers are limited, hospitalists often manage these patients and should actively pursue transfers for burns involving hands, feet, genitals, third-degree burns, electrical/chemical burns, or inhalation injuries.<br /><br />Inhalational injury, graded 0 to 4 by bronchoscopic airway visualization, is a leading cause of fire-related deaths and may occur without skin burns. Smoke inhalation exposes patients to various toxins, including cyanide from burning synthetic polymers. Severely elevated lactate levels (>10) suggest cyanide poisoning, warranting treatment consideration with hydroxocobalamin.<br /><br />Carbon monoxide exposure impairs oxygen delivery by binding hemoglobin, yet pulse oximetry readings remain falsely normal even in severe poisoning. Real-time toxicology advice is accessible nationwide via Poison Control at 800-222-1222.<br /><br />Overall, early fluid resuscitation, multidisciplinary care, vigilant assessment for inhalational injuries and toxic exposures, and utilization of specialized resources or transfers are critical to improving outcomes in burn patients in disaster settings.

Keywords

disaster preparedness

burn care

inhalational injury

carbon monoxide exposure

Parkland Formula

fluid resuscitation

multidisciplinary burn team

cyanide poisoning

hydroxocobalamin treatment

Poison Control