Post on 01-Jul-2018
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J. Kevin Bailey, MDAssociate Professor
Department of SurgeryDivision of Trauma, Critical Care and Burn
The Ohio State University Wexner Medical Center
Outpatient Burn Care for Primary Care: Who needs
a referral?
Does this patient need a specialist?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, oraffect 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 (potentialresource need).
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Does this patient need a specialist?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 (potentialresource need).
“Rule of Palms”
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Does this patient need a specialist?
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).
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Does this patient need a specialist?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
Does this patient need a specialist?
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 resourceneed).
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Burn Clinic 614.294.BURN (2876)Burn Clinic 614.294.BURN (2876)
@BuckeyeBurnDoc
Case #1Case #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
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Case #2Case #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 #3Case #3
• 25-year old man extracted from burning house
• Found unconscious
• In the ER, confused with erythematous hands
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Case #4Case #4
• 50-year old woman
• Intoxicated and passed out on a heating pad
• 1 day later, presents with rectangular-shaped erythematous pattern on her back
Case #5Case #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
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Case #6Case #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 #7Case #7
• 55-year old man
• Earlier that day, grabbed the handle of a hot cast iron skillet
• Erythema over the palm and fingers