injuries poisoning
Burns
Diagnosis of Burns
Clinical assessment of burn extent and depth Laboratory testing and chest x-ray in admitted patients Location and depth of burned areas are recorded on a burn diagram. Burns with an appearance compatible with both deep partial-thickness and full-thickness are presumed to be full-thickness. The percentage of TBSA involved is calculated; only partial-thickness and full-thickness burns are included in this calculation ( Diagnosis reference ). For adults, the percentage TBSA for parts of the body is estimated by the rule of nines ( (Redrawn from Artz CP, JA Moncrief:The Treatment of Burns, ed. 2. Philadelphia, WB Saunders Company, 1969; used with permission.) , protein, phosphate, and ionized calcium should be measured. ECG, urinalysis for myoglobin, and a chest x-ray are also required. Myoglobinuria (suggesting hemolysis or rhabdomyolysis) is suggested by urine that is grossly dark or that tests positive for blood on dipstick in the absence of microscopic red blood cells. These tests are repeated as needed. Diagnosis are evaluated in patients with myoglobinuria. Burn infectionis suggested by wound exudate, impaired wound healing, or systemic evidence of infection (eg, feeding intolerance, decrease in platelet count, increase in serum glucose level). Fever and white blood cell count elevation are common in burn patients without infection and therefore are unreliable signs of developing sepsis. If the diagnosis is unclear, infection can be confirmed by biopsy; cultures from the wound surface or exudate are unreliable. Many centers test patients on admission for colonization with methicillin-resistantStaphylococcus aureus(MRSA). 1.Kamolz LP, Parvizi D, Giretzlehner M, et al: Burn surface area calculation: What do we need in future.Burns40(1):171-172, 2014. doi: 10.1016/j.burns.2013.07.021 