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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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6/8 6/7 9/14

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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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Electrophoresis injury

Excision to Achilles Tendon

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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 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

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Case #8Case #8• 50-year old farmer with diminished range

of motion in right shoulder & arm

• Last year, he pulled cattle out of a burning barn and had burns to the right axilla and chest

• Self-treated with veterinary silver sulfadiazine

• Now has taught scar in right axilla