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Burns

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23 views47 pages

Burns

Uploaded by

mehwishfatyma123
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Dr.

UNZA SHAIKH (MBBS, FCPS)


CONSULTANT PLASTIC SURGEON
SENIOR REGISTRAR, INCHARGE
Dept. Of Plastic and Burn Surgery,
Abbasi Shaheed Hospital,
Karachi Metropolitan University
OUTLINE:
Definition.
Types of Burns.
Pathophysiology.
Classification of burns.
Assessment of burns.
Clinical Features.
Management of burns
DEFINITION:
Burns is defined as a wound caused by an
exogenous agent leading to coagulative
necrosis of the tissue.
Majority of burns in children are scalds.
Majority of burns in adults are flame burns.
Most of the electrical and chemical burns
occur in adults.
There is an associated condition in 80% of
patients such as mental disease, epilepsy,
and alcohol or drug abuse.
TYPES OF BURNS:
Thermal (most common).
Electrical- High and low voltage.
Chemical- alkali and acids.
Cold Burns- Frostbite.
Radiation.
PATHOPHYSIOLOGY:

LOCAL

SYSTEMI
C
Lungs and Airway:
Injury to the airway above the larynx is caused by hot gases.
Injury to the airway below larynx is caused by inhaled steam.
Minuteparticles within the thick smoke can cause chemical
pneumonitis and respiratory failure.

History of being trapped in closed space.

Stridor

Change in voice.

Burns around face and neck.


Gastrointestinal:
Reduction of Gastric motility and increase in
translocation of bacteria resulting in infection.
Curling ulcer formation.
Abdominal Compartment syndrome.

Metabolic:
Hyper metabolic state.
Increase consumption of oxygen and calories.
Increase in body temperature.
Increase in Gluconeogenesis, lipolysis and Proteolysis.
Immune System:
It
causes decrease function of B and T cells rendering
patients susceptible to bacterial and fungal infections.
CLASSIFICATION OF BURNS
Depending on the percentage of
burn:

Mild:
•Partial
thickness burn less than 15% in adults or less
than 10% in children or full thickness less than 2%.
Moderate:
•Second degree 15-25% burn in adults and 10-20%
burns in children or third degree 2-10% burns.
Severe:
•Second degree >25% burn in adults or >20% burns
in children or third degree >10% burns or burns
involving hands , feet, ears ,eyes and perineum. All
inhalational and electrical burns.
ASSESMENT OF BURNS:
Wallace’s rule of 9.
Lund and Browder Chart:
CLINICAL FEATURES:
MANAGEMENT:
Pre-Hospital Care(First Aid):
Stop the burning process- STOP,DROP and
ROLL
Cool the burn wound for a minimum of
10minutes.
Remove clothing or any jewelry but not
anything that is stuck to skin.
Give oxygen.
Elevate the patient.
Definitive Treatment:
Maintain airway, breathing and circulation.
Sedation and analgesia.
Assessment of percentage, degree and type of
burn and accordingly fluid management.
Tetanus toxoid, antibiotics and local
antiseptics.
ESCHAROTOMY:
Fluid Resuscitation:
It is required to maintain intravascular
volume for perfusion of major organs and
peripheral tissues.
It in indicated in:
 - >10% TBSA in children.
 - >15% TBSA in adults.
Ringer lactate is the fluid of choice. Add
dextrose 5 % in children
Blood transfusion after 48hrs.
The key to monitoring of resuscitation is
urine output.
PARKLAND’S FORMULA:
It is the simplest formula for fluid replacement in
first 24hrs.
Half of this volume is given in first 8hrs and the
second half of this in the next 16hrs.

Formula=TBSA x Body weight x 4 =


volume(ml).

Muir and Barclay Formula:


Colloids should be given after 12hrs.
0.5 x %Body surface area burnt x weight = one
portion.
Periods of 4/4/4, 6/6 and 12hrs respectively.
One portion to be given in each period.
Topical Treatment of Superficial
Partial Thickness and Mixed
Depth burns:
Dressings should be easy to apply , non-
painful, simple to manage and locally
available.

If
the wound is acute, heavily contaminated
then clean the wound under general
anesthesia.

If
the wound is chronic, heavily
contaminated, then use silver sulphadiazine
dressings for 2-3 days.
Topical Treatment Of Deep
Burns:
Biological dressings such as amniotic
membrane are useful for superficial burns.
These provide good healing environment and
don’t need to be changed.
Superficial burns will heal spontaneously and
need simple dressings like Vaseline
impregnated or silicone sheets.
Surgical Management:
Surgery is indicated in deep partial-thickness and
full thickness burns except those that are <4cm.
All burn tissue need early excision in < 72hrs after
adequate resuscitation.
All burns need re-assessment in 48hrs.
The core temperature of patient should not drop
<36 C.
Placement of an arterial line and CVP line if
excising large burns.
Subcutaneous epinephrine and tourniquet
application are necessary for bleeding control.
Deep-Dermal Burns:
These need tangential shaving of dead dermis until
punctuate bleeding is noted.
The defect is closed by split-skin grafting.
Skin grafting is contraindicated if culture is positive
for Beta-hemolytic streptococcus or >10 bacterial
growth.

Full Thickness Burns:


These require full thickness excision of skin.
Stable cover should be applied at once to reduce the
burn load.
Stable cover can be permanent that includes split-
thickness and full thickness graft or temporary such
as homograft or xenografts.
Postoperative care:
Elevation of the affected limb to reduce
edema.
Careful evaluation of fluid balance.
Check hemoglobin levels.
Physiotherapy of the affected joint after
5days.
Splint application.
NUTRITION (cureri
formula):
• Adult:

• Children:
ELECTRICAL
BURN

ECG – arrhythmias, cardiac arrest


Maintain urine output at least 2cc/hr and up to
10 cc/hr in presence of myoglobinuria
CHEMICAL BURNS
RADIATION BURN:
 Radiation injuries result
from exposure to
electromagnetic or
particulate ionizing
radiation.
 At low doses, the primary
effect is the production of
ionized free radicals that
readily damage DNA.
 Sunburn is a radiation
injury caused by
COLD INJURIES/FROST
BITE:

 Active rewarming by immersion in a circulating water


bath at 40-42°C is the most rapid conductive rewarming
technique IN SETTING OF HYPOTHERMIA.
 Restore normothermia- GOAL
LONG TERM SEQUELAE:
POST
BURN CONTRACTURE- USE RECONSTRUCTIVE
LADDER
HYPERTROPHIC SCARRING-
 CONFORMING DRESSINGS IN EARLY STAGES
 SILICON SHEETS
 INTRALESIONAL STEROIDS
 RADIATION
 SURGICAL EXCISION
JOINT
STIFFNESS- PHYSIOTHERAPY IN EARLY
STAGES
PIGMENTATION - LASERS
1. A lab technician spills acid on a) Chest X-ray
his arm, leading to redness and b) ECG
blistering.
c) Complete blood count
What should be the first action? d) Blood culture..
a) Cover with a sterile dressing
3. A 4-year-old has partial-
b) Rinse thoroughly with water thickness burns on her face,
c) Apply alkaline solution neck, and chest from spilling
hot tea.
d) Cover with petroleum jelly..

What is a primary concern in


this case?
2. A 45-year-old electrician has a) Dehydration
an entry wound on his hand b) Infection
and an exit wound on his foot
after a high-voltage shock. c) Airway compromise
d) Hypothermia…
Which diagnostic test is
essential?
4. A 30-year-old patient presents b) 22.5%
with burns on the entire
c) 27%
anterior chest and abdomen, as
well as the entire left arm. d) 32%...
Using the Rule of Nines, what
percentage of the TBSA is
burned? 6. Palmar Method:
a) 27% A patient arrives with scattered
small burns across their body.
b) 18% The palmar surface of the
c) 36% patient’s hand, which
represents approximately 1% of
d) 45%.
TBSA, is used to measure each
burn area. If the burns cover
roughly ten hand-sized areas,
5. Burn Assessment in Children:
what percentage of TBSA is
A 5-year-old child has partial- affected?
thickness burns on the entire
head and neck, as well as the a) 5%
entire right leg. Using the b) 20%
modified Rule of Nines for c) 15%
children, estimate the total
percentage of TBSA burned. d) 10%....
a) 18%

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