BURNS AND MANAGEMENT

Sreedhanya Sreedharan

TOPICS DISCUSSED ARE

Causes of burns and types Classsification of burns and how to

differentiate Pathophysiology of burns Management of burns-

prehospital ,hospital and further management

Complications of burns

CLASSIFIED Based on mechanisim 1. Scald-hot fluid2. Flash-brief burn3. Flame-usually full thickness4. Contact-direct5. Chemical-acid,alkali6. electrical

GRADES OF BURNS

SUPERFICIAL BURNS (FIRST DEGREE)

painful and erythematous, blanch to the touch, intact epidermal barrier

no vesicles or blister initially Not serious unless large areas involved i.e. sunburn

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SECOND DEGREE SUPERFICIAL Second degree – superficial: blister

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DEEP (SECOND DEGREE)• Second degree – deep :pale and

mottled • do not blanch to touch, but remain

painful to pinprick• Hospitalization required if over 25% of

body surface involvedi.e. tar burn, flame

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FULL THICKNESS (THIRD/FOURTH DEGREE)

Third degree a hard, leathery eschar that is painless

Fourth degree- involve other organs beneath the skin, such as muscle, bone, and brain

Destruction of all skin layers Requires immediate hospitalization Dry, waxy white, leathery, or hard skin,

no pain Exposure to flames, electricity or

chemicals can cause 3rd degree burns4/1/2011 11

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The area of cutaneous injury has been divided into three zones: •zone of coagulation•zone of stasis•zone of hyperemia

PATHOPHYSIOLOGY OF BURNS

MANAGEMENT OF BURNS Assess burns Surface area of burns Immediate trauma care Early management Further management

TOTAL BODY SURFACE AREA (TBSA) Superficial burns are not involved in the

calculation Lund and Browder Chart is the most

accurate because it adjusts for age Rule of nines divides the body – adequate

for initial assessment for adult burns

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RULES OF NINES Head & Neck = 9% Each upper extremity (Arms) = 9% Each lower extremity (Legs) = 18% Anterior trunk= 18% Posterior trunk = 18% Genitalia (perineum) = 1%

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ASSESSING BURN DEPTH Gold standard is clinical assessment by the

doctor completely expose area. 60-70% accuracy

Biopsy and histology experienced pathologist required

Laser Doppler techniques: Assesses perfusion-90-97% accurate.

disadvantages are ambient light problems, high cost, wound infection and topical substances affect readings.

Video microscopy_ :90-97% accurate. disadvantages are skin contact so risk for infection. Pt compliance necessary so problematic in kids and restless pts

MANAGEMENT

Prehospital care

Primary survey

secondary survey

Further management

PREHOSPITAL CARE removed from the source of injury burning process stopped Inhalation injury suspected and

100% oxygen given by facemask precautions for rescuer Jewelry removed Room-temperature water can be

poured on the wound within 15 minutes of injury to decrease the depth of the wound,

HOSPITAL CARE

MANAGEMENT Initial assessment and management Analgesic,fluid

management,antibiotics,wound care Fluid resuscitation Escharotomy To prevent complication Treat complication

FLUID RESUSCITATION

Burns >20% TBS require initial fluid resuscitation

PARKLAND FORMULA 4 * % surface area*weight of patient= x

ml x/2 in first 8 hours x/2 in next 16 hours Ideal urine output 1ml/kg/hr Severe burns 0.5 ml/kg/hr is adequate Next 24 hour.second day requires x/2 Third day onwards previous 24 hour

urine output+insensible loss If possible start feed/RT feed

CHOICE OF DRESSING based on the characteristics of the wound First-degree wounds --no dressing keep the skin moist pain control Second-degree :daily dressing changes

Deep second-degree and third-degree wounds escharotomyexcision and grafting the choice of initial dressing is aimed at holding

bacterial proliferation until surgery

TOPICAL AGENTS Silver sulfadiazine- effective 24hrs ,water soluble,

low toxicity, most commonly used. Pov-iodine :short half life ,inactivated by wound

exudates ,did not improve healing times Mupirocin: broad spectrum antimicrobial but not

effective against pseudomonas Chlorhexidine:effective against pseudomonas but

difficult to apply Mafenide: broad spectrum and good penetration.

Causes electrolyte imbalance and painful application Acriflavin: good antiseptic. Can be cytotoxic, irritate

skin , stain skin Acticoat; anti bacterial + anti fungal , 5 day

application. Treatment choice with good outcomes Melladerm: local honey based products ,

antibacterial , promotes moist wound healing ,very promising results

CURLING’S ULCER Acute ulcerative gastro duodenal disease Occur within 24 hours after burn Due to reduced GI blood flow and

mucosal damage Treat clients with H2 blockers,

mucoprotectants, and early enteral nutrition

Watch for sudden drop in hemoglobin

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FURTHER MANAGEMENT Minimising complication Nutritional support and other supportive

management Skin graft

CHEMICAL BURN

ELECTRICAL BURNS

Injuries are divided into high-volt: varying degrees of

cutaneous burn at the entry and exit sites

combined with hidden destruction of deep tissue

low-volt:without transmission to deeper tissues age injuries

Myoglobin- obstructive nephropathy

Cardiac arrythmia=VF

MANAGE ELECTRIC BURNS Fasciotomies vigorous hydration and infusion of

IV sodium bicarbonate (5% continuous infusion) and mannitol (25 g every 6 hours for adults to solubilize and maintain urine output if significant amounts are found in serum. In this situation, urine output is maintained at 2 mL/kg/hr.

Thank you