Burn Injury Typess Classification Causes Assesment and Managment
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Transcript of Burn Injury Typess Classification Causes Assesment and Managment
Dr Syed Kashif Hussain
Benazir Bhutto Hospital
Rawalpindi
BURNS: ASSESSMENT & MANAGEMENT
1
Introduction Assessment Treatment
•Definition
•Types
•Causes
•Classification
•Accidental burn ?
•Total Surface Area
TSAB
•Burn Thickness
•ATLS Approach
•Skin Tx
•Special site
•Supportive Tx
2
BURNS: INTRODUCTION
DEFINITION. TYPES, CAUSES, CLASSIFICATION
3
BURN:
Tissue Injury caused by application of thermal
energy in any form to the body surface is termed as
Burn.
Coagulative necrosis of tissue occur with depth of
coagulation corresponding to temperature and
duration of exposure.
4
CAUSES:
Flames
Fumes
Electricity
Chemical
Radiation
Friction
5
THERMAL INJURY
Flames:
Majority in Adults
Suicidal / Homicidal / Accidental
Fumes:
Hot fluids and gases
result in scalds
Contact:
too hot object
too long contact6
ELECTRIC BURNS:
Domestic Current: 220V -240V
Arrhythmias
High tension Injuries: >1000 V
Severe burn at entry & exit points
Flash injuries:
No direct current through the body but
heat nearby by can cause superficial burns.7
CHEMICAL BURNS:
Alkali’s burn more than Acids
Until the corrosive agent is completely removed
burn tends to be deep.
Never treat an Acid burn with Alkali
Vice versa!
8
RADIATION BURNS:
UV – Radiations damage the DNA and results in
Temporary Damage
Benign Changes
Malignancies
Dark Skin Protects
Not for long
Later Malignancy occurs often aggressive
9
IONIZING RADIATIONS:
Detaches electrons and damages the DNA of cell
Mostly superficial in nature
If pregnant are exposed to excessive Diagnostic or
Therapeutic Radiation
Offspring can Develop Cancer later in life
Born with Birth defects
10
ACUTE RADIATION SYNDROME / RADIATION POISONING:Symptoms develop in first 24 hours
Nausea
Vomiting
Bleeding tendencies
Falling blood count
Neurological defects
Rapid death
If above symptoms develop treat aggressively eg. Antibiotic
, Blood transfusion, marrow transplant etc. 11
ASSESSMENT OF BURN INJURY
HX TAKING, TBSAB, BURN THICKNESS,
12
CONSIDER NON ACCIDENTAL INJURIES:
Indicators:
No splash marks in a scald injury
Symmetrical burns of uniform depth
Burn of Face, genital, buttocks, sole , palms
Only upper limbs
On investigation:
Inconsistent story
Lack of guilt / concern13
Do it early and quick
Exact timing
Exact injury
Exact mechanism
Look for previous injuries
Rule out non accidental injury
14
TOTAL BODY SURFACE AREA BURNED
There are three methods to estimate TBSAB:
i. Hand surface Area
ii. Wallace Chart: Rule of Nine
iii. Lund and Browder Chart
15
TBSAB: HAND SURFACE AREA
Surface hand palm and finger is 0.8%
It is used to calculate
<15% TBSAB
>85% TBSAB
It is not 100% accurate but quick and
convenient for initial management
It may differ
Bit smaller in obese patients.16
WALLACE CHART: RULE OF 09
Adapted version for children
( Less accurate )
17
Best solution in children
Given more percent to face/head and less area to
lower limbs, gradually decreasing the percentage
as the child ages.
It is more extensive but accurate
Separate anterior and posterior %age
Difficult to remember..!
18
TBSAB: LUND & BROWDER’S CHART
TBSAB: LUND & BROWDER’S CHART
19
HISTOLOGY OF SKIN:
20
FIRST DEGREE BURNS:
SUPERFICIAL EPIDERMAL
Superficial
Painful
Red base
Brisk bleeding on prick
Blanch on pressure
Quick return of color
No scars
21
SECOND DEGREE BURNS:
SUPERFICIAL DERMAL
Painful
Red base
Bleed on prick
Blanch on pressure
Slow return of color
Sometimes scar
22
SECOND DEGREE BURNS:
DEEP DERMAL
Delayed bleeding on prick
Dull sensation
Dry wound
Whitish color
No blanching
No scar
23
THIRD DEGREE:
FULL THICKNESS BURNS
No sensation
No bleeding on prick
Leathery white
no blanching
Severe scar
24
FORTH DEGREE:
Full thickness burn
Bones and tendon exposed
25
26
DeathIncreasing Age
InfectionInhalation
Trauma
Increasing
Burn Size
MANAGEMENT OF BURN INJURY
LABS, ATLS, FIRST AID, PROPER TREATMENT
27
INVESTIGATIONS:
Full blood count
Urea
Electrolyte
12 lead ECG
ABGs
Cardiac enzymes
CXR
28
ATLS APPROACH:
AIR WAY
Inhalation of hot gases:Look for inhalation trauma
Edema
Indication for intubation:•Orophryngeal swelling
•Stridor
•Tachypnea
•dyspnea
•Hoarseness of voice29
BREATHING:
Mechanical restriction due to chest Escher
CO inhalation and carboxy hemoglobin
Smoke a direct irritant
100% humidified o2 inhalation
30
CIRCULATION:
Too much fluid results in edema
Too little results in poor perfusion and hypoxia
The goal is to achieve a proper organ perfusion
PARKLAND Formula for Resuscitation:
04ml (crystalloids )x (TBSAB %) x Weight (kg)
50 % in first 08 hours
50% in remaining 16 hours
Also add daily maintenance fluid31
PAIN CONTROL:
Use combine analgesics to reduce Narcotic doses
Never give IM drugs if TBSA >10%
Lorazepam : it decrease pain by decreasing
acute anxiety
32
FIRST AID TO BURN SKIN:
Remove clothing
Cooling with tap water for 20 minutes
Avoid very cold water / Hypothermia
It cause vasoconstriction and worsen ischemia
Dressing: eg
water soak gauze, paraffin gauze,
Vaseline gauze, silver sulfadiazine gauze
Augment healing
Maintain hygiene
Alleviate pain
33
Epidermal burns:
Analgesia is required at most
Superficial dermal burns:
Analgesia + limb elevation
Keep the wound moist
Healing occurs in 02 weeks
Deep dermal burns:
Reassess after 48 hours
Slow healing with keloids and contractures
Excise to a viable depth
Non adhesive dressing and elevation34
Full thickness burns:
Excise the necrotic tissue
if impossible than grafts or transposition flaps
New developments:
Vacuum assisted closure
Skin traction technique
35
SPECIAL SITES:
FACIAL SKIN BURNS
Clean face with chlorhexadine BD
Liquid paraffin x01 hourly
Men shave daily
Use pillow to minimize edema
For eye use Chloromphenicol eye drops/cream
Avoid application of steroids and gauze to cornea
36
BURN HANDS:
Refer burned tendon, cartilage, bone and joints
Expose joints usually require arthrodesis /
amputation
Thick burn to fingers need escharotomy
Excising and grafting of hand / foot injury must be
preferred
Raise hands to minimize edema
Dressing with moist plastic bags
Physiotherapy and splinting to prevent stiffening
and contracture.
37
SUPPORTIVE TREATMENT:
Special burn centre care
Systemic antibiotic prophylaxis
Topical antimicrobials
Maintain a good nutrition to prevent catabolic state
Burn injuries cause 03x BMR with hyperpyrexia
Splanic hypo perfusion and decrease absorption
38
Daily dressing
Pressure garments
Special contact media i.e. silicon gel
Moisturizing creams
Sun protection
Early mobilization
Physiotherapy
Psychological support
Monitoring
Brief Counseling39
SUPPORTIVE TREATMENT:
MANAGE HYPER METABILIC STATE:
Reduce heat lose
Treat infection
Early entral feeding
Early wound closure
40
SYSTEMIC COMPLICATIONS
When the burn reaches >30% TBSA
Bronchoconstriction / RDS
Shock and electrolyte disturbance
3x BMR
Down regulation of immune responses
Inability of local vasoconstriction
41
OTHER COMPLICATIONS:
Keloids
Hypertrophic scars
Contractures
Amputation
Cosmetic effects
Pruritis
Pain / agony
Acute anxiety
Depression
Social deprivation42
43
CARE IS BETTER THAN CURE