BURN INJURY

Zhang wei Department of Surgery

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Burn injury is a acute damage caused by heat, electricity and chemical materials.

·devastating injury ·very bad consequence ·septicemia and MSOF ·prevention

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heat

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electricity Chemical materials

Radioactivematerials laser

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lightning

explosive

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Daily life

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Prevention:

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• PATHOPHYSIOLOGY OF BURN INJURY

• AREA, DEPTH, AND SEVERITY OF BURN INJURY

• CLINICAL MANIFESTATION AND DIAGNOSIS OF BURN INJURY

• TREATMENT OF BURN INJURY

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PATHOPHYSIOLOGY OF BURN INJURY

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1.Pathologic stage

▣ effusion phase ▣ infective phase ▣ repair phase ▣ rehabilitative phase

2.Local lesions and general responses

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3. Complications

◧ shock ◧ sepsis ◧ pulmonary complications and respiratory failure ◧ acute renal failure ◧ stress ulcer ◧ heart failure ◧ cerebral edema

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AREA, DEPTH, AND SEVERITY OF BURN INJURY

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1. Calculating area of burn injury ★ · Rule of nine · Rule of palm

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中国九分法

部位 占体表面积

头颈 发部 3 面部 3 9X1(9%) 颈部 3双上肢 双上臂 7 双前臂 6 9X2(18%) 双手 5躯干 躯干前 13 躯干后 13 9X3(27%) 会阴 1双下肢 双臀 5 双大腿 21 9X5+1(46%) 双小腿 13 双足 7

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2. Estimating depth of burn injury ★ ▦Ⅰ0: epidermis ▦ Ⅱ0: dermis superficial Ⅱ0: superficial dermis deep Ⅱ0: deep dermis ▦ Ⅲ0: entire epidermis and dermis (full-thickness)

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3. Severity of burn injury ·mild: Ⅱ0 <10%TBS ·moderate: Ⅱ0 10-30%; or Ⅲ0<10%TBS ·severe: total area 30-50%; or Ⅲ0 10-20%; or with shock, airway burn, combined injury ·major: total area >50%; Ⅲ0 >20%; or with severe complications

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depth: superficial: Ⅰ0and superficial Ⅱ0

deep: deep Ⅱ0 and Ⅲ0 area: small area: <15% middle area: 15-30% large area: >30%

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CLINICAL MANIFESTATION AND DIAGNOSIS OF BURN INJURY

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Ⅰ0

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superficial Ⅱ0

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superficial Ⅱ0

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deep Ⅱ0

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Ⅲ 0

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Chemical burns

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TREATMENT OF BURN INJURY

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1. emergency aids ★ · remove heat source · avoid re-damage · lessen contamination · control pain · manage combined injury

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cold therapy

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Don’t like this !

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2. General treatments (1) Correct burn shock (2) Prevention and treatment of systemic infection (3) Nutritional support

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(1) Correct burn shock ★ ◨ choice of fluid: water, crystalloid, colloid ◨ route for fluid administration: peripheral, central vein ◨ volume and rate of infusion: 24h volume = 1.5ml×%burn×weight (kg) 1/2 in first 8 h ◨ monitor:

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volume and rate of infusion for Ⅱ0 and Ⅲ0 burn

first 24h second 24h

volume of adult child baby ½ of first 24h %burn/weight 1.5ml 1.8ml 2.0ml

colloid : moderate and severe 1:2 as left crystalloid major 1:1

basic water 2000ml 60-80ml/Kg 100ml/Kg as left

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(2) Prevention and treatment of systemic infection ·control of wound infection: ·systemic antibiotics: ·support therapy:

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(3) Nutritional support · total energy requirement: • proportions of carbohydrate, protein, and fat: · replacement of vitamins and trace elements · route

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3.Management of burn wound ★ (1)debridement: (2)dressing and exposure methods:

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(3) removal of eschar: ·escharectomy ·tangential excision ·escharotomy ·eschar slough

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(4) skin graft:

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(5) management of burn wound infection: • wet dressing · local antibiotics

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Important points

◈ evaluation of area and depth for burn injury ◈ emergency treatment principle of burn injury ◈ treatment of burn shock ◈ management of burn wound

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