Burn management
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Transcript of Burn management
Burn Management
Amila kasun163
Burn
• DefinitionsA burn is the response of the skin and subcutaneous tissues to thermal injury.
Types of burns
• Thermal injury -scald –spillage of hot liquids -Flame burns -Flash burns due to exposure of natural gas,alcohol,combustible liquidsElectrical injuryChemical burnsCold injuryIonising burns Sun burns
Classification of burns
• Mild –partial thickness burns<15% in adults or <10% in children
-full thickness burns <2%-can treat as outpatient
• Moderate-15-25%(10-20% in children),burns not in eye,ears,face,hand
• Severe ->25%(20% in child)-All inhalation & electrical burnsinvolve eye.ear,face,hand,feet,perineum
Depending on thickness of skin involved
• 1st degree -epidermis looks red,painful,no blisters,heals rapidly in 5-7 days
• 2nd degree -with blisters,heals 2-3weeks
• 3rd degree -charred,parchment,painless,thrombosis with superficial vessels,(contracted full thickness burns called Eschar)
Clinical features
• Pain,anxious status,tachycardia,tachypnoea,fluid loss
• In severe-shock
PathophysiologyHeat causes coagulation necrosis of skin & subcutaneous tissue
Release of vasoactive substance
capillary permeability
Loss of fluids.
• severe hypovolamiadecreased myocardial funtion
Decreased COP reduced renal blood flow oligurea
Altered pulmonary resistance causing pulmonary oedema
MODS
Causes of deaths in Burns
• Hypovolamia & shock• Renal failure• Pulmonary oedema & ARDS• Septicaemia• Multiorgan failure
Management of burns
• 1st aid-stop burning process & keep pt away from
burning area-cool area with tap water for 20 mints(not
cold water can be hypothermia)
Indications for admission in burns
• Any moderate & severe burns• Airway burns of any type• Burns of extremes of age• All electrical/deep chemical burns
Initial management
• Cloths should removed• Cleaning the part remove mud,dust….etc• Chemoprophylaxis-tetanus,antibiotics,local
antseptics• Covering with dressing• Comforting by sedation & pain killers
Definitive treatment
• Admit pt• Maintain ABC• Asses the percentage involved • Fluid resuscitation
parkland regime—4ml/%burn/kg body weight/24hrsmaximum percentage considered is
50%..half of the volume is given in 1st 8 hrs,rest given in 16 hrs
• Muir & Burclay regime%burn*body weight in kg/2 =1 ration3 rations given in 1st 12hr2 rations in 2nd 12hr1 ration in 3rd 12 hr
Fluids used are N.saline,ringer lactate(FOC),hartmann,blood
1st 24 hour• Only crystalloids(can easily pass through the
capillary)Na should be assessed by formula0.52mmol*kg body weight*%burn.Give at a rate 4.0-4.4ml/kg/hrAfter 24 hourColloid can give upto 30-45hrs to compansate plasma loss…..plasma,gelatin,dextran,hetarstarch usedAt a rate of 0.35-5ml/kg/%burns
• Urine out put should be 30-50ml/hr• Tetanus toxoid• Monitor hourly
bp,pulse,saturation,SE,BU,nasal oxygen• Iv ranitidine 50mg 8 hrly• Antibiotics-
penicillins,aminoglycosides,cephalosporins,metronidazole
• Culture on discharge• TPN
Local management
• Dressing• Open method (used sulfadiazine without any
dressing in face,head,neck)• Closed method(dressing for soothen & protect
wound)• Tangenital excision• Apply sulfadiazene(neutropeania)…other
agents-sulfamylon,silver nitrate
Complications of burn contracture
• Ectropian of eyelid causing keratitis & ulcer• Disfigurement of face• Narrowing of mouth(microstomia)• In neck involvement reduced movement• Hypertrophic scar & keloid formation• Infection,ulcer & cellulitis• Marjolin’s ulcer
Rx for contracture
• Release by surgically & use skin graft/ Z plasty• Physiotherapy & rehabilitation• Pressure garments for prevent hypertrophic
scar• For itching aloe vera,
antihistamine,moisturizing creams
Electrical burns
• Always deep burn. wound of entry & wound of exit
• Internal organ injury• Most of deaths due to ventricular fibrillation• Gas gangrene common • Release of myoglobin causes ARF• Acidosis
management
• Depending on injury• Mannitol used in ARF• Mafenide acetate is better it has good
penetration & useful against clostridial infection
Inhalation injury
• Occurs after major fire burns• Inhaled by heat, noxious gas, incomplete
products of combustion• If fire area has <2% oxygen can die 45 sec• Formation of carboxyhaemoglobin with CO• Laryngeal & bronchial oedema• Later -ARDS,pneumonia,atelectasia,PE,PO,
pneumothorax
• Clinical featureslow oxygen levelcharring of mouth, oropharynxcarbon sputumchange voicestridor,tachypnoea,reduced consciousness
Managementventilatory supporttracheostomy
Chemical burns
• Tissue destruction is extensive• Acid burns nitric/sulphuric acid damage in
skin, soft tissue & stomach……so severe gastritis & pyloric stenosis. Cause metabolic acidosis,ARDS,ARF,heamolysis
mgt by IV sodium bicarbonate,calcium gluconate 10% gel,tropical ziphrin solution
• Alkali burns occur in oral cavity oesophagus.complications are oesophageal
stricture,saponification of fat,fluid loss,release of alkali proteinases,
mgt with 0.2% acetic acid.
Medco-legal & ethics of burn management
• Police should be informed in a female,pregnant pt arrive with burns
• Burns should be assessed whether accidental/homicidal
• Relatives should be informed about duration of stay,complications.
• Dying declaration arranged
Thank you