Evaluation and Management of Burns Geoffrey Lee Plastics Intern

Physiology

Anatomy

Types Thermal Cold exposure Chemical Electrical current Inhalation Radiation

Severity Size Depth Site

Size Percentage of body surface area estimates Palm method = 1% Rules of Nines Each leg represents 9 x 2 = 18% Each arm 9% Anterior and posterior trunk each 9 x 2 = 18% Head 9% Lund-Browder chart

Depth Colour Moist vs dry Blanching Blisters Pain

Superficial Only epidermal layer Painful Dry Red Blanch with pressure Do not blister Heal 5-7 days No scarring

Superficial Partial Thickness Epidermis and superficial part of dermis Painful Red Weeping Blanches with pressure Heal in 7-21 days Unlikely scarring, pigment changes may occur

Deep Partial Thickness Epidermis and deeper dermis Painful to pressure only Blister Wet or waxy dry Mottled colorisation Do not blanch with pressure Heal in 3-9 weeks Hypertrophic scarring likely

Full Thickness Extend through all layers of dermis Anaesthetic or reduced sensation Appearance varies Dry Do not blanch with pressure No vesicles Severe scarring with contractures Usually require grafting

Forth Degree Deep and extend through skin into underlying tissues such as fascia, muscle and/or bone

Dangerous Sites Face Ears Eyes Hands Feet Genitalia Perineum Major joints

Management Major vs moderate/minor Major burns should be transferred to specialized burns centres Victoria: Victorian Adult Burns Service (VABS) at the Alfred Burns Unit at RCH

Victorian State Burns Service Referral Criteria Burns with associated inhalation injury Burns greater than 10% total body surface area Burns to special areas – face, hands, major joints, feet and genitals Full thickness burns greater than 5% total body surface area Electrical burns Chemical burns Circumferential burns of limbs or chest Burns with associated trauma Burns in the very young or elderly people Burn injury in patients with pre-existing illness or disability that could adversely affect patient care and outcomes Suspected non-accidental injury in children or the elderly Burns in children under the age of 12 months Small area burns - in patients with social problems, including children at risk Burns occurring in pregnant women

Major burns Primary survey Assess extent of burns Beware of circumferential full thickness burns Analgesia NGT insertion Tetanus Prevent hypothermia Fluid resus

Fluid Resus Parkland formula Amount required in 24hrs = 4 x wt(kg) x BSA(%) Half in first 8hrs Half in next 16hrs Maintenance fluids in addition for children weighing less than 30kg Guided clinically and by urine output

Minor Burns First aid Cleaning burns Blister management Dressings Analgesia Tetanus Follow up Post burn skin care

Electrical Burns Low voltage (<1000V) High voltage (>1000V) First aid Turn power off Ensure own safety Dysrhythmias Compartment syndrome Fluid resus Full thickness exit wound to armpit post high voltage electrical burn injury

Chemical Burns History First aid Type of agent Strength and concentration Site of contact, swallowed or inhaled Manner and duration of contact Mechanism of action of chemical First aid Prolonged irrigation of water Remove contaminated clothing Brush off metals and powders Do not attempt neutralising without specialist advice Full thickness burns to the legs caused by kneeling in cement

Questions?