BURNS Dr.Ishara Maduka M.B.B.S. (Colombo)

What causes burns?

heat

electricity Chemical materials Radioactive materials laser

lightning explosive

Daily life

Prevention:

PATHOPHYSIOLOGY OF BURN INJURY • AREA, DEPTH, AND SEVERITY OF BURN INJURY • CLINICAL MANIFESTATION AND DIAGNOSIS OF BURN INJURY • TREATMENT OF BURN INJURY - COMPLICATIONS OF BURN

PATHOPHYSIOLOGY OF BURN INJURY

2.Local lesions and general responses Pathologic stage ▣ effusion phase ▣ infective phase ▣ repair phase ▣ rehabilitative phase 2.Local lesions and general responses

Complications of a burn Acute Chronic Shock Scarring Sepsis Contractures Multi organ failure Psychological implications Airway obstruction Stress ulceration

AREA, DEPTH, AND SEVERITY OF BURN INJURY

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

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)

Skin involvement according to depth of a burn

First degree burns Needs to be differentiated from erythema Epidermis and papillae only are involved Results in red serum filled blisters Skin blanches on pressure Burn is painful and sensitive Healing occurs in 10 days with no scarring

2nd degree burns Epidermis is lost with varying degrees of dermis Burn is usually coloured pink and white May or may not blanche on pressure Variable degrees of reduced sensation may be present Epithelial cells are present in hair follicles and sweat glands Results in regeneration and spread Healing occurs in 14 days Some depigmentation of scar may occur May require skin grafting

Third degree burns Both epidermis and dermis are destroyed Burn appears white and does not blanche Sensation is absent Without grafting healing occurs from edge of wound

Who require specialized burn care? BSA > 20% in an adult BSA > 10% in a child

CLINICAL MANIFESTATION AND DIAGNOSIS OF BURN INJURY

Ⅰ0

Blisters

superficial Ⅱ0

deep Ⅱ0

Ⅲ 0

Chemical burns

Healing following 1st degree burn

Healing following 2nd degree burn

TREATMENT OF BURN INJURY

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

BURN INJURY (48)

cold therapy

Don’t run like this!

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

(1) Correct burn shock ★ ◨ choice of fluid: water, crystalloid, ◨ route for fluid administration: peripheral, central vein ◨ volume and rate of infusion: 24h volume = 4ml×BSA x weight (kg) ½ in first 8 h ¼ in second 8 h ¼ in third 8 h ◨ monitor – UOP, BP

(2) Prevention and treatment of systemic infection ·control of wound infection: Application of (Silver sulphadiazine) SSD and Betadine ·systemic antibiotics: · support therapy: Pain relief

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

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

(3) removal of eschar: ·Escharotomy

Burn rehabilitation Continued passive ROM to prevent contractures Increasing active ROM and strengthen Minimizing edema – by elevation (Activities of daily living)ADL training Initial scar management Preparing for work or play or school

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

Thank You Questions?