BURN INJURY Zhang wei Department of Surgery BURN INJURY (1)

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Presentation transcript:

BURN INJURY Zhang wei Department of Surgery BURN INJURY (1)

Burn injury is a acute damage caused by heat, electricity and chemical materials. ·devastating injury ·very bad consequence ·septicemia and MSOF ·prevention BURN INJURY (2)

heat BURN INJURY (3)

electricity Chemical materials Radioactive materials laser BURN INJURY (4)

lightning explosive BURN INJURY (5)

Daily life BURN INJURY (6)

BURN INJURY (7)

BURN INJURY (8)

BURN INJURY (9)

BURN INJURY (10)

BURN INJURY (11)

Prevention: BURN INJURY (12)

BURN INJURY (13)

PATHOPHYSIOLOGY OF BURN INJURY AREA, DEPTH, AND SEVERITY OF BURN INJURY CLINICAL MANIFESTATION AND DIAGNOSIS OF BURN INJURY TREATMENT OF BURN INJURY BURN INJURY (14)

PATHOPHYSIOLOGY OF BURN INJURY BURN INJURY (15)

1.Pathologic stage ▣ effusion phase ▣ infective phase ▣ repair phase ▣ rehabilitative phase 2.Local lesions and general responses BURN INJURY (16)

3. Complications ◧ shock ◧ sepsis ◧ pulmonary complications and respiratory failure ◧ acute renal failure ◧ stress ulcer ◧ heart failure ◧ cerebral edema BURN INJURY (17)

AREA, DEPTH, AND SEVERITY OF BURN INJURY BURN INJURY (18)

1.Calculating area of burn injury ★ · Rule of nine · Rule of palm BURN INJURY (19)

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 BURN INJURY (20)

BURN INJURY (21)

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2. Estimating depth of burn injury ★ ▦ Ⅰ 0 : epidermis ▦ Ⅱ 0 : dermis superficial Ⅱ 0 : superficial dermis deep Ⅱ 0 : deep dermis ▦ Ⅲ 0 : entire epidermis and dermis (full-thickness) BURN INJURY (23)

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3. Severity of burn injury ·mild: Ⅱ 0 50%; Ⅲ 0 >20%; or with severe complications BURN INJURY (27)

depth: superficial: Ⅰ 0 and superficial Ⅱ 0 deep: deep Ⅱ 0 and Ⅲ 0 area: small area: 30% BURN INJURY (28)

CLINICAL MANIFESTATION AND DIAGNOSIS OF BURN INJURY BURN INJURY (29)

BURN INJURY (30)

BURN INJURY (31)

BURN INJURY (32)

Ⅰ0Ⅰ0 BURN INJURY (33)

superficial Ⅱ 0 BURN INJURY (34)

superficial Ⅱ 0 BURN INJURY (35)

deep Ⅱ 0 BURN INJURY (36)

Ⅲ 0Ⅲ 0 BURN INJURY (37)

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Chemical burns BURN INJURY (40)

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TREATMENT OF BURN INJURY BURN INJURY (45)

1. emergency aids ★ · remove heat source · avoid re-damage · lessen contamination · control pain · manage combined injury BURN INJURY (46)

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cold therapy BURN INJURY (49)

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Don’t like this ! BURN INJURY (52)

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2. General treatments (1) Correct burn shock (2) Prevention and treatment of systemic infection (3) Nutritional support BURN INJURY (54)

(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: BURN INJURY (55)

volume and rate of infusion for Ⅱ 0 and Ⅲ 0 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 BURN INJURY (56)

(2) Prevention and treatment of systemic infection ·control of wound infection: ·systemic antibiotics: ·support therapy: BURN INJURY (57)

(3) Nutritional support · total energy requirement: · proportions of carbohydrate, protein, and fat: · replacement of vitamins and trace elements · route BURN INJURY (58)

3.Management of burn wound ★ (1)debridement: (2)dressing and exposure methods: BURN INJURY (59)

BURN INJURY (60)

(3) removal of eschar: ·escharectomy ·tangential excision ·escharotomy ·eschar slough BURN INJURY (61)

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(4) skin graft: BURN INJURY (65)

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(5) management of burn wound infection: · wet dressing · local antibiotics BURN INJURY (70)

BURN INJURY (71)

Important points ◈ evaluation of area and depth for burn injury ◈ emergency treatment principle of burn injury ◈ treatment of burn shock  ◈ management of burn wound BURN INJURY (72)