Dr. Maria Auron, Ilembula 2014 Burns Dr. Maria Auron, Ilembula 2014

Burns Injury to tissues caused by Thermal burns heat, electricity, chemicals, radiation Thermal burns scalds (liquid), contact burns or flame burns Smoke inhalation can cause Airway burns, edema, atelectasis, pneumonia and possible CO intoxication Electrical burns may cause deep tissue necrosis with few initial signs Children <5 years and elderly >70 years have highest mortality

First aid Stop the burning 2. Cool the burn 3. Cover Extinguish, roll on the ground if on fire, remove burning clothes If chemical: large amounts of water 2. Cool the burn 20 min cool, running water No ice, avoid hypothermia 3. Cover Clean cloth

Thermal burns Assessment Extent Calculate body surface area (BSA) by the ”Rule of nines”

Assessment 2. Depth Partial thickness 1st degree (epidermal) Red, blanches with pressure, painful, pin-prick sensation preserved 2nd degree (part of dermis) Swollen, red, BLISTERS, moist, pin-prick sensation preserved Full thickness 3rd degree (full thickness of dermis) Dry, painless, pale/charred, thrombosed skin vessels

Assessment Prevent dehydration and infection of the burn site! 2nd – 3rd degree burns cause loss of tissue fluid, most fluid loss in the first 24 hours but continues up to 36 hours Risk for infection with Strep. pyogenes and Pseudomonas Prevent dehydration and infection of the burn site!

Severe burns Extent: Full thickness burns Adults >15% of BSA Children >10% of BSA Full thickness burns Burns in critical areas (face, hands, feet, perineum) Circumferential burns of limb or chest Electrical burns Inhalation injury look for smoke around mouth/nose, facial burns, black sputum, respiratory distress -> usually a sign of serious inhalation injury

Primary survey for severe burns Airway – intubate if upper airway obstruction or impending respiratory failure Breathing – humid oxygen by mask Circulation – assess color, refill, HR, blood pressure Insert 1-2 peripheral iv lines Formal fluid resuscitation in 2nd – 3rd degree burns is critical Use when burned skin area >15% BSA (10% in children) Crystalloid solution with Parkland formula

Parkland formula for fluid resuscitation

Management Analgesia Keep patient warm Wound care Clean with normal saline Remove loose debris and large blisters Cover with paraffin gauze + chlorhexidine dressing, change dressings every 1-2 days Elevate limbs with circumferential burns, assess distal perfusion (capillary refill, pulse, warmth, color) -> escharotomy if perfusion is compromised! (cool to touch, weak or no pulse)

Management Tetanus prophylaxis There is no proven benefit from systemic prophylactic antibiotics Partial thickness burns heal in 2-3 weeks Full thickness burns need skin grafting, delayed for 2 weeks Later complications: contractures, scar hypertrophy and keloids

Thank you!