1. B U R N S. Dept of General Surgery(SBAH-UP) Prof L.M. Ntlhe

2. Definition: Thermal injury, open flame, hot water, hot contact, chemical & electrical

3. Classification: Skin Histology

4. Depth First Degree: sunburn – Erythema, pain no blisters. 2 nd Degree: partial-thickness-blisters,weeping wet & painful.Blanches 3 rd Degree: full thickness-dark,leathery, wary white, painless charrel & swollen. Combinations

5. Body surface area- Rule of nine Palm & fingers(1%)

6. Inhalation Burns Special Areas Thumbs Perineum Joints Face Circumferential Limbs

7. Chemical Burns Acids Alkali Petroleum Concentration, duration of contact & amount Rx-flush with lots of H2O(shower/hose) Powder – brush away before flushing

8. Electrical Burns Body acts as a conductor of electricity- generates heat(i.e. electrical energy→heat→-tissue injury) ARF…….rhabdomyolysis Different rates of heat loss i.e. skin & deeper tissue muscle. Rx-ABC, ECG, Urinary catheter Dark urine=haemochromogens IVF-u/o 100mls/hr 25g manitol & 12.5g – subsequently +- NaHo3 if fluid resistant acidosis.

9. Resuscitation of acute burn: ABCD Airway: confined spaces burn – ETT Cfs: earlysubtle & delonged. Breathing: Oedema – obstruction -Toxic fumes Chemical tracheo- bronchiolitis

10. Co poisoning-Diagnosis.. history - <20 % asymptomatic - >20-30% - headache/nausea - >30-40% - confusion - 40-60% - coma - >60% - death Cherry red skin (rare) -Co 240x affinity for Hb cf 02(T1/2=4hrs cf 40min on 100% 02

11. Circulation Foley in place, BP maybe impossible Aim @ 1ml/kg /1hour for kids <30kg, 30ml/kg /1 hour adults R/L: 2-4 mls/kg/2 or 3 rd degree BSA burn – 24 hours. 1.Parklands Calculated Volume – ½ - 8hours -1/2- 16hours – 24hrs based on the time of injury not on admission. 2. Muir Burclay 3.Galveston regime (pediatric) 4.Modified Brooke 5.Evans Associated injuries Rx as per necessity. Flow sheet(input/output Antibiotics – not immediately

12. Circumferential burns Jewelry Check pulses & circulation – dopplers Escharotomy Fasciotomy…..rarely(high voltage electrical burn NGT Analgesia-IVI morphine Wound care- cover burns

13. Cold Injury Frostnip -mildest, pain, pale, numbness, reversible( unless )chronic… Frostbite-freezing due to Intracellular ice crystals & microvascular occlusion….anoxia Classified: 1.1 st degree – hyperaemia,oedema 2.2 nd degree- vesicles,hyperaemia,oedema 3.3 rd degree- full thickness,subcutaneous fat 4.4 th degree-necrosis of skin,muscle & bone

14. Non-freezing injury Due to microvascular endothelial damage & stasis Trernch foot / Fishermen 1.6 to10 C

15. Frostbite Warm clothes & fluids. CirculatING H2O at 40c until pink (20-30 mins), maybe painful – Analgesia -Cardiac monitor Goal – preserve (damaged/injured) tissue Tet Toxoid A/B if infection present Sterile dressing No smoking Adjuvants – Heparin – Thombolytic Px – Hyperbaric O2 Px – Dextran 40 % Weeks/months to demarcate

16. Hypothermia Definition: Temperature <35c Mild 35 – 32c Moderate 32 – 30c Severe <30c Dropping maybe rapid or slow Elderly & kids prone, PVDx Polytrauma=<36c

17. CFs Temperature low — LOC —Cold to touch, gray, cyanotic —Vitals….. cardiac arrest

18. ABCD CPR Prevent heat loss O2 ICU U&E – K+ 10mml/L Passive external warming Active core warming – Peritoneal/pleural - Cardiopulmunary Bypass Cardiac drugs fibrillation..<28c –Bretillium Tosilate…..good –Dopamine……..good –Lignocain…….not effective