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

2. What causes burns?

3. heat

4. electricity
Chemical
materials
Radioactive
materials
laser

5. lightning
explosive

6. Daily life

9. Prevention:

11. 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

12. PATHOPHYSIOLOGY OF BURN INJURY

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

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

15. AREA, DEPTH, AND SEVERITY OF BURN INJURY

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

19. 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)

20. Skin involvement according to depth of a burn

21. 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

23. 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

24. 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

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

26. CLINICAL MANIFESTATION AND DIAGNOSIS OF BURN INJURY

29. Ⅰ0

30. Blisters

31. superficial Ⅱ0

32. deep Ⅱ0

33. Ⅲ 0

36. Chemical burns

37. Healing following 1st degree burn

38. Healing following 2nd degree burn

39. TREATMENT OF BURN INJURY

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

41. BURN INJURY (48)

42. cold therapy

45. Don’t run like this!

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

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

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

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

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

52. (3) removal of eschar: ·Escharotomy

56. 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

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

59. Thank You
Questions?