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    Burns Presentation

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    Al Thai
    Burns are injuries caused by heat, fire, scalding liquids, electricity, chemicals or radiation. In the US, around 500,000 people are treated annually for burns, with 4,000 deaths. Burns are classified based on severity from first to fourth degree. Treatment depends on severity but may include wound care, skin grafts, fluid resuscitation, nutrition, and surgery. Complications can include infection, scarring, respiratory distress and more. Prognostic scoring systems are not useful for clinical decision making.

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    Burns Presentation

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    Al Thai
    212 views32 pages
    Burns are injuries caused by heat, fire, scalding liquids, electricity, chemicals or radiation. In the US, around 500,000 people are treated annually for burns, with 4,000 deaths. Burns are classified based on severity from first to fourth degree. Treatment depends on severity but may include wound care, skin grafts, fluid resuscitation, nutrition, and surgery. Complications can include infection, scarring, respiratory distress and more. Prognostic scoring systems are not useful for clinical decision making.

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    A presentation on burn classification, complications, and current medical management.

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    Burns are injuries caused by heat, fire, scalding liquids, electricity, chemicals or radiation. In the US, around 500,000 people are treated annually for burns, with 4,000 deaths. Burns are classified based on severity from first to fourth degree. Treatment depends on severity but may include wound care, skin grafts, fluid resuscitation, nutrition, and surgery. Complications can include infection, scarring, respiratory distress and more. Prognostic scoring systems are not useful for clinical decision making.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    212 views32 pages

    Burns Presentation

    Uploaded by

    Al Thai
    Burns are injuries caused by heat, fire, scalding liquids, electricity, chemicals or radiation. In the US, around 500,000 people are treated annually for burns, with 4,000 deaths. Burns are classified based on severity from first to fourth degree. Treatment depends on severity but may include wound care, skin grafts, fluid resuscitation, nutrition, and surgery. Complications can include infection, scarring, respiratory distress and more. Prognostic scoring systems are not useful for clinical decision making.

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    BURNS

    Al Thai February 25, 2013 Introduction to Clinical Medicine

    Outline
    Epidemiology Etiology

    Classification of Burns
    Burn Extent Burn Severity

    Treatment Surgical interventions Complications

    Epidemiology
    In the US, ~ 500,000 people treated annually.

    ~ 4,000 people die as a consequence of injuries caused by fire and smoke inhalation

    In 2011, there were 45,000 hospitalizations, of which 25,000 were in specialized burn centers

    Definition & Etiology


    Injuries to tissues (typically skin) caused by:
    Heat (majority of cases)
    Fires

    Scalding (from steam or hot liquids)

    Electricity Chemicals
    Strong acids or bases, oxidants

    Radiation
    Sunburn, medical radiation treatment

    Classification

    Classification- Burn Extent


    Determined by total body surface area (TBSA) Rule of 9s used to quickly estimate TBSA Lund and Browder chart- more specific

    Palm method

    Wallace Rule of 9s
    Head & neck = 9% Thorax (front) = 9% Abdomen (front) = 9% Each upper limb = 9% Each lower limb (front) = 9% Genitalia = 1% Patients palm surface = 1%

    Lund and Browder Estimation of Burns

    Classification- Burn Severity


    1st degree (superficial)

    2nd degree (partial thickness)


    3rd degree (full thickness) 4th degree (full thickness)

    Burn Severity
    First degree (superficial)
    Limited to epidermis Commonly due to scalding or sunburn Erythema, pain, edema, but no blistering Heals in <1wk

    No scarring

    Burn Severity
    Second degree (partial thickness)
    Involves epidermis with variable dermal involvement Very painful Erythema, blistering/raw skin Takes weeks to heal Complications include local infection/cellulitis

    Superficial partial thickness

    Difference between superficial and deep partial thickness:


    Superficial: blanches with pressure Deep: does not blanch with
    Deep partial thickness

    Burn Severity
    Third degree (full thickness)
    Loss of epidermis and dermis Painless Usually has a stiff, whitebrown appearance May have significant edema surrounding burn Loss of ability to re-epithelialize scarring Needs debridement, excision and grafting

    Burn Severity
    Fourth degree (full thickness)
    Loss of epidermis, dermis and subcutaneous tissue Damage of muscles, fascia and/or bone

    Appears black and charred

    Complications

    Complications
    Infection
    Common organisms:
    Pseudomonas Streptococcus, S. aureus, E. coli

    Check tetanus immunization status

    Hypermetabolic state Acute tubular necrosis

    Contractures
    Hypertrophic scarring Respiratory distress Edema*
    Compartment syndrome Airway obstruction

    Treatment

    Treatment
    American Burn Association criteria for transfer to burn center:
    2nd degree burns > 10% TBSA 3rd degree burns Burns to face, hands, feet, genitalia, perineum Electrical burns (including lightning injury) Chemical burns Inhalation injury Patients with pre-existing conditions

    Treatment
    1st degree burns
    None required Moisturizers Topical anesthetic

    Treatment
    2nd degree burns:
    Debridement Topical antibiotic Silver sulfadiazine (for dirty wounds) Petroleum jelly + gauze Temporary skin substitute Dressing changes as necessary Pain management HBOT

    Treatment
    3rd and 4th degree burns:
    Stop any continuing burn injury Airway management
    Intubate before respiratory problems

    FiO2 100%
    Check ABG, and CO level (carboxyhemoglobin >10% significant)

    Temperature regulation (keep patients warm) Fluid resuscitation (if > 20% TBSA) Topical antibiotics Surgical treatment
    Excision of burned area followed by skin grafting

    Enteral nutrition HBOT

    Treatment
    Fluid resuscitation for adults
    Parkland formula: calculates amount of resuscitation fluid required for the first 24 hrs **does not apply to larger burns
    First 24h - Lactated Ringers solution 4mL/kg/% burn

    Give first half resuscitation volume over first 8 hours Give second half resuscitation volume over next 16 hours Monitor urine output: 30-50 cc/hour
    After 24h Lactated Ringers solution 1 mL/kg/% burn daily

    Surgical Interventions

    Surgical Interventions

    Surgical Interventions

    Surgical Interventions

    Surgical Interventions

    Surgical Interventions

    Prognosis

    Prognosis
    With regard to prognostic scoring systems for burns:
    There is no evidence to support their use at the bedside for decision-making. -Sheppard, NN, 2011

    Reference
    Sheridan, R.L. (2012). Burns: A Practical Approach to Immediate Treatment and Long Term Care. London. Manson Publishing. DeSanti, L. Pathophysiology and Current Management of Burn Injury. Adv Skin Wound Care. 2005;18:323-32. Barret, J.P. & Herndon, D.N. Principles and Practice of Burn Surgery. New york. Marcel Dekker. Sheppard N.N., Hemington-Gorse, S., Shelley, O.P., Philp, B., Dziewulski, P. Prognostic scoring systems in burns: a review. Burns. 2011;37:1288-95 Robbins & Cotran (2010). Pathologic Basis of Disease (8th Ed.). Philadelphia: Saunders Elsevier. Goljan, E.F. (2010). Rapid Review: Pathology (3rd Ed.). Philadelphia: Mosby Elsevier. Heimbach DM, Engrav LH and Marvin J. Minor burns: guidelines for successful outpatient management. Postgrad Med. 1981 May;69(5):22-6, 28-32. http://www.medicinenet.com/burns/article.htm. Accessed February 10, 2012.

    http://life.familyeducation.com/wounds-and-injuries/first-aid/48249.html. Accessed February 11, 2012.


    http://emedicine.medscape.com/article/934173-treatment#a1128 http://www.indiasurgeons.com/burns.htm

    Questions

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