Scribd Logo
Upload

Welcome to Scribd!

  • 26 views

    Burn Injuries

    Uploaded by

    Indra Prasetya
    This document summarizes the epidemiology, classification, pathophysiology, and management of thermal injuries. It notes that 2-3 million thermal injuries occur annually, with 100,000 requiring hospitalization and 5-6 thousand deaths directly resulting. Burns are classified based on cause, depth, and other factors. Management involves ABCs, fluid resuscitation, wound care including topical agents, skin grafting or substitutes, and ICU considerations like tight glucose control and early enteral nutrition. Thermal injuries prompt local and systemic responses, with fluid resuscitation and infection prevention critical to attenuating the inflammatory response and improving outcomes.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd

    Burn Injuries

    Uploaded by

    Indra Prasetya
    26 views30 pages
    This document summarizes the epidemiology, classification, pathophysiology, and management of thermal injuries. It notes that 2-3 million thermal injuries occur annually, with 100,000 requiring hospitalization and 5-6 thousand deaths directly resulting. Burns are classified based on cause, depth, and other factors. Management involves ABCs, fluid resuscitation, wound care including topical agents, skin grafting or substitutes, and ICU considerations like tight glucose control and early enteral nutrition. Thermal injuries prompt local and systemic responses, with fluid resuscitation and infection prevention critical to attenuating the inflammatory response and improving outcomes.

    Copyright

    © © All Rights Reserved

    Available Formats

    PPT, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    This document summarizes the epidemiology, classification, pathophysiology, and management of thermal injuries. It notes that 2-3 million thermal injuries occur annually, with 100,000 requiring hospitalization and 5-6 thousand deaths directly resulting. Burns are classified based on cause, depth, and other factors. Management involves ABCs, fluid resuscitation, wound care including topical agents, skin grafting or substitutes, and ICU considerations like tight glucose control and early enteral nutrition. Thermal injuries prompt local and systemic responses, with fluid resuscitation and infection prevention critical to attenuating the inflammatory response and improving outcomes.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    26 views30 pages

    Burn Injuries

    Uploaded by

    Indra Prasetya
    This document summarizes the epidemiology, classification, pathophysiology, and management of thermal injuries. It notes that 2-3 million thermal injuries occur annually, with 100,000 requiring hospitalization and 5-6 thousand deaths directly resulting. Burns are classified based on cause, depth, and other factors. Management involves ABCs, fluid resuscitation, wound care including topical agents, skin grafting or substitutes, and ICU considerations like tight glucose control and early enteral nutrition. Thermal injuries prompt local and systemic responses, with fluid resuscitation and infection prevention critical to attenuating the inflammatory response and improving outcomes.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    You are on page 1of 30

    Sub Department of Plastic & Reconstructive Surgery,

    Department of Surgery, School of Medicine Udayana University, Sanglah


    Public Hospital
    Denpasar Bali

    EPIDEMIOLOGY
    2-3million thermal injury every year.
    100 000 require hospital admission.
    5-6 thousend people die as direct

    result of thermal injury every year.


    Patients require 1-1.5 hospital
    days/percent of TBSA burned.
    Age groups 25-34
    22%

    35-44
    45-54
    55-64
    65+

    35%
    50%
    33%
    36%

    CLASSIFICATION
    Cause:
    Flame: damage from superheated

    oxidized heat
    Scald: damage from contact with
    hot liquid
    Contact: damage from contact
    with hot or cold solid materials
    Chemical :contact with noxious
    chemicals
    Electricity: conduction of electrical
    current through tissue

    CLASSIFICATION Cont

    Electrical
    Low voltage domestic electrocution

    deep burns at contact and exit sites


    High voltage > 1000v results in
    severe injury with tissue loss and
    renal failure due to rhabdomyolysis
    Chemical
    Acids cause coagulative necrosis
    Alkalis cause liquefactive necrosis
    with deeper wounds
    Irradiation exposure to high energy
    electromagnetic waves

    CLASSIFICATION Cont
    Depth
    First degree: injury localised to epidermis. Painful,

    red, blanches to touch. Heals spontaneously. E.g.


    sunburn.

    Second degree superficial: injury to the epidermis

    and superficial dermis. Red painful, blistering,


    blanches to touch. Usually heals from intact skin
    appendages with some skin discoloration.

    Second degree deep: injury through the epidermis

    deep into dermis. Pale mottled, does not blanch to


    touch, painful to pin prick. Heals with scarring

    Third degree : full thickness injury into

    subcutaneous fat. Hard leathery eschar, painless


    black, white or red. No visible skin appendages. Skin
    grafting necessary.

    Fourth degree : injury to underlying muscle and

    bone

    PATHOPHYSIOLOGY
    Local response : Jackson's burn zones
    1. Zone of coagulation: irreversible tissue

    loss due to coagulative necrosis

    2. Zone of stasis: decreased tissue

    perfusion. Tissue is viable but can


    deteriorate to necrosis if not adequate
    resuscitation.

    3. Zone hyperaemia: outermost zone with

    increased tissue perfusion. Tissue


    usually recovers in absence of severe
    infection or severe tissue hypo perfusion

    PATHOPHYSIOLOGY cont
    Systemic Response.
    Associated massive release of inflammatory

    mediators leads to SIRS and then death. Early


    adequate resuscitation and prevention of
    wound sepsis attenuates the SIRS response.

    Drugs to attenuate SIRS response can

    favorable improve outcomes. E.g. thalidomide ,


    tromboxane inhibitors

    Increased vascular permeability and oedema


    Altered haemodynamics
    Decreased renal perfusion
    Decreased cardiac output
    Increased gut mucosal permeability
    Immunosuppression
    hyper metabolism

    MANAGEMENT
    ABCS
    Primary survey
    Secondary survey
    Wound management
    Icu
    Rehabilitation

    ABCS
    AIRWAY: protect airway in suspected inhalation
    burns.
    Signs of inhalation injury:
    History flame burns or injury in enclosed
    space
    Burns to face
    Nasal singing
    Hoarse voice
    Intubate if: hypoxic , swollen oropharynx or
    signs of respiratory distress
    CONSIDER BRONCHOSCOPY, MUCOLYTICS,
    HIGH FREQUENCY OSCILLATING VENTILATION,
    BRONCHODILATORS
    BREATHING
    Escharectomy if circumferential burns restrict
    ventilation
    100% o2 to treat carboxyhaemoglobinaemia
    Analgesia titrate ivi acc to pt discomfort
    monitor saturation and blood pressure

    CIRCULATION
    Cool burn wound over 20 mins with

    cool water (ice water damages viable


    tissue)
    Cover burn (cling wrap ,burn shield)
    Escharectomy for impaired circulation
    (circumferential burn has inelastic
    tissue which can swell with fluid
    resuscitation and precipitate
    compartment syndrome)
    Escharectomy : only burnt tissue is
    divided, not underlying fascia
    differentiating from fasciotomy

    Fluid management:
    Fluid losses must be replaced to

    prevent shock which are main causes of


    death in severe burns
    Burns > 15% TBSA in adult and >10%
    in child will require monitored
    resuscitation
    Fluid monitoring: urine catheter , CVP
    line , arterial line , pulse oximetry
    Maximum fluid loss occurs in 1st 24 hrs
    Several formulas have been developed,
    Globally the parklands formula is most
    commonly used.(4ml/kg/%bsa burned.
    50% over 1st 8hrs since time of injury
    and 50% over next 16hrs )

    FLUID MANAGEMENT cont


    Pediatric fluid administration :
    Most commonly used is parklands plus maintenance fluid as well
    Lund and bower chart most accurate to calculate fluid

    requirements in children
    Also varying formulas for children , but all similarly effective

    European survey of fluid management in burn pts showed :


    use of crystalloids is dominant strategy
    Colloids not used often ( especially in first 24hrs due to capillary

    leak)
    Colloid or crystalloid: literature suggests equal efficacy
    Hypertonic saline not recommended
    More than 3 decades after Baxter formulated their concepts for
    fluid therapy we are still lacking the answers to what fluid, how
    much and how to guide fluid therapy
    Tradition based fluid concepts need to be revisited in the face of
    modern volume replacement strategies

    Monitoring : (urine output ( 0.5 1ml/kg/hr ), cvp, cardiac index,

    mixed venous saturation) is more important than formulas!

    Primary /secondary survey


    Assess extent of burn:
    Erythema should not be considered
    Lund and Browder chart: most
    accurate method ,it compensates for
    variation in body shape with age.
    Useful in children
    Wallace rule of nines: good quick
    assessment, not accurate in kids
    Palmar surface: area of palm and
    fingers =0.8% TBSA
    Burn card method
    Using gauze on the wound

    The lund and browder


    charts:

    RULE OF NINE

    MANAGEMENT
    First-Degree Burns
    do not require wound dressings or
    topical antimicrobial agents.
    Pain may be managed with oral or
    topical analgesics or anti-inflammatory
    agents.
    Itching can be treated with cool
    compresses or oatmeal based solution
    supplemented with oral antihistamines,especially before bedtime,
    when indicated.

    MANAGEMENT cont
    Superficial Second-Degree Burns
    With the open method of wound
    care antimicrobial agents are used
    to minimize bacterial proliferation
    and fungal colonization.
    The routine use of antimicrobial
    agents has resulted in a
    substantial decrease in the
    mortality associated with burn
    injuries

    MANAGEMENT cont
    With the closed wound care method,

    the burn surface is washed and then


    covered with one of many synthetic
    or biological occlusive dressings
    creating a moist wound environment

    MANAGEMENT cont
    deep second degree burns
    The outer layer of deep second degree
    burns is composed of exposed collagen
    which has been denatured.
    This layer must be debrided before
    reepithelialization can occur.
    The topical use of an enzymatic
    debriding agent such as collagenase
    may result in earlier reepithelialization
    and healing

    MANAGEMENT cont
    third degree
    should be treated on the initial visit with

    a topical anti-microbial agent and a


    dressing.
    The patient should be admitted to the
    hospital or a Burn Center for definitive
    care which involves excision of the
    eschar and skin grafting or primary
    closure if the wound is sufficiently
    limited.

    TOPICAL AGENTS
    Silver sulfadiazine- effective 24hrs ,water

    soluble, low toxicity, most commonly used.


    Pov-iodine :short half life ,inactivated by
    wound exudates ,did not improve healing
    times
    Mupirocin: broad spectrum antimicrobial but
    not effective against pseudomonas
    Chlorhexidine:effective against
    pseudomonas but difficult to apply
    Mafenide: broad spectrum and good
    penetration. Causes electrolyte imbalance and
    painful application
    Acriflavin: good antiseptic. Can be cytotoxic,
    irritate skin , stain skin
    Acticoat; anti bacterial + anti fungal , 5 day
    application. Treatment choice with good
    outcomes
    Melladerm: local honey based products ,
    antibacterial , promotes moist wound
    healing ,very promising results

    SKIN SUBSTITUONS
    allograft : cadaver skin for temporary cover.

    Tissue lasts 3 weeks before rejection.


    Expensive needs special preservation
    Xenografts (pig skin) : temporary coverage,
    less expensive than allograft, more readily
    available, sloughs easily
    Human amnion : for temporary wound closure,
    superficial wounds and excised wounds, poor
    screening for viruses so not recommended.
    Synthetic coverings
    Opsite : provides moisture barrier,
    accumulation of exudates.
    Biobrane :2layer membrane with outer silicone
    membrane to prevent bacterial
    invasion.accumalation of exudates but
    otherwise good product. inexpensive long
    shelve life
    Transcyte: similar to biobrane, can stimulate
    wound healing
    Integra: provides complete wound closure,
    leaves a dermal equivalent, sporadic take rates

    Icu considerations

    No place for prophylactic antibiotics


    Stress ulcer prevention
    Tight glucose control
    Early enteral nutrition superior to
    parenteral feeding . Curreri formula
    ( 25kcal x weight) +(40 kcal x %TBSA
    burned)
    Immunonutrition: glutamine , arginine ,
    omega fatty acids
    B blockers to attenuate hyper metabolism
    Icu monitoring
    Dvt prophylaxis-clexane
    Anabolic steroids-controversial.
    Oxandrolone attenuates post burn
    catabolism
    myoglobinaemi

    THANK YOU

    You might also like