Definition:: Is Defined As A Wound Caused by Exogenous Agent Leading To Coagulative Necrosis of The Tissue
Definition:: Is Defined As A Wound Caused by Exogenous Agent Leading To Coagulative Necrosis of The Tissue
Definition:: Is Defined As A Wound Caused by Exogenous Agent Leading To Coagulative Necrosis of The Tissue
Definition:
II. Classification:
A. Assessing depth.
B. Assessing size:
1. Palmer method.
2. Wallace’s rule of nine.
3. Lund and Browder chart.
IV. Pathophysiology:
A. Local changes.
B. Systemic:
1. Cardiovascular alterations.
2. Renal changes.
3. Pulmonary changes.
4. GIT abnormalities.
5. Metabloic changes.
6. Sepsis and immunity.
V. Management:
A. Pre-hospital care:
Stop the burning process.
Check for other injuries.
Cool the burn wound.
Give oxygen.
Elevate.
If there is any indication for admission?
B. Hospital care:
Admit the patient, should be in burns unit.
- Maintain airway, breathing, circulation (ABC).
- Assess the percentage, degree, and type of burn.
- Sedation and proper analgesia.
Chemoprophylaxis: tetanus toxoid, antibiotics and local
antiseptics.
- Ryle’s tube insertion: initially for aspiration purpose, later for
feeding.
VI. Fluid resuscitation:
Formulas to calculate the fluid replacement:
1. Parkland regime.
2. Muir and Burclay regime.
3. Galveston regime.
4. Modified brooke formula.
5. Evan’s formula.
VII. Local management:
1. Open method:
Silver sulphadiazine application without dressings commonly used in burns of
face, head and neck.
2. Closed method:
Dressing done to soothen and to protect the wound, to reduce the pain, as an
absorbent.
3. Tangential excision:
Can be done within 48 hours with skin grafting in patients with less than 25%
burn. Usually done in deep dermal burns wherein dead dermis is removed layer by
layer until fresh bleeding occurs. Later skin grafting done.
VIII. Wound coverage:
- In 3 weeks the area granulate well, split skin grafting is done
(SSG, Thiersch graft).
- MESH split skin graft is used for wider area.
- If there is eschar, escharotomy is required to prevent
compression of vessels.
IX. Complications of burn:
1. Eschar:
It is a charred, denatured, full thickness, deep burns with
contracted dermis.
Escharotomy:
• Incise along medial and/or lateral surfaces.
• Avoid bony prominences.
• Avoid tendons, nerves, major vessels.
2. Contracture:
Disorganized over formation of compact collagen (three times than
normal) causes hypertrophic scar finally leading to contracture.
Treatment:
Release of contracture surgically and use of skin graft or “Z” plasty.
Proper physiotherapy and rehabilitation is essential.
Pressure garments to prevent hypertrophic scars.
Management of itching in the scar using aloe vera, antihistamines and
moisturizing creams.
X. Non-thermal burn:
Electrical burns.
Chemical burn.
Cold injuries.
Ionizing radiation.
N.B:
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