burns

BURNS MANAGEMENTDr. Mansoor Khan, MBBS, FCPS-I, PGY2

Khyber Teaching Hospital, Peshawar

“Coagulative necrosis of tissue due to extremes of temperature,

chemicals or irradiation”

Carelessness(40%), Accidents(35%), Fit or faint(5%),Alcohol(5%), Psychiatric(5%)

Scalds account for 60% of burns in childrenFlame accounts for 50% of burns in adultsContact(10%),Electrical(5%),Chemical(3%)

SCALDS

FLAME

CONTACT

ELECTRIC

CHEMICAL

RADIATION

RADIATION

Jackson’s burn wound model

Jackson’s burn wound model

S

K

I

N

FIRST DEGREE BURNS

Epidermal layer, Pink, painful, and edematousHeals 3-5 days w/o scarring

Causes: Flame, Sun, Flash from explosion

SUPERFICIAL SECOND DEGREE

Epidermis and papillary region of dermis, Blisters, bullae, serous fluidCherry red moist appearing, Painful, sensation intact, Edematous

Heals in 7-28 days with minimal scarringCause: flame, flash, scald, contact

Epidermis and reticular region of dermisBlisters, bullae, serous fluid, Pale ivory moist appearing

Painful, sensation intact, Edematous, Heals in 7-28 days with variable scarringCause: flame, flash, scald, contact

DEEP SECOND DEGREE

THIRD DEGREE FULL THICKNESS

Extends into subcutaneous tissue, White, yellow, brown leatheryAppearance, Thrombosed vessels, loss of elasticity, marked edema

Possible escharotomy, Painless to touch, Requires graftingCauses: flame, electricity, chemicals, prolonged exposure

May take 2-3 days to fully present true depth

FOURTH DEGREE

Extends to muscle, Loss of function, Black, charred appearanceMay require amputation, May require escharotomy and fasciotomy

Causes: very prolonged exposure to flame, chemicals, and high voltage

Total body surface area burned

Palmar Surface of Patient’s Hand =1% Wallace’s “Rule of Nines”Lund and Browder Charts

Lund-Browder chart

Management of the Burns Patient

PreventionFirst Aid Measures

Emergency treatment/triageAcute/on-going phases

Reconstruction/rehabilitation

First Aid Measures for Burns

Remove patient from cause.Put out flames “stop, drop and roll”.

Blanket or douse with waterRemove clothing in scalds

Airway, protect c/spine, give oxygenCalm and reassure patient

COOL THE BURN SURFACE

Cold running water or packs between 8 and 25 deg C for 30 mins.

15 deg C is ideal tempTemperatures below 5 deg may deepen burn

Watch for HYPOTHERMIA! Wrap patient in clean sheet or towel and keep

warm

Emergency treatment/triage

ABCDESecondary Survey

Triage Area,depth Minor vs MajorAnalgesia

?Resuscitate ?Monitoring?Admit

Dressing

Burns are extremely painfulMorphine 0,05-0,1 mg/kg as

starting doseAvoid oral or im routes

EntonoxKetamine

Tetanus ProphylaxisAntibiotics

Parkland formula

4 mL/kg body weight per percentage burn TBSA

half the volume is given in the first 8 hours postburn,

with the remaining volume delivered over 16 hours

Burns Surgery

EscharotomyTangential Excision

ExcisionExcision to deep fascia

Repair-direct, graft or flapReconstruction

Escharotomy

Circumferential deep burns to limbs, chest and abdomenIncisionsDepth of incisionNo anaesthetic except for kids

Excision/direct closure

Skin grafting:

Skin grafting:

Reconstruction

THANKS