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Assessment and types of burn PBL 02 Skin Deep Peter Byrnes, 27 Jan 2011 Rehabilitation starts at the time of injury Every person who touches a burn survivor can positively impact their outcome. - ANZBA guidelines, Introduction.

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Resources ANZBA Guidelines The epidemiology of burn injuries in an Australian setting, 20002006 The epidemiology of burn injuries in an Australian setting, 20002006 Psychological and social aspects of burns Lectures Burns and wound healing P Pakkiri Issues facing the burns patient M Rudd

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Summary Classification Cause of injury Depth and TBSA (Area) Accidental and non-accidental Special types Assessment History of injury Depth and Area Complicating factors Psychosocial factors

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Classification by cause

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Special types of burn

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Chemical burns Toxicity? eg Hydrogen Flouride Electrical burns deep tissue injury Need to record voltage, current, and time of exposure

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History Need information to predict the severity of tissue damage How hot? How long? How fast did temp rise and fall? What first aid was applied? Concomitant injuries Other trauma fall, MVC, explosion trauma Smoke inhalation

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Psychosocial assessment Scars and disfigurement adjustment Stress disorders Non-accidental injury? Abuse Cigarette burns Immersion burns sock, glove, or donut patterns Self harm?

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Classification by Area TBSA = Total Body Surface Area Area (and depth) dictates the severity of the inflammatory and hypermetabolic response A burn of > 20 25% TBSA creates a global inflammatory reaction and indicates a significant risk for the respiratory system (ANZBA guide, p28)

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Assessment of TBSA

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http://www.tg.org.au/etg_demo/etg-lund-and -browder.pdf

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Special areas Burns involving: Hands Face Perineum Joints Should be transferred to a burn centre. complexity of post burn reconstruction functional impact of inappropriate management ANZBA Guide, p 33

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Classification by depth ANZBA Guide p32 Partial thickness Epidermal necrosis Dermis spared Separation of epidermis from dermis Clinically recognized as a blister

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Classification by depth Deeper burn more tissue destruction More likely to need surgery More likely to form scar tissue Tissue destruction should be monitored for at least 48 hours post burn injury Usually multiple depths involved

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ANZBA Guide p32 Classification by depth An intermediate partial thickness burn is the most difficult to assess and is most likely to change depending on the early management e.g. appropriate first aid and other patient factors. (Guide p29)

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ANZBA Guide p32 Classification by depth Full thickness Epidermis and dermis damaged Cell structures completely lost Three zones can be identified Zone of coagulation maximum damage, irreversible damage Zone of stasis area around zone of coagulation, tissue perfusion decreased, potentially salvageable Zone of hyperaemia outermost tissue where perfusion is increased

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Assessment of depth ANZBA Guide p31

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Assessment of depth ANZBA Guide p31

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Assessment of depth Bedside evaluation Biopsy and histology Perfusion measurement techniques thermography angiography (ICG video) Modalities for the Assessment of Burn Wound Depth Devgan et al, J Burns Wounds 2006 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1687143/