B U R N S .Dept of General Surgery(SBAH-UP)

Prof L.M. Ntlhe

Definition: Thermal injury, open flame, hot water, hot contact,

chemical & electrical

Classification: Skin Histology

Depth

•First Degree: sunburn – Erythema, pain no blisters.•2nd Degree: partial-thickness-blisters,weeping wet & painful.Blanches•3rd Degree: full thickness-dark,leathery, wary white, painless charrel & swollen.

• Combinations

Body surface area- Rule of ninePalm & fingers(1%)

Inhalation Burns

Special Areas•Thumbs•Perineum•Joints•Face•Circumferential Limbs

Chemical Burns

• Acids• Alkali• Petroleum• Concentration, duration of contact & amount

Rx-flush with lots of H2O(shower/hose)• Powder – brush away before flushing

Electrical Burns

• Body acts as a conductor of electricity- generates heat(i.e. electrical energy→heat→-tissue injury)

• ARF…….rhabdomyolysis• Different rates of heat loss i.e. skin & deeper tissue

muscle.Rx-ABC, ECG, Urinary catheterDark urine=haemochromogens• IVF-u/o 100mls/hr• 25g manitol & 12.5g – subsequently• +- NaHo3 if fluid resistant acidosis.

Resuscitation of acute burn: ABCD

• Airway: confined spaces burn – ETT Cfs: earlysubtle & delonged.

• Breathing: Oedema – obstruction -Toxic fumes Chemical tracheo-

bronchiolitis

Co poisoning-Diagnosis.. history- <20 % asymptomatic- >20-30% - headache/nausea- >30-40% - confusion- 40-60% - coma- >60% - deathCherry red skin (rare)-Co 240x affinity for Hb cf 02(T1/2=4hrs cf 40min

on 100% 02

Circulation• Foley in place, BP maybe impossible• Aim @ 1ml/kg /1hour for kids <30kg, 30ml/kg /1 hour adults• R/L: 2-4 mls/kg/2 or 3rd degree BSA burn – 24 hours.1. Parklands Calculated Volume – ½ - 8hours -1/2- 16hours – 24hrs based on the time of injury not on admission.2.Muir Burclay3.Galveston regime (pediatric)4.Modified Brooke5.EvansAssociated injuries Rx as per necessity.Flow sheet(input/outputAntibiotics – not immediately

Circumferential burns

• Jewelry• Check pulses & circulation – dopplers• Escharotomy• Fasciotomy…..rarely(high voltage electrical

burnNGTAnalgesia-IVI morphineWound care- cover burns

Cold Injury

• Frostnip -mildest, pain, pale, numbness, reversible( unless )chronic…

• Frostbite-freezing due to Intracellular ice crystals & microvascular occlusion….anoxia

Classified:1.1st degree – hyperaemia,oedema2.2nd degree- vesicles,hyperaemia,oedema3.3rd degree- full thickness,subcutaneous fat4.4th degree-necrosis of skin,muscle & bone

Non-freezing injury

• Due to microvascular endothelial damage & stasis

• Trernch foot / Fishermen• 1.6 to10 C

Frostbite• Warm clothes & fluids.• CirculatING H2O at 40c until pink (20-30 mins), maybe painful – Analgesia-Cardiac monitor• Goal – preserve (damaged/injured) tissue• Tet Toxoid• A/B if infection present• Sterile dressing• No smoking• Adjuvants – Heparin – Thombolytic Px – Hyperbaric O2 Px – Dextran 40 %• Weeks/months to demarcate

Hypothermia

Definition: Temperature <35c• Mild 35 – 32c• Moderate 32 – 30c• Severe <30cDropping maybe rapid or slowElderly & kids prone, PVDx• Polytrauma=<36c

CFs

• Temperature low— LOC—Cold to touch, gray, cyanotic—Vitals….. cardiac arrest

ABCD

• CPR• Prevent heat loss• O2• ICU• U&E – K+ 10mml/L• Passive external warming• Active core warming – Peritoneal/pleural• - Cardiopulmunary BypassCardiac drugs fibrillation..<28c– Bretillium Tosilate…..good– Dopamine……..good– Lignocain…….not effective