burn injuries adaobi okobi, m.d.. learning objectives epidemiology pathophysiology classification of...
TRANSCRIPT
![Page 1: Burn Injuries Adaobi Okobi, M.D.. Learning Objectives Epidemiology Pathophysiology Classification of burns Red flags Treatment](https://reader036.vdocument.in/reader036/viewer/2022062314/56649db25503460f94aa0f96/html5/thumbnails/1.jpg)
Burn InjuriesBurn InjuriesAdaobi Okobi, M.D.
![Page 2: Burn Injuries Adaobi Okobi, M.D.. Learning Objectives Epidemiology Pathophysiology Classification of burns Red flags Treatment](https://reader036.vdocument.in/reader036/viewer/2022062314/56649db25503460f94aa0f96/html5/thumbnails/2.jpg)
Learning ObjectivesLearning ObjectivesEpidemiologyPathophysiologyClassification of burnsRed flagsTreatment
![Page 3: Burn Injuries Adaobi Okobi, M.D.. Learning Objectives Epidemiology Pathophysiology Classification of burns Red flags Treatment](https://reader036.vdocument.in/reader036/viewer/2022062314/56649db25503460f94aa0f96/html5/thumbnails/3.jpg)
EpidemiologyEpidemiologyBurns are the 3rd leading cause of
accidental death in the U.S.>120,000 children under 20
receive care for burns in the E.D. every year
Under 5 years, scald burns cause 65% of thermal injuries
![Page 4: Burn Injuries Adaobi Okobi, M.D.. Learning Objectives Epidemiology Pathophysiology Classification of burns Red flags Treatment](https://reader036.vdocument.in/reader036/viewer/2022062314/56649db25503460f94aa0f96/html5/thumbnails/4.jpg)
PathophysiologyPathophysiologyZone of coagulation-
maximal injury from coagulation of proteins
Zone of stasis- decreased tissue perfusion; tissue is potentially salvageable
Zone of hyperemia- increased tissue perfusion
![Page 5: Burn Injuries Adaobi Okobi, M.D.. Learning Objectives Epidemiology Pathophysiology Classification of burns Red flags Treatment](https://reader036.vdocument.in/reader036/viewer/2022062314/56649db25503460f94aa0f96/html5/thumbnails/5.jpg)
Classification of BurnsClassification of Burns
![Page 6: Burn Injuries Adaobi Okobi, M.D.. Learning Objectives Epidemiology Pathophysiology Classification of burns Red flags Treatment](https://reader036.vdocument.in/reader036/viewer/2022062314/56649db25503460f94aa0f96/html5/thumbnails/6.jpg)
First DegreeFirst DegreeDryNo blistersMinimal or no
edemaErythematous,
blanchesVery painfulEpidermis onlyHeals in 2-5 days
without scarring
![Page 7: Burn Injuries Adaobi Okobi, M.D.. Learning Objectives Epidemiology Pathophysiology Classification of burns Red flags Treatment](https://reader036.vdocument.in/reader036/viewer/2022062314/56649db25503460f94aa0f96/html5/thumbnails/7.jpg)
Second Degree (Partial Second Degree (Partial Thickness)Thickness)Moist blebs, blistersUnderlying tissue is
mottled pink and white with fair cap refill
Very painful Involves epidermis
and reticular layers of dermis
Superficial: 5-21 daysDeep partial: 21-35
days with no infection; if infected converts to full thickness burn
![Page 8: Burn Injuries Adaobi Okobi, M.D.. Learning Objectives Epidemiology Pathophysiology Classification of burns Red flags Treatment](https://reader036.vdocument.in/reader036/viewer/2022062314/56649db25503460f94aa0f96/html5/thumbnails/8.jpg)
Third Degree (Full Third Degree (Full Thickness)Thickness)
Dry, leathery escharWhite or waxy
appearanceNo blanching or
bleedingSensation: deep
pressureIncludes epidermis
and dermis and may go down to subcutaneous fat, muscle or bone
Will not heal without skin graft
![Page 9: Burn Injuries Adaobi Okobi, M.D.. Learning Objectives Epidemiology Pathophysiology Classification of burns Red flags Treatment](https://reader036.vdocument.in/reader036/viewer/2022062314/56649db25503460f94aa0f96/html5/thumbnails/9.jpg)
Fourth DegreeFourth DegreeExtends into
muscle or boneSensation: only
deep pressureRequires skin
graft
![Page 10: Burn Injuries Adaobi Okobi, M.D.. Learning Objectives Epidemiology Pathophysiology Classification of burns Red flags Treatment](https://reader036.vdocument.in/reader036/viewer/2022062314/56649db25503460f94aa0f96/html5/thumbnails/10.jpg)
Size of BurnSize of BurnPalm method- palm of patient’s
hand is ~1% TBSALund-Browder method (Rule of
nines)
![Page 11: Burn Injuries Adaobi Okobi, M.D.. Learning Objectives Epidemiology Pathophysiology Classification of burns Red flags Treatment](https://reader036.vdocument.in/reader036/viewer/2022062314/56649db25503460f94aa0f96/html5/thumbnails/11.jpg)
![Page 12: Burn Injuries Adaobi Okobi, M.D.. Learning Objectives Epidemiology Pathophysiology Classification of burns Red flags Treatment](https://reader036.vdocument.in/reader036/viewer/2022062314/56649db25503460f94aa0f96/html5/thumbnails/12.jpg)
Red Flags: AbuseRed Flags: Abuse
![Page 13: Burn Injuries Adaobi Okobi, M.D.. Learning Objectives Epidemiology Pathophysiology Classification of burns Red flags Treatment](https://reader036.vdocument.in/reader036/viewer/2022062314/56649db25503460f94aa0f96/html5/thumbnails/13.jpg)
ResuscitationResuscitationAirwayBreathingCirculationDisabilityExposureFluids
![Page 14: Burn Injuries Adaobi Okobi, M.D.. Learning Objectives Epidemiology Pathophysiology Classification of burns Red flags Treatment](https://reader036.vdocument.in/reader036/viewer/2022062314/56649db25503460f94aa0f96/html5/thumbnails/14.jpg)
![Page 15: Burn Injuries Adaobi Okobi, M.D.. Learning Objectives Epidemiology Pathophysiology Classification of burns Red flags Treatment](https://reader036.vdocument.in/reader036/viewer/2022062314/56649db25503460f94aa0f96/html5/thumbnails/15.jpg)
Fluid ResuscitationFluid ResuscitationParkland formula: 4ml/kg/%TBSA (+
maintenance IVF if <5 years)Give 1st half in 8 hoursGive 2nd half over next 16 hoursD5LR is the fluid of choice in 1st 24
hoursColloids (ie albumin) may be added to
restore oncotic pressure and intravascular volume after the first 24 hours
Urine output should be >0.5-1ml/kg/hr
![Page 16: Burn Injuries Adaobi Okobi, M.D.. Learning Objectives Epidemiology Pathophysiology Classification of burns Red flags Treatment](https://reader036.vdocument.in/reader036/viewer/2022062314/56649db25503460f94aa0f96/html5/thumbnails/16.jpg)
TreatmentTreatmentSilver sulfadiazine cream- impedes
epithelializationTopical antibiotics (Bacitracin)Chlorhexidine- antimicrobial skin cleanserMafenide acetate- carbonic anhydrase
inhibitor (treat patient with high bacterial load on wound)
Providone-iodine ointment- controversial because of cytotoxicity and delay in wound epithelialization
Bismuth-impregnated petroleum gauze (Xeroform) – helps prevent or control wound infection
Skin graft
![Page 17: Burn Injuries Adaobi Okobi, M.D.. Learning Objectives Epidemiology Pathophysiology Classification of burns Red flags Treatment](https://reader036.vdocument.in/reader036/viewer/2022062314/56649db25503460f94aa0f96/html5/thumbnails/17.jpg)
TreatmentTreatmentPain control Clean with soap and waterDebridement (large or painful
blisters may be ruptured)Glycemic controlHigh protein dietProphylactic antibiotics-
controversialRehabilitation
![Page 18: Burn Injuries Adaobi Okobi, M.D.. Learning Objectives Epidemiology Pathophysiology Classification of burns Red flags Treatment](https://reader036.vdocument.in/reader036/viewer/2022062314/56649db25503460f94aa0f96/html5/thumbnails/18.jpg)
Take Home PointsTake Home PointsBurns can be classified by size and
depthFirst and superficial partial second
degree burns are very painfulDeep second, third and fourth degree
burns are not painful because of damage to nerves
Be suspicious of abuse for burns that do not match the mechanism of injury, immersion burns or cigarette burns
Fluid resuscitation should be aggressive in the first 24 hours with monitoring of the urine output