BURNS Dr. Maria Auron, Ilembula 2014. BURNS Injury to tissues caused by heat, electricity, chemicals, radiation Thermal burns scalds (liquid), contact.

BURNSDr. Maria Auron, Ilembula 2014

BURNS• Injury to tissues caused by• heat, electricity, chemicals, radiation

• Thermal burns • scalds (liquid), contact burns or flame burns

• Smoke inhalation can cause • Airway burns, edema, atelectasis, pneumonia and possible CO

intoxication

• Electrical burns may cause deep tissue necrosis with few initial signs

• Children <5 years and elderly >70 years have highest mortality

FIRST AID

1. Stop the burning

• Extinguish, roll on the ground if on fire, remove burning clothes

• If chemical: large amounts of water

2. Cool the burn

• 20 min cool, running water • No ice, avoid hypothermia

3. Cover

• Clean cloth

Thermal burns

Assessment

1.Extent

Calculate body surface area (BSA) by the ”Rule of nines”

Assessment

2. Depth

Partial thickness

•1st degree (epidermal)• Red, blanches with pressure, painful, pin-prick

sensation preserved

•2nd degree (part of dermis)• Swollen, red, BLISTERS, moist, pin-prick

sensation preserved

Full thickness

•3rd degree (full thickness of dermis)

• Dry, painless, pale/charred, thrombosed skin vessels

Assessment

• 2nd – 3rd degree burns cause • loss of tissue fluid, most fluid

loss in the first 24 hours but continues up to 36 hours

• Risk for infection with Strep. pyogenes and Pseudomonas

Prevent dehydration and infection of the burn site!

Severe burns

• Extent: • Adults >15% of BSA• Children >10% of BSA

• Full thickness burns

• Burns in critical areas (face, hands, feet, perineum)

• Circumferential burns of limb or chest

• Electrical burns

• Inhalation injury • look for smoke around mouth/nose, facial burns, black sputum,

respiratory distress -> usually a sign of serious inhalation injury

PRIMARY SURVEY for severe burns• Airway – intubate if upper airway obstruction or impending

respiratory failure

• Breathing – humid oxygen by mask

• Circulation – assess color, refill, HR, blood pressure• Insert 1-2 peripheral iv lines

• Formal fluid resuscitation in 2nd – 3rd degree burns is critical• Use when burned skin area >15% BSA (10% in children)• Crystalloid solution with Parkland formula

PARKLAND FORMULA for fluid resuscitation

MANAGEMENT• Analgesia

• Keep patient warm

• Wound care• Clean with normal saline• Remove loose debris and large blisters• Cover with paraffin gauze + chlorhexidine dressing,

change dressings every 1-2 days• Elevate limbs with circumferential burns, assess distal

perfusion (capillary refill, pulse, warmth, color)-> escharotomy if perfusion is compromised! (cool to touch, weak or no pulse)

MANAGEMENT

• Tetanus prophylaxis

• There is no proven benefit from systemic prophylactic antibiotics

• Partial thickness burns heal in 2-3 weeks

• Full thickness burns need skin grafting, delayed for 2 weeks

• Later complications: contractures, scar hypertrophy and keloids

THANK YOU!