BURNS Epidemiology: Quality of Burn Care Survival Long-term Function Appearance Surgeon’s Goal Well-healed, durable skin with normal function and near-normal appearance *Depth of Injury is directly proportional to: Temperature applied Duration of contact Thickness of the skin Etiology: 1. Scald Burns - usually household from hot water - most common among civilians injuries especially children 2. Flame Burns - 2 nd most common mechanism - secondary to house fires, MVA 3. Flash Burns - explosion of gases & other combustible liquids - covers larger TBSA - with thermal damage to upper airway 4. Contact Burns - contact with hot metals, plastics, glass - common in industrial accidents - often 4 th degree 5. Electrical Burns - either occupational or household injuries - severity based on voltage, duration of contact & resistance of the patient 6. Chemical Burns - due to strong acids or alkalis - industrial accidents or assaults PHASES OF BURN INJURY •Acute Phase Fluids & Electrolytes Pain Control Burn Wound Care & Coverage Septic Complications Nutritional Management •Chronic Phase Rehabilitation Reconstruction Psychological Support Pathophysiology of Burn Injury 1. Coagulation Necrosis 2. Increased Capillary Permeability 3. Hemolysis ACUTE PHASE •Immediate Care Rescue and First Aid = on scene - remove source of heat - CPR if necessary; O2 inhalation Assessment and Resuscitation = at the ER - ABC’s take priority - Intubation if necessary Preparation for transfer to a burn facility - for burns more than 5 – 10% TBSA •Immediate first aid measures Cooling the burned area - application of cool water NOT iced water Removal of patient’s clothing - remove source of heat & exposure of injuries
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BURNS
Epidemiology:Quality of Burn Care
SurvivalLong-term FunctionAppearance
Surgeon’s GoalWell-healed, durable skin with normal function and near-normal appearance
*Depth of Injury is directly proportional to:Temperature appliedDuration of contactThickness of the skin
Etiology:1. Scald Burns
- usually household from hot water- most common among civilians
injuriesespecially children
2. Flame Burns- 2nd most common mechanism- secondary to house fires, MVA
3. Flash Burns- explosion of gases & other
combustible liquids- covers larger TBSA- with thermal damage to upper
airway4. Contact Burns
- contact with hot metals, plastics, glass
- common in industrial accidents- often 4th degree
5. Electrical Burns- either occupational or household
injuries- severity based on voltage, duration
of contact & resistance of the patient6. Chemical Burns
- due to strong acids or alkalis- industrial accidents or assaults
“Rule of Nines” for estimating TBSAAnatomic Area % body surfaceHead 9Rt. Upper extremity 9Lt. Upper extremity 9Rt. Lower extremity 18Lt. Lower extremity 18Anterior trunk 18
Posterior trunk 18 Perineum 1
Estimation of Burn Injury SeverityBurn Depth is dependent on: a. Temperature of burn source b. Thickness of the skin c. Duration of contact d. Heat dissipating capability of skin
Classification of Burn Depth1. Shallow Burns a) Epidermal Burns
(1st Degree Burns)- do not blister but erythematous- relatively painful
ex. Sunburn b) Superficial Partial-Thickness Burns
(2nd Degree Burns)
- form blisters, pink & wet- hypersensitive to pain- blanch with pressure- spontaneously heal
< 3 weeks2. Deep Burns
a) Deep Partial-Thickness Burns (2nd Degree)
- blisters, mottled pink and white - capillary refill is slow to absent - less sensitive to pain - heals in 3 to 9 weeks
b) Full Thickness Burns
(3rd Degree) - all layers of dermis
- leathery, dry white, firm & insensate- develop “ESCHAR”- heal by contracture or skin grafting
c) Fourth Degree Burns - full thickness skin, SQ fat,fascia & muscles
- electrical, contact, immersion burns in an unconscious patient
Assessment of Burn DepthMethods:1. Clinical observation – only 70% accurate2. Detection of Dead cells or denatured collagen
- biopsy, ultrasound, use of vital dyes3. Assessment of Change in Blood Flow
- fluorometry, laser Doppler, thermography4. Analysis of Wound Color
- light reflectance method5. Evaluation of Physical Changes
resistance3. Eicosanoids – increase levels of vasodilator PG’s
Diagnostic Work-upComplete Blood CountUrinalysis, BUN & Serum CreatinineBaseline electrolytesArterial blood gas determinationX-rays (Chest, other areas)Electrocardiography
Fluid ResuscitationRecommended Fluids:
Plain Lactated Ringer’s Solution = 1st 24 hours
Colloids or D5Water = after 24 hours
Fluid Computation & Administrationa) 1st 24 hours
“Parkland Formula” TFR = BW x TBSA x 4 mg/kg/%burns(1/2 given in1st 8H; 1/2 next 16H)b) 2nd 24 hours
Effects: a) prevents reversible displacement of O2b) decrease O2 unloading at tissue levelc) less effective intracellular respirationd) directly toxic to cardiac & skeletal