assessment and types of burn
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Rehabilitation starts at the time of injury Every person who touches a burn survivor can positively impact their outcome. - ANZBA guidelines, Introduction. Assessment and types of burn. PBL 02 – Skin Deep Peter Byrnes, 27 Jan 2011. Resources. ANZBA Guidelines - PowerPoint PPT PresentationTRANSCRIPT
Assessment and types of burn
PBL 02 – Skin DeepPeter 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.
Resources
• ANZBA Guidelines• The epidemiology of burn injuries in an Austra
lian setting, 2000–2006
• Psychological and social aspects of burns• Lectures– Burns and wound healing – P Pakkiri– Issues facing the burns patient – M Rudd
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
Classification by cause
Special types of burn
Special types of burn
• Chemical burns– Toxicity? eg Hydrogen Flouride
• Electrical burns – deep tissue injury– Need to record voltage, current, and time of
exposure
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
Psychosocial assessment
• Scars and disfigurement – adjustment• Stress disorders• Non-accidental injury?– Abuse• Cigarette burns• Immersion burns – sock, glove, or donut patterns
– Self harm?
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)
Assessment of TBSA
Assessment of TBSA
http://www.tg.org.au/etg_demo/etg-lund-and -browder.pdf
Special areas
Burns involving:– Hands – Face – Perineum – Joints
Should be transferred to a burn centre.• complexity of post burn reconstruction• functional impact of inappropriate managementANZBA Guide, p 33
Classification by depth
ANZBA Guide p32
Partial thickness• Epidermal necrosis• Dermis spared• Separation of epidermis from dermis• Clinically recognized as a blister
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
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)
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
Assessment of depth
ANZBA Guide p31
Assessment of depth
ANZBA Guide p31
Assessment of depth
• Bedside evaluation• Biopsy and histology• Perfusion measurement techniques– thermography– angiography (ICG video)
Modalities for the Assessment of Burn Wound DepthDevgan et al, J Burns Wounds 2006http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1687143/