Burn trauma. Pathogenesis. Diagnostic criteria. Clinic. Doc. Guda N.V.

In Greek mythology, Prometheus is a Titan known for stoling fire from Zeus and giving it to mortals for their use.

Burn isBurn injuries are caused by a variety of sources, including dry heat (flame), moist heat (scald, by hot liquids), contact with hot surfaces, chemicals, electricity, and ionizing radiation. The causative agent of the injury affects both the prognosis and the treatment.According to this, there are thermal, chemical, electrical, contact, radiation, sun burns.Among surgical diseases burns take 2 %.

Pathogenesis The tissue destruction caused by a burn injury can cause many local and systemic problems, including fluid and protein losses, sepsis, and disturbances of the metabolic, endocrine, respiratory, cardiac, hematological, and immune systems. Complex of these disturbances is called burn disease.

Burn diseaseappears in case of burns of more than 10-15% of body area in adults and 5-7% in children

Burn shock (24-72 hours and more)

Acute burn toxemia

Burn septic toxemia (lasts till the all wounds will be closed by autografts)

Recovery period ( 12 months and more)

Pathogenesis of the development of burn shock traumatic hypovolemic hypercoagulative pain

Pathogenesis of the development of burn shockPain CNS adrenalin -adrenoreceptors of precappilares spasm of precappilares s-m of hypo perfusion of organs and tissues

Pathogenesis of the development of burn shock decreasing of oxygen, going to organs and tissues acidosis blocking of -adrenoreceptors of precapillars paretic dilation of precapillars increased capillary permeability (capillary leak syndrome) increased capillary hydrostatic pressure

NORMAL BLOOD CAPILLARYPOSTBURN BLOOD CAPILLARYWater moleculeWater is the smallest molecule that can pass through the capillary pores.Protein molecule Permeability is increased, which allows large molecules such as proteins to pass through the capillary pores easily. The vascular capillary response to burn injury - fluid shift (capillary leak syndrome)

liquid part of blood to tissuesPathogenesis of the development of burn shockLocal inflammatory answerSystemic inflammatory answer to 15% of burns more than 15% of burns changes in veins of para necrotic zone Injury of endothelium by ferments of granulocytes liquid part of blood to tissues edema, blisters increasing amount of inflammatory inhalations influence on veins of interior organs staying of blood in capillaries edema of organs

Clinic of burn shockGeneralized edema acute cardio-vessel insufficiency main reason of death (develops during 1-2 hours)In urine cylinders,its dark red, anuria

Restrictive respiratory insufficiency - hypoxiaConcentration of blood, hyper coagulation, DVS on 2-3 day

Slow or no gastric motility. Decreased bowel sounds. Abdominal distention Nausea and vomiting Beginning ulceration of gastrointestinal mucosa. Translocation of microorganisms to vessels

Central nervous system disorders (exciting, depression)

Pathogenesis of the development of acute burn toxemia The inflammatory responses gradually subside 24 to 36 hours after the injury, and the capillary leak abates. Fluid shifts back into the circulation. But with toxic substances from metabolism of necrotic tissues. Endogen intoxication - period of acute burn toxemia (from few hours or days after the trauma)

disorders of CNS, depressing, inversion of sleeping, psychosis;hyperthermia;tachycardia, hypotension;polyuria (cylinders, leucocytes, erythrocytes in urine);dynamic impassability;decreasing of protein level in blood;leukocytosis, left shift.

Clinic of acute burn toxemia

Main criterions of burnsarea (%)depth (I,II,III,IV)severity (units)

Determination of burn areaRule of 9Rule of palm

Dolinins scheme

Dolinins scheme

Skin structure

Classification of burns according to the depth

Classification of burns according to the depth

superficial-thickness woundspartial-thickness wounds (separated into superficial and deep subgroups)full-thickness woundsdeep full-thickness wounds

Classification of burns according to the depthI stage epidermal burnII stage dermal superficial burnIII stage dermal deep burnIV stage under fascia burn

Determination of burn depthII IV II-III

The American Burn Association (ABA) describes burns as minor, moderate, or major depending on the depth, extent, and location

MINOR BURNSDeep partial-thickness burns 10%Any burn involving the eyes, ears, face, hands, feet, perineumElectrical injuryInhalation injuryClient over 60 yr of ageBurn is complicated with other injuries (e.g., fractures)Client has cardiac, pulmonary, or other chronic metabolic disorders

Methods of determination of burn depth

1) primary examination : - color of epidermis and derma ( epidermis - red or pink in case of I,II stages, white or yellow or black in case of deep burns ; derma red in II stage, grey in III) - edema - vesicles - is or not necrosis (III, IV)2) needle test ( hyper aesthesia in II st., superficial hypoaestesia in case of III st. and so on)3) application of wet gauze with special solutions (spiritus)4) depilation test ( painful in I,II st., easy, without pain in case of deep burns)5) instrumental methods: a) usage of radioactive isotopes b) impedance measuring c) thermography d) infrared zonding e) histological and biochemical methods

IV stage burns

IV stage burns

III-IV stage burns

urns severity

rule of hundreds is used (age in years + total area of burns in %)

Franks index is more exact. (FI= Area of superficial burns + 3 * area of deep burns)

Lesion Severity Index. (LSI) is the most exact .LSI = Area of I-IIst. +2 area of II + 3 area of III st.+ 4 area of IV st.+ age coefficient (factor)+ factor of respiratory burnsThe age factor : every year more then 60 is 1 unitThe factor of respiratory burns :- if there is a light degree = 15 units (respiratory disorders are not fixed);- if middle degree = 30 units (respiratory disorders are fixed first 6-12 hours after trauma);- if severe degree = 45 units (respiratory insufficiency from the moment of burn is fixed)Prognosis of burns is favorable, if LSI is not more than 30 unit, is relatively favorable, if 30-60 un., is doubtful 61-90 units , unfavorable more than 90 units.

Burn shockEasy burn shock - LSI from 10 up to 30 units, lasts 24-36 h, Hb is 151-160, normal diuresis.

Medium burn shock - LSI from 31 up to 60 units lasts from 36 up to 48 h, Hb 161-170, diuresis is decreased, urine is concentrated

Severe burn shock - LSI from 61 up to 90 units., lasts up to 64 h, Hb 171-190, oligouria to 30ml/hour

The most severe burn shock LSI > 90 units, lasts up to 72 hours, Hb more than 190, anuria.

Respiratory burns

Such diagnosis we can suggest if:Patient got the burn in the close roomThe burn is caused by the steam , flame or during explosion Patients cloth was in a fireThere are burns of chest, neck and face

Respiratory burnsProofs of the respiratory burns are:There are burns of the nose, lips, tongueNose hair is burnedInterior organs of the mouth are injuredProblems with the voiceCyanosis, disorders of breezingMechanical asphyxiaDates of consultation of otorynolaryngologistX-ray examinationFiberoptic bronchoscopy Arterial blood gas determinationPulmonary function tests

Respiratory burnsThere are 3 degrees of respiratory burns:light: there are no respiratory disorders during the first day after traumamedium: respiratory disorders are during first 6-12 hours after burnsevere: respiratory insufficiency from the moment of the burn

Formulation of the diagnosis in case of burns

1. The word burn2. The etiological factor: flame, hot water, steam, acid3. The stage of burn ( I, II, III, IV)4. The burn area in % (area of deep burns is putting in brackets)5. Injured organs, areas.6. Accompanying injuries that deal with the action of thermal agent ( respiratory burns, carbon monoxide poisoning )7. Dates about burn shock with its degree or another period of the burn disease ( toxemia, septic toxemia, recovery)8. LSI (lesion severity index)9. Complications10. Accompanying traumas and diseases

The clinical diagnosis: Burn by the fire I and II st. 25% of face, neck, right upper limb, chest. Respiratory burn of light degree. Burn shock, medium degree.LSI 40 units.Accompanying diagnosis: Stomach ulcer.

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