burns - principles
DESCRIPTION
Gen SurgTRANSCRIPT
Burns
Lecture- Medical Lincenciate
Dr Robert Zulu
Introduction
• Burn injury may be defined as damaged to an epithelial surface caused by heat.
• Scald refers to burns caused by hot water.
• Morbidity and mortality depends on the Body surface area involved, depth of the injury and age of the patient
Pathophysiology
Local effects• Thermal injury causes coagulative necrosis
to the epidermis and the underlying tissues.• These constitute local effects. The zone of
coagulation is surrounded by a zone of stasis which is surrounded by a zone of hyperaemia.
•
Pathophysiology
Burn depth• the specific material involved in the burn
injury will determine the severity of the burn injury
• May be classified as first degree, second degree, third degree, and fourth degree
• May also be classified as superficial and deep burns
Pathophysiology
• First degree burns are localised to the epidermis• Second degree burns involve the superficial
dermis, and may go as far as deep into the dermis• Third degree burns also called full thickness burns
involve the epidermis, dermis and into the subcutaneous fat
• Fourth degree burns may extend into the underlying muscle
PathophysiologyPathophysiology
Burns size
Determination of the burn size estimates the extent of injury
Rule of nines
Rule of sevens
Rule of the palm
Pathophysiology
Systemic Effects
Significant burns associated with release of massive inflammatory mediators
These produce vasoconstriction and vaso dilatation, increased capillary permeability and oedema locally and distant organs
Pathophysiology
Systemic effects
• Hypermetabolic state
• Vascular permeability and oedema
• Immunosuppression
• Increased GUT mucosal permeability
• Decreased renal blood flow
• Alter haemodynamics
Aetiology
• Flame:- superheated, oxidised air
• Scald:- Hot liquids
• Friction:-
• Chemical:-
• Electrical:-
Management
Resuscitation
• A-Inhalation burns
• B-Breathing
• C-Fluid management
• D-specific type of burns
Management
Pre-hospital
Remove patient from hazard
Inhalation burns- 100% oxygen
Caregiver should wear protective clothing
Burning clothes should be removed, cover victim with dry blanket
Remove all rings, belts, watches and jewelry
Management
• Wound care outside the hospital involves applying clean dry dressing on the wounds
• Do not apply any creams or lotions or herbs
• Cover the patient in a warm dry blanket
• Morphine may be given after initial assessment
Manaement
Wound care• Daily cleaning, +/- silver sulphadiazin• Wet soaks• Pus swabs• Antibiotics• Blood transfusion• Sloughectomy• Escharotomy
Management
Fluid management
Muir and Barclay
-% Burns X Weight X 0.5= x mls
-1st 24hrs= x(4hrs) x(4hrs) x(4hrs), x(6hrs) x(6hrs)
-2nd 24hrs= x(12hrs), x(12)
-Remember to add maintenance fluid
Management
Monitoring
a. Fluid replacement:-
.Urine output, Pulse, Mental status, oedema
b. Wound healing
. Colour, pus, slough, features of the wound
c. Nutritional status
.Weight, skin fold thickness, oedema
Complications
Early complications
Airway obstruction,
Hypothermia
Fluid and electrolyte inbalance
Anaemia
Myoglobinuria
Hyponatraemia
Hypernatraemia
Complications
Late complications
Wound infection
SIRS
MODS
Skin Contractures
Curling’s ulcer
Skin Grafting
• Autograft ( own skin)• Xeno graft (pig skin)Provides wound cover and some
immunological benefit. Must be removed completely or allowed to slough.
• Allograft ( Homograft, Cadaver skin)Provides all the normal skin functions.
Epithelium can be allowed to slough.
Skin grafting
• Deep burns do not heal in timely fashion.• Superficial burns heal by re-epitheliasing
within 10-14days as long as the wounds the conditions for healing are present
• Excision and grafting of deep burns on the 3rd or 4th post burn day.
• Or assess after two weeks and skin graft unhealed areas
Skin Grafting
• Early excision and grafting is the current practice
• Some wounds may need serial excision of slough
• Leaving these dead tissues only serves as a niddus of infection
Skin grafting
• Split thickness skin graft
• Full thickness skin graft
• Flaps( rotational, advancement)
Skin Grafting
Avoid
Infected wound
Anaemic patients
Wound with slough
Absence of granulation tissue
Malnourished patients
Exercise
• One year child with burns of both lower limbs. Is seen at the hospital 6 hours latter.
• The child weigh 10kg.
• Describe your management plan the next 24hrsfrom the time you see the patient