Scribd
Upload
9 views21 pages

Burn Injury

Uploaded by

fekaduteje
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
9 views21 pages

Burn Injury

Uploaded by

fekaduteje
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
You are on page 1/ 21

BURN INJURY

Warning signs of burns to the respiratory


system
■ Burns around the face and neck
■ A history of being trapped in a burning room
■ Change in voice
■ Stridor

2
DANGERS OF SMOKE, HOT GAS OR
STEAM INHALATION
■ Inhaled hot gases can cause supraglottic airway
burns and laryngeal oedema
■ Inhaled steam can cause subglottic burns and
loss of respiratory epithelium
■ Inhaled smoke particles can cause chemical
alveolitis and respiratory failure
■ Inhaled poisons, such as carbon monoxide, can
cause metabolic poisoning
■ Full-thickness burns to the chest can cause
mechanical blockage to rib movement
3
THE SHOCK REACTION AFTER BURNS

■ Burns produce an inflammatory reaction


■ This leads to vastly increased vascular
permeability
■ Water, solutes and proteins move from the
intra- to the extra-vascular space
■ The volume of fluid lost is directly
proportional to the area of the burn
■ Above 15% of surface area, the loss of fluid
produces shock

4
Other complications of burns
■ Infection from the burn site, lungs, gut, lines
and catheters
■ Malabsorption from the gut
■ Circumferential burns may compromise
circulation to a limb

Major determinants of the outcome of a


burn
■ Percentage surface area involved
■ Depth of burns 5

■ Presence of an inhalational injury


THE CRITERIA FOR ACUTE ADMISSION TO A BURNS
UNIT

■ Suspected airway or inhalational injury


■ Any burn likely to require fluid resuscitation
■ Any burn likely to require surgery
■ Patients with burns of any significance to the
hands, face, feet or perineum
■ Patients whose psychiatric or social
background makes it inadvisable to send them
home
■ Any suspicion of non-accidental injury
■ Any burn in a patient at the extremes of age
■ Any burn with associated potentially serious
sequelae including high-tension electrical
6
burns and concentrated hydrofluoric acid
burns
Initial management of the burned airway

■ Early elective intubation is safest


■ Delay can make intubation very difficult
because of swelling
■ Be ready to perform an emergency
cricothyroidotomy if intubation is delayed

7
Recognition of the potentially burned
airway
■ A history of being trapped in the presence of
smoke or hot gases
■ Burns on the palate or nasal mucosa, or loss
of all the hairs in the nose
■ Deep burns around the mouth and neck

8
ASSESSING THE AREA OF A BURN

■ The patient’s whole hand is 1% TBSA, and is


a useful guide in small burns
■ The Lund and Browder chart is useful in
larger burns
■ The rule of nines is adequate for a first
approximation only

9
ASSESSING THE DEPTH OF A BURN

■ The history is important – temperature, time


and burning material
■ Superficial burns have capillary filling
■ Deep partial-thickness burns do not blanch
but have some sensation
■ Full-thickness burns feel leathery and have
no sensation

10
FLUIDS FOR RESUSCITATION

■ In children with burns over 10% TBSA and


adults with burns over 15% TBSA, consider
the need for intravenous fluid resuscitation
■ If oral fluids are to be used, salt must be
added
■ Fluids needed can be calculated from a
standard formula
■ The key is to monitor urine output

11
Options for topical treatment of deep
burns
■ 1% silver sulphadiazine cream
■ 0.5% silver nitrate solution
■ Mafenide acetate cream
■ Serum nitrate, silver sulphadiazine and
cerium nitrate

12
PRINCIPLES OF DRESSINGS FOR BURNS

■ Full-thickness and deep dermal burns need


antibacterial dressings to delay colonisation
prior to surgery
■ Superficial burns will heal and need simple
dressings
■ An optimal healing environment can make a
difference to outcome in borderline depth
burns

13
NUTRITION IN BURNS PATIENTS

■ Burns patients need extra feeding


■ A nasogastric tube should be used in all
patients with burns over 15% of TBSA
■ Removing the burn and achieving healing
stops the catabolic drive

14
INFECTION CONTROL IN BURNS
PATIENTS

■ Burns patients are immunocompromised


■ They are susceptible to infection from many
routes
■ Sterile precautions must be rigorous
■ Swabs should be taken regularly
■ A rise in white blood cell count,
thrombocytosis and increased catabolism are
warnings of infection

15
SURGICAL TREATMENT OF DEEP
BURNS

■ Deep dermal burns need tangential shaving


and split-skin grafting
■ All but the smallest full-thickness burns need
surgery
■ The anaesthetist needs to be ready for
significant blood loss
■ Topical adrenaline reduces bleeding
■ All burnt tissue needs to be excised
■ Stable cover, permanent or temporary,
should be applied at once to reduce burn
load 16
Delayed reconstruction of burns
■ Eyelids must be treated before exposure
keratitis arises
■ Transposition flaps and Z-plasties with or
without tissue expansion are useful
■ Full-thickness grafts and free flaps may be
needed for large or difficult areas
■ Hypertrophy is treated with pressure
garments
■ Pharmacological treatment of itch is
important 17
Electrical burns
■ Low-voltage injuries cause small, localized, deep
burns
■ They can cause cardiac arrest through pacing
interruption without significant direct myocardial
damage
■ High-voltage injuries damage by flash (external
burn) and conduction (internal burn)
■ Myocardium may be directly damaged without
pacing
interruption
■ Limbs may need fasciotomies or amputation 18
■ Look for and treat acidosis and myoglobinuria
Chemical burns
■ Damage is from corrosion and poisoning
■ Copious lavage with water helps in most
cases
■ Then identify the chemical and assess the
risks of
absorption

19
Radiation burns
■ Local burns causing ulceration need excision
and
vascularised flap cover – usually with free flaps
■ Systemic overdose needs supportive
treatment

20
Cold injuries
■ The damage is more difficult to define and
slower to develop than burns
■ Acute frostbite needs rapid rewarming, then
observation
■ Delay surgery until demarcation is clear

21

You might also like