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Burn Injuries

This trauma PowerPoint presentation covers how to deal with burns. Topics covered include:

• Types of burn
• Depths of burn
• Picture examples
• First aid management

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Burn Injuries & Its Management

Published by Amy Willis Modified over 6 years ago

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Presentation on theme: "Burn Injuries & Its Management"— Presentation transcript:

Chapter 11 Burns. An estimated 2 million burn injuries occur each year in the United States, resulting in 75,000 hospitalization and more than 3000 deaths.

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Burn Management - PowerPoint PPT Presentation

Burn Management

Burns ... chemical burns: necrotizing substances (acids, alkali) ... brooke formula. burns. assessment of adequacy of fluid replacement ... – powerpoint ppt presentation.

• Mohamed Ahmed Sayed
• Assistant Lecturer of Plastic and Reconstructive Surgery
• Ain Shams University Faculty of Medicine
• dr_mohamed_a_at_yahoo.com
• http//www.geocities.com/dr_mohamed_a
• Burn wounds occur when there is contact between tissue and an energy source, such as heat, chemicals, electrical current, or radiation.
• The effects of the burn are influenced by the
• intensity of the energy
• duration of exposure
• type of tissue injured
• 0 - 4 years, from kitchen, bathroom.
• 5-74 years, outdoors, kitchen.
• Teenagers, suicide (females).
• gt 75 years, kitchen, outdoors.
• Winter more than summer
• Carelessness with cigarettes!!
• Hot water from water heaters set at high levels above 60 C
• Cooking accidents
• Space heaters
• Gasoline, lighter fluids, etc.
• Thermal burns flame, flash, contact with hot objects.
• Scald burns hot fluids.
• Chemical burns necrotizing substances (acids, alkali).
• Electrical burns intense heat from an electrical current
• Smoke inhalation injury inhaling hot air or noxious chemicals
• Cold thermal injury frostbite.
• examples cleaning agents...
• Tissue destruction may continue for up to 72 hours.
• It is important to remove the person from the burning agent or vice versa.
• The latter is accomplished by lavaging the affected area with copious amounts of water.
• Can damage the tissues of the respiratory tract
• Although damage to the respiratory mucosa can occur, it seldom happens because the vocal cords and glottis closes as a protective mechanisms.
• Injury from electrical burns results from coagulation necrosis that is caused by intense heat generated from an electric current.
• The severity depends on
• amount of voltage
• tissue resistance
• current pathways
• surface area in contact with the current
• length of time the current flow.
• Fractures of long bones and vertebra
• Cardiac arrest or arrhythmias--can be delayed 24-48 hours after injury
• Severe metabolic acidosis--can develop in minutes
• Myoglobinuria--acute renal tubular necrosis.
• Fluids--Ringers lactate or other fluids-flushes out kidneys--you want 75-100 cc/hr until urine sample clear
• an osmotic diuretic (Mannitol) may be given to maintain urine output
• Severity is determined by
• depth of burn
• extend of burn calculated in percent of total body surface (TBSA)
• location of burn
• patient risk factors
• Vital organs of burn
• Joint regions
• Other areas
• Associated trauma
• Inhalation injuries
• Circumferential burns
• Electricity
• Age (young or old)
• Pre-existing disease
• emergent (resuscitative)
• rehabilitative
• Remove from area! Stop the burn!
• If thermal burn is large--FOCUS on the ABCs
• Aairway-check for patency, soot around nares, or signed nasal hair
• Bbreathing- check for adequacy of ventilation
• Ccirculation-check for presence and regularity of pulses
• Burn too large--dont immerse in water due to extensive heat loss
• Never pack in ice
• Pt. should be wrapped in dry clean material to decrease contamination of wound and increase warmth
• Lasts from onset to 5 or more days but usually lasts 24-48 hours
• begins with fluid loss and edema formation and continues until fluid motorization and diuresis begins
• Greatest initial threat is hypovolemic shock to a major burn patient!
• Airway management-early nasotracheal or endotracheal intubation before airway is actually compromised (usually 1-2 hours after burn)
• ventilator? ABGs? Escharotomies?
• 6-12 hours later Bronchoscopy to assess lower respiratory tact
• chest physiotherapy, suction
• Cardiovascular
• Respiratory
• Renal systems
• 1 or 2 large bore IV lines
• Fluid replacement based on
• size/depth of burn
• individualized considerations.
• options- RL, D5NS, dextam, albumin, etc.
• there are formulas for replacement
• Parkland formula
• Brooke formula
• Urine output is most commonly used parameter
• Urine osmolarity is the most accurate parameter
• UOP 30-50 ml/hr in an adult
• Escharotomy / Fasciotomy
• Escharectomy homograft
• Dressing / hydrotherapy
• Debridement
• Application of autograft
• PB contractures management
• Staff should wear disposable hats, gowns, gloves, masks when wounds are exposed
• appropriate use of sterile vs. nonsterile techniques
• keep room warm
• careful handwashing
• any bathing areas disinfected before and after bathing
• Physiotherapy
• Analgesics and Sedatives
• Tetanus immunization
• Antimicrobial agents Silver sulfadiazine
• Burn patients need more calories failure to provide will lead to delayed wound healing and malnutrition.
• Burn wound either heals by primary intention or by grafting.
• Scars may form contractures.
• Mature healing is reached in 6 months to 2 years
• Avoid direct sunlight for 1 year on burn
• new skin sensitive to trauma
• B - breathing
• U - urine output
• R - rule of nines
• resuscitation of fluid
• N - nutrition
• 2nd or 3rd Degree Burns
• Burns to vital organs of burn
• circumfrential burns
• Electrical Burns
• Chemical Burns
• Inhalation Injury
• Concomitant trauma (If Major Trauma, The Trauma Center , Not the Burn Center should be the initial stabilizing unit)
• When in doubt , consult with a burn center

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‘Millers in Marriage’ Review: Edward Burns Contends with Age and Art-Making in Mature Mid-Life Drama

What’s old feels new again as the 'Brothers McMullen' director pulls together an experienced ensemble for a drama about the roads not traveled after turning 50.

By Stephen Saito

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In the films and television shows he’s made as a writer-director, Edward Burns has never not made things personal, but retaining the same level of creative control that he had on his breakthrough “The Brothers McMullen” has often required working on modest budgets and with younger casts and crews, naturally making the work itself move farther away from who he is now. In a marketplace starved of thoughtful adult dramas, that makes his return to center stage in “ Millers in Marriage ” a welcome one, as Burns mines territory he’s familiar with after turning 50.

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His other sister Maggie (Julianna Margulies) isn’t happy in her marriage either, with her husband Nick (Campbell Scott) down in the dumps since their kids moved away for college, but she’s less inclined to express it unless she can fictionalize it in her work as an author. It turns out all of the Millers have artistic pursuits — or they did, at least. Eve fronted a band until she and Scott got pregnant, and while it’s not central to the story, Burns can offer wry observations on the twists and turns of a career in an area he knows well. He also shows self-awareness when Nick reads a manuscript of his wife’s latest novel and concludes, “It’s rich people with champagne problems,” a not-so-veiled reference to the fact that no one in “Millers in Marriage” is scraping by.

“Millers in Marriage” is striking in how relaxed it feels, in spite of all the characters acting so uptight around one another. A cast that can look so comfortable in their own skin brings real gravitas to characters who have settled into lives they’re loathe to jeopardize with change, and Burns, with editor Janet Gaynor, finds an elegant, unhurried structure for the film with subtle flashbacks embedded in the course of conversations that expose what happened versus what someone would like to share or remember about their experience. What’s withheld is what drives the drama when the three main couples reach a reckoning, but when honesty is the premium currency, the romance takes shape in any open dialogue the characters can have with one another, which is even more seductive to an audience when Burns hasn’t lost his sharp ear for lived-in banter.

The film dips into the melodramatic as it inches closer to the end and choices have to be made, but if its players are revealed to be starring in a movie, they are also shown to be movie stars, making relatively mundane miseries well worth watching. While the issues may be as old as time, there’s solace in finding that some things really do get better with age.

Reviewed at the Toronto Film Festival (Special Presentations), Sept. 6, 2024. Running time: 117 MIN.

• Production: A Marlboro Road Gang production. (World sales: Republic Pictures, Los Angeles). Producers: Aaron Rubin, Ellen H. Schwartz, Edward Burns.
• Crew: Director, writer: Edward Burns. Camera: William Rexer. Editor: Janet Gaynor. Music: Andrea Vanzo.
• With: Morena Baccarin, Benjamin Bratt, Edward Burns, Minnie Driver, Brian d'Arcy James, Julianna Margulies, Gretchen Mol, Campbell Scott, Patrick Wilson.

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Presentation & Management of Burn Patients

Jul 23, 2014

530 likes | 1.52k Views

D r. Gamal Hassanain. Presentation & Management of Burn Patients. Introduction. Classification. Pathophysiology. Content. Complications. Management. Estimate of burn size. Introduction. A burn is defined as a coagulative necrosis causing destruction of the epithelium.

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• initial burn treatment
• silver sulphadiazine cream
• special care
• thickness 2nd

Presentation Transcript

D r. GamalHassanain Presentation & Management of Burn Patients

Introduction Classification Pathophysiology Content Complications Management Estimate of burn size

Introduction • A burn is defined as a coagulative necrosis causing destruction of the epithelium.

Causative Agents Introduction Wet Heat Friction Burn Radiation Dry Heat Electricity Chemicals

Wet Heat Commonest type of burn injury 1-Water 2-Steam 3-fat-oil ( the max temperature u can hold in your hand without throwing the object away is 60 degrees). Friction Burn Radiation Dry Heat Electricity Chemicals

Dry Heat 1-Flame :e.g matches, cigarettes, gas . 2-Domestic appliances e.g: irons. Wet Heat Friction Burn Radiation Electricity Chemicals

Chemicals • 1-It can be acid or alkali. • 2-Degree of injury depends on strength of agent, its concentration and duration of contact with skin. • 3-Risk of absorption and systemic effect. • 4-Risk of inhalation of fumes. Wet Heat Friction Burn Radiation Dry Heat Electricity

Chemicals • Indicators of inhalation injury: • In closed space • Head, Face, Neck or Chest burn • Singed Nasal hair or eyebrow • Hoarseness, tachypnea • Nasal/Oral mucosa red or dry • Soot around mouth or nose • Coughing up black sputum (carbon particle). Wet Heat Friction Burn Radiation Dry Heat Electricity

Electrical • Effects depend on: • 1-Amount of electricity (Voltage) • 2-Nature of current (AC or DC) • 3-Area of contact • 4-Duration of contact • -Dry skin has high resistance. • -Wet or sweaty skin has low resistance • in electrical burns there is an entery wound (small) and an exit wound (large) Wet Heat Friction Burn Radiation Dry Heat Chemicals

Radiation • 1-UV light from sun or sunbeds(the commonest) • 2-Usually superficial but may be widespread. • 3-Post radiotherapy. Wet Heat Friction Burn Dry Heat Electricity Chemicals

Friction Burns • E.g RTA When the victim is pulled out of the car , Slides over the road. Wet Heat Radiation Dry Heat Electricity Chemicals

Pathophysiology • Local Effect: • Three Zones within a major burn • Zone of coagulation • Zone of stasis • Zone of Hyperemia

Pathophysiology • Systemic Effect: • The release of cytokines and other inflammatory mediators at the site of injury has a systemic effect once the burn reaches 30% of total body surface area. • Cardiovascular changes—Capillary permeability is increased, leading to loss of intravascular proteins and fluids into the interstitial compartment., result in systemic hypotension and end organ hypoperfusion. • .Immunological changes—Non-specific down regulation of the immune response occurs, affecting both cell mediated and humoral pathways.​

Classification • destruction of epidermis. • Very painful, dry, red burns due to dilation of dermal capillaries, which blanch with pressure. They usually take 3 to 7 days to heal without scarring. • The most common type of first-degree burn is sunburn. First-degree burns are limited to the epidermis, or upper layers of skin. 1 Superficial burns 1st degree 2 Superficial partial-thickness 2nd degree 3 Deep partial-thickness 2nd degree 4 Full thickness 3rd degree 5 4th degree

Classification • Involve epidermis & superficial portion of dermis. • Typically, they blister with clear fluid and are moist, red, weeping burns which blanch with pressure . • They heal in 7 to 21 days. • Scarring is usually confined to changes in skin pigment. 1 Superficial burns 1st degree 2 Superficial partial-thickness 2nd degree 3 Deep partial-thickness 2nd degree 4 Full thickness 3rd degree 5 4th degree

Classification • Extend to reticular dermis. • Bloody blistering which are non blanching which could be wet or waxy. • Their color may range from patchy, cheesy white to red. • Less painful than superficial partial thickness burn. • They take over 21 days to heal and scarring may be severe, May need grafting. 1 Superficial burns 1st degree 2 Superficial partial-thickness 2nd degree 3 Deep partial-thickness 2nd degree 4 Full thickness 3rd degree 5 4th degree

Classification • Whole of the dermis . • It is Painless, dry, hard leathery. • Capillary refill will be absent . • May see coagulated vessels. • Skin grafts are necessary. • Charred with eschar which is black, grey, white or cherry red in colour, hairs not attached, may see thrombosed veins. 1 Superficial burns 1st degree 2 Superficial partial-thickness 2nd degree 3 Deep partial-thickness 2nd degree 4 Full thickness 3rd degree 5 4th degree

Classification 1 Superficial burns 1st degree • It is a life threatening injuries. • Extends through skin, subcutaneous tissue and into underlying muscle and bone. • Dry, painless. 2 Superficial partial-thickness 2nd degree 3 Deep partial-thickness 2nd degree 4 Full thickness 3rd degree 5 4th degree

Estimation of burn size • Rule of nines • Also known as Wallace’s rule of 9. • The most common method, but not the best. • It is different in children due to their different surface area, they have bigger head and small limbs in proportion to their trunk

Estimation of burn size • Lund an Browder Chart • The best and most accurate method. • It considers the variation of the surface area according to the age. • Is expressed as a percentage of total body surface area. • There are 3 variables (A, B and C) which are the areas that their size percentage is affected by growth. • Only partial and full thickness burns are included in this estimate of burn size. (A) head (B) thigh (C) lower leg

Estimation of burn size • Rule of Outstretched Hand • Gives a rough estimate of the total body surface area. • The out stretched patient’s hand equals 1% of his body’s surface area.

Management • Resuscitation • ABC’s a)Airway: ensure adequate airway. b)Breathing: • Circumferential burns of neck or chest may constrict breathing. • Stridor or difficulty breathing indicates endotracheal intubation or ventilation . • Prophylactic endotracheal/ nasotracheal intubation in case of: inhalation Injury. supraglottic obstruction. extensive burns > 60%. deep facial burns. facial fracture. Closed head injury with unconsciousness. c)Circulation: Monitor : pulse, BP, failure to maintain adequate circulation may be followed by renal failure and eventually multi-organ failure.

Management • Hx • The cause • Time and place • Age • Any chronic illnesses, e.g. DM, HTN..etc • Immunization for tetanus ( open wounds), we give immunoglobulins for patients who have never been vaccinated

Management • Exam. • Expose patient TOTALLY, remove any burned clothing. • Examine generally. • Suspect any associated injury. • Examine locally at the site of burn: Assess depth (degree) & calculate the size of burn.

Management • Monitor the resuscitation by IV fluids: • Fluid replacement is the prime object of initial burn treatment. • IV resuscitation is required for any burn patient with; more than 10% of body surface in children or more than 15% of body surface in adult. • Assess fluid requirement. • To assess fluid requirement we need to identify: • Time of burn • Patient weight • %TBSA involved

Resuscitation Formulas • Parkland’s formula: • Using Ringer's lactate solution 4ml ringer's lactate x body weight x % of burn = total fluids for 24 hours • Give half of the calculated total fluid in first 8. • Second and third 8 hrs, give one fourth. • In the 2nd day u give colloids..and plasma protien factors..and pottasuim

Resuscitation Formulas • Muir and Barclay formula: • Using colloid with plasma Body weight x % of burn /2 =1 ratio • In first 12hours, give 3 ratios. • In second 12 hours, Give 2 ratios . • In the third 12hours, give 1 ratio.

Resuscitation Formulas • Modified Brook formula: • Using lactate Ringer’s solution. • In adult at the first day: 2ml/(body weight X %burn) • In children at the first day: 3ml/(body weightX%burn) • In the second day, to maintain urine output: 0.5 ml colloid x %burn + 5% dextrose water

Management • Maintenance fluid: • For adult ; 2-3 liters/day • For children A- first 10 kg 100cc/kg B- from 10-20kg 50cc/kg C- above 20kg 20cc/kg

Management • Dressing: • The aim of the burn dressing is to keep the wound clean and dry, and prevent infection • Two types.

Closed Method Open Method Management Dressing Types

Open Method Management • Leave it exposed • Just put ointment such as Flamazine (silver sulphadiazine cream or Mebo ). • Used for face or limbs burns (the limb should be elevated to reduce edema). • SilverSulphadiazine is for pseudomonas & not to apply on face ( very irritant !)  use MEBO instead . • Be careful for silver allergy( they will lose their skin). Dressing Types

Closed Method Management • The burn is cleansed with antiseptic solution • Covered with silver sulphadiazine cream (antibacterial). • Non adherent layer of gauze. • Absorbent layer Cotton wool • Change the dressing daily or as often as necessary. • On each dressing change, remove any loose tissue. • Always use Closed dressing except : • Face ,hand ,perineum. Dressing Types

Management • Burned Hand Dressing • Treat burned hands with special care to preserve function. • Cover the hands with silver sulfadiazine and place them in loose polythene gloves or bags

Management • Skin Graft • Skin grafts are used in treating partial thickness and full thickness burns • Early surgical removal (excision or debridement) of burned skin followed by skin grafting reduces the number of days in the hospital and usually improves the function and appearance of the burned area, especially when the face, hands, or feet are involved. • Role of grafting: • Decrease evaporation & pain. • Protects neurovascular tissue & tendons. • Prevent facial desiccation & subsequent infection. • Prevent scarring ,contracture & deformity.

Management • Types of Skin Graft • Autograft(from self). 1. Split-thickness (sheet vs. mesh). 2. Full-thickness. • Allograft ( same species i.e. cadaver) • Xenograft( different species i.e. porcine) • Skin substitutes ( e.g. cultured keratocytes)

Management • Supportive Care • Physiotherapy: from the first day. • Analgesia: Methadone. IV morphine for acute pain • Don't give analgesia in cases of intracranial or intra abdominal injury (we have to exclude them first)  coz it will mask them.

Burn Complication • Infection: most serious complication (pneumonia) • GI complications: Curling ulcer in 12% of all burn patients (prevented by prophylactic antiacids and H2 blockers) • Respiratory complication: major cause of death in burned patient. • Hyperkalaemia in the 1st 24 hr because the destruction of RBCs. In the 2nd day there will be hypokalemia due to potassium loss in the urine. • Suppurativethrombphlebitis(change iv position in the first 72hours) • Circumferential burn relived by escharotomy • Cataract. • Late Complications: • Dyspigmentation . • Wound contracture. • hypertrophic scar and keloid (in deep parital & post-graft) . • Hyperpigmentation .

Burn Unit Referral Criteria • Greater than 15% burns in an adult, and more than 10% burns in a child . • Inhalation injury. • Any full thickness or deep dermal burn . • Burns of special regions: face, hands, perineum. • Circumferential burns . • Associated trauma or significant pre-burn illness: e.g. diabetes . •   Any patients with burns and concomitant trauma (e.g., fractures).

Thank You Any Questions

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