25.Burns..............................pptx

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1. Mariamawit Aknaw Burns For: Dr. Zekarias November 1, 2024

2. Outline The ABC. The mechanism of injury History taking, assesment and investigations (+worrying concerns) Management

3. Airway injury .

4. Thermal injury Inhalational injury Mechanical block for breathing Metabolic injury

5. Time frame from burn to airway occlusion - 4-24hrs Usually takes 48 hrs for the swelling to subside symptoms of laryngeal oedema - change in voice, stridor, anxiety and respiratory difficulty acute cricothyroidotomy equipment - delayed diagnosis is of airway burn. Deep burns around the mouth and neck, blisters on the hard palate, (anterior) burned noise hairs.

6. Metabolic Vs Inhalational Metabolic injury Often caused by CO. Check for Carboxyhemoglobin (oxygen for 24hr if >10%) Hydrogen cyanide Metabolic Acidosis Inhalational injury Soot in the nose, oropharynx and/or radiograph showing patchy consolidation Symptoms-24hrs to 5 days Chemical Pneumonia Both are caused by long stays in a confined space during burn.

7. Assesment of wound size and depth History and physical ex amination are essential

8. Assessing burn Depth 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

9. Shock For adults 15% and for children 10% TBSA but sometimes 30% for certain setups is the recommended indications to start fluid recestations Parkland Formula->total percentage body surface area × weight (kg) × 4 = volume (mL).

10. For oral rehydration do NOT use unsalted water-> hyponatremia and water intoxication Diurisis inhibited by stress hormones in first 24hrs Fluid loss maximum in first 8hrs and slows down in 36 hrs Monitor urine output Shock cont

11. Urine output in burn resuscitation should be between 0.5 and 1.0 mL/kg body weight per hour. <infusion rate should be increased by 50%. >2mL/kg then infusion rate should be decreased Signs of hypoperfusion -> 10mL/kg of bolus fluid.

12. Ringer’s lactate is the most common as effective as colloids for maintaining intravascular volume Affordable Hypertonic saline Colloid resuscitation reduces the shift of intracellular water to the extracellular space. less tissue edema hyperosmolarity and hypernatraemia Human albumin solution (HAS) is commonest Proteins administration first 12 hours of burn massive fluid shifts cause proteins to leak out of the cells Muir and Barclay formula Crystalloid resuscitation

13. Surgeries for burn Grafts tissues that are transferred without their blood supply, Flaps tissues that are transferred with a blood supply,bringing vascularity to the new area.

14. Any deep partial-thickness and full-thickness burns, except those that are less than about 4 cm2, need surgery. Less sever burns → reassessed in 48 hrs A wide bore cannula inserted (monitor BP) → two wide bore Cannula in patients with more than 40% TSAB

15. Tangential Shaving + topical adrenaline (1:1,000,000 or 1:500,000) + tourniquet control Excise all dead tissue Keep temp >36° (clotting irregularities) Full thickness burn→down to viable fat With very large burns→ synthetic dermis or homografts provides temporary stable coverage

16. Post graft splinting Important to reduce joint contracture and maintain movement Applied in a position of maximal streatch→ knees in extension, axilla in abduction