5. Burns and Skin Grafts.pdf this slides contains

This slide contains information on burns, classification types and many more information you need to make a diagnosis

1. Burns
Emmanuel M. Chewe MPH, Ph.DFellow.

2. Functions of the Skin
•Keeps fluids and electrolytes on the inside
•Protects from bacterial invasion from the outside
•Regulates body temperature
•Sensory integration with the environment
•Social interaction

3. Anatomy of the skin

9. The Skin –Nerve fibres

10. •A burnis a type of injury to skin, or other tissues, caused
by heat, cold, electricity, chemicals, friction, or radiation.
•Most burns are due to heat from hot liquids, solids, or fire

12. Burns -Initial Care at Scene
•Stop the burning process
•ABC
•Unless a chemical injury, burn wounds are the lowest
priority!

13. Initial Care at the Scene:
Chemical Injury
•Remove clothing, jewelleryetc
•Brush off powders
•Flush with LARGE volumes of water (irrigate eyes with
normal saline)
•Personal protective equipment
•Keep patient warm!
•Determine what chemical caused the burns

14. Initial Care at the Scene:
Electrical
•Do NOT touch a patient who is in contact with electricity
•Break electrical circuit
•ABCs
•CPR
•Trauma care
•Keep patient warm

15. Initial Care at the Scene: Transport
•Warm transport vehicle!
•Support airway and breathing
•Assess and treat trauma
•Large bore IVs: Ringer’s Lactate preferred
•Elevate burned extremities
•Cover with dry sheet/blanket

16. Initial Care at the Scene:
History
•Time of burn
•Cause
•Smoke Inhalation?
•Trauma?
•Pre-existing medical conditions/medications?
•First responder care at the scene

17. Severity of Burn Injury
•Burn depth (degree) -“how deep”
•Burn size (% TBSA) -“how big”
•Areas of circumferential full-thickness –“do they go
round?”
•Burns of “special areas”
•Concomitant injuries
•Smoke inhalation
•Trauma

18. Burn Depth -Degree

20. Anatomy -BurnsDepthClass.
1.Superficial
2.SuperficialPartialthickness
3.Deep Partial thickness
4.Full Thickness

21. Burn Severity -First Degree Burn
•Superficial, involving only epidermis
•Local pain and erythema
•Little or no systemic response
•Usually heals in 3-5 days without scarring
•Does not count in burn calculation!

22. Severity of Burn –Depth
Partial Thickness (Second Degree)
•Extends into dermis
•Best identified by MOIST surface
•Exquisitely painful and oedematous
•Usually red
•Associated with scalds, flashes and brief contact with hot
objects

24. Blisters are usually partial-thickness

26. Healing of the Partial Thickness Burn
•Heals by epithelialization
from epidermal
remnants in the dermis
•Heals in 7-21+ days with
variable amounts of
scarring

28. The longer the wound takes to heal
the more the wound tends to scar
•Burn units may
electively graft
partial-thickness
wounds that have
not healed within 21
days.

29. Full Thickness Burn
(4thDegree)
Severity of Burn -Depth
•Extends through skin into deeper tissue
•Usually dry, leathery and painless
•May be white, brown, black, greenish
•Associated with flame, grease, very hot object, or
extended duration of contact
•Circumferential eschararound extremity or trunk can
have tourniquet effect

30. Third degree burn (Full-thickness)

33. Circumferential Eschar
Severity of Burn –Related to Depth
•Assess
circulation
distal to
eschar

34. Circumferential Eschar
•Monitor BP/pulse
•Complaints of numbness and
tingling
•Loss of motor function
•Decreased capillary refill
•Cyanosis
•Aching, throbbing pain

35. Circumferential Eschar
•Circumferential
trunk escharcan
lead to
respiratory
embarrassment

36. Escharotomies
•Done in bed, with scalpel or electrocautery
•Incisions just through eschar

38. Full Thickness Burn Eschar
•Ultimately, escharis excised, and Donor skin harvested
from an unburned area

39. A Skin Graft is applied for definitive closure of the
wound.

40. Burn Size Determination
Severity of Burn -Size
•Rule of Nines
•Lund and Browder Chart
•Rule of the Palm
•Fluid resuscitation and surgery plans will be based on
this calculation

49. Special Burned Areas
Severity of Burn –Special Burns
•Face
•Hands
•Feet
•Across joints
•Perineum
•Circumferential full-thickness

50. Face
Severity of Burn –Special Burns
•Airway
–Maintaining
–Securing
•Eyes
•Disfigurement
•Contracture

51. Face
Severity of Burn –Special Burns
•Massive oedema

52. Hands
Severity of Burn –Special Burns
•Oedema
•Function
•Webbing
•Contracture
•Pain
•Body image

53. Feet
Severity of Burn –Special Burns
•Oedema
•Pain
•Ambulation
•Webbing
•Contracture

54. Across Joints
Severity of Burn –Special Burns
•Contracture
•Disability

56. Perineum
Severity of Burn –Special Burns
•Contamination
•Faecal management
•Webbing
•Pain
•Body Image

57. Smoke Inhalation
Significance
•In Burned individuals,
–Smoke inhalation increases mortality significantly
–increases resuscitation fluid requirements
•Fire consumes oxygen –can lead to an hypoxic arrest
when patients are in a closed space

59. Burn Shock

63. Treatment of Burn Shock
Fluid Resuscitation using various formulae which take into account
the body weightand the burn surface area. The most commonly
used formulas are
•the Parkland,
•modified Parkland,
•Brooke,
•modified Brooke,
•Evans and
•Monafo’sformulas.

65. MyPeopleParishbecause of Luck Of Knowledge…..
i.Burns carefocusesonthe6 C’s
ii.AdmissionCriteria
iii.SkinGrafting