9 burn

Engidaw Ambelu

1. Burn Leaynadis kassa (MD)

2. SOME TERMS Burn is a type of coagulative necrosis caused by heat transferred from the source to the body. Frost bite is also a coagulative necrosis but is caused by extreme degrees of cold. Scald is a burn caused by moist heat(steam) Burn never occur at T0< 440c.

3. Types of burn Thermal burn :- severity depend on Temprature , duration of exposure, and thickness of the skin. eg . Flame, hot liquid, hot solid objects and steams Chemical burn :- caused by a wide range of caustic reactions, including alteration of PH, disruption of cellular membranes, and direct toxic effect on metabolic processes. :- severity depends on nature of the agent in addition to the duration of exposure Electrical burn :- severity depends on t he path way of the current, the resistance to the current flow through the tissue, and the strength and durtion of the current flow Inhalational burn :- toxic product of combustion injure airway tissues and frequently occur with flash burns from fire and steam. Radiation burn :- most common cause is sun burn. Often associated with due to ability of ionizing radiation to interact and damage DNA.

4. Classification of burn Based on the depth of tissue injury cutaneous burns can be classified into Superficial (first degree burn) -only epidermal layer - no blister but painful red , and blanch with pressure. - heals with in 6 days with out scar eg , sun burn flame flash from explosion

5. 2, partial thickness( second degree) involves the whole epidermis and parts of the dermis. :- superficial -epidermis and papillary layer of dermis. -painful red, and weeping, blanch with pressure -heal in 7-21 days -scaring is unusual but pigment change may occur.

6. :- deep second degree burn - involve up to the reticular layer of the dermis -damage hair follicles and glandular tissue -painful to pressure only, blister (easily unroofed) - wet or waxy dry, not blanch with pressure - patchy cheesy white to red

7. 3, full thickness ( third degree) burn -involve the whole layers of the dermis and often injure the subcutaneous tissue. - usually anesthetic or hypo esthetic - waxy white to leathery gray to charred and black - skin is dry and inelastic and does not blanch with pressure. -no vesicles or blister - hair follicles pulled off easily

8. 4 , fourth degree burn Extends to muscle Loss of function Black, charred appearance May require amputation May require escharotomy and fasciotomy Causes: very prolonged exposure to flame, chemicals, and high voltage

9. Zones of a burn wound

10. Percent body surface area estimates A thorough and accurate estimation of burn size is essential to guide therapy and to determine when to transfer a patient to a burn center . The two commonly used methods of assessing TBSA in adults are the Lund-Browder chart and "Rule of Nines," whereas in children, the Lund-Browder chart is the recommended method because it takes into account the relative percentage of body surface area affected by growth. “rule of nine” Each leg represents 18 percent TBSA Each arm represents 9 percent TBSA The anterior and posterior trunk each represent 18 percent TBSA The head represents 9 percent TBSA

11. continued Palm method Small or patchy burns can be approximated by using the surface area of the patient's palm. The palm of the patient's hand, excluding the fingers, is approximately 0.5 percent of total body surface area and the entire palmar surface including fingers is 1 percent in children and adults

12. Classes of burn based on severity MINIOR BURN Less than 15% of TBSA in adults Less than 10% of TBSA in children or older population Less than 2% full thickness burn No functional loss to: Eyes Ears Face Hands/feet Perineum

13. Moderate burn Partial-thickness of 15-25% TBSA in adults 10-20% TBSA in children or older person Full thickness of 2-10% TBSA No loss of function to: Eyes, ears, face, hands, feet or perineum Excludes: High-voltage electrical burns Inhalation injury Requires hospitalization

14. Major burn Partial thickness burns > 25% of TBSA in adults 20% of TBSA in children/older persons Full-thickness of 10% of TBSA Involving: Face, eyes, ears, hands, feet or perineum Burns caused by: Caustic agents High-voltage electrical Complicated inhalation injuries Requires specialized care

15. Initial evaluation and treatment Initial evaluation involves -ATLS -estimation of the burn size -diagnosis of CO and cyanide poisoning. - early transfer to burn center injuries meet the criteria

16. Guidelines for referral to a burn center Partial-thickness burns greater than 10% TBSA Burns involving the face, hands, feet, genitalia, perineum, or major joints Third-degree burns in any age group Electrical burns, including lightning injury Chemical burns Inhalation injury Burn injury in patients with complicated pre-existing medical disorders

17. Guidelines ……. Patients with burns and concomitant trauma in which the burn is the greatest risk. If the trauma is the greater immediate risk, the patient may be stabilized in a trauma center before transfer to a burn center. Burned children in hospitals without qualified personnel for the care of children Burn injury in patients who will require special social, emotional , or rehabilitative intervention

18. T reatment FLUID Resuscitation parkland formula…4ml/%/kg Oxygen supplementation Blood transfusion Immediate burn care and cooling  — Any hot or burned clothing, jewelry, and obvious debris should immediately be removed to prevent further injury and to enable accurate assessment of the extent of burns Burned areas should be cooled immediately using cool water or saline soaked gauze Pain and anxiety management Chemoprophylaxis ….tetanus and topical antibiotics Wound management .

19. Reading assignment Complications of burn Electrical burn and lightning Fluid management of a burn patient

20. Thank u!!!!!