BURN

Basic introduction about burn, types of burn, pathophysiologies, hospital admission criterial, resuscitation and management.

1. PRESENTER : DR DEBASHIS NANDA PGT, DEPT. OF GENERAL SURGERY HI-TECH MEDICAL COLLEGE & HOSPITAL BHUBANESWAR BURN

2. Introduction 27/11/23 2 Burns are classified into five different causal categories and depths of injury. Currently, burn depth is most accurately assessed by judgment of experienced practitioners, although modern imaging technologies, such as laser Doppler flowmetry, laser speckle imaging, and optical coherence with or without artificial intelligence techniques hold the promise of improving the assessment and guiding better treatment and outcomes.

3. PATHOPHYSIOLOGY OF BURNS Local Changes 1. Burn Depth 2. Burn Size Systemic Changes 1. Inflammation and Edema 2. Effects on the Renal System 3. Effects on the Immune System 4. Hypermetabolism 27/11/23 3

4. Burn Depth 27/11/23 4

5. Burn Size Burn size is traditionally assessed manually by the “rule of nines”. Another method of estimating smaller burns is to equate the area of the open hand (including the palm and the extended fingers) of the patient as approximately 1% TBSA, and then to transpose that measurement visually onto the wound for a determination of its size. Children have a relatively larger portion of the body surface area in the head and neck, which is compensated by a relatively smaller surface area in the lower extremities. Infants have 21% of the TBSA in the head and neck and 13% in each leg, which incrementally approaches the adult proportions with increasing age. The Berkow formula is used to accurately determine burn size in children. 27/11/23 5

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7. Systemic Changes Inflammation and Edema Effects on the Renal System Effects on the Immune System Hypermetabolism 27/11/23 7 Genomic storm C ontinuous venovenous hemofiltration G lobal depression in immune function

8. TREATMENT OF BURNS Prehospital Initial Assessment Wound Care Transport Resuscitation Escharotomies 27/11/23 8

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11. INHALATION INJURY 27/11/23 11 The clinical course of patients with inhalation injury is divided into three stages. The first is acute pulmonary insufficiency. The second stage occurs from 72 to 96 hours after injury and is associated with increased extravascular lung water, hypoxia, and development of diffuse lobar infiltrates. In the third stage, clinical bronchopneumonia dominates and ap- pears in up to 60% of these patients

12. WOUND CARE Current therapy directed specifically toward burn wounds; can be divided into three stages: assessment, management, and rehabilitation. 27/11/23 12

13. Antimicrobials 27/11/23 13 Available topical antibiotics can be divided into three classes: salves, soaks, and antimicrobial dressings. Salves are generally applied directly to the wound with cotton dressings placed over them. S oaks are solutions poured into cotton dressings on the wound. A ntimicrobial dressings contain active agents to inhibit microbial growth, generally some form of silver ion or other antibiotic.

14. Synthetic and Biologic Dressings These coverings include allograft (cadaver skin), xenograft (pig skin), Biobrane , Suprathel , and dermal equivalent-like products. These should generally be applied within 72 hours of the injury, before high bacterial colonization of the wound occurs. Most often, synthetic and biologic dressings are used to cover second- degree wounds while the underlying epithelium heals or it is used to cover full-thickness wounds for which autograft is not yet available. 26/11/23 14

15. Organ Failure Renal Failure Pulmonary Failure Hepatic Failure Hematologic Failure 27/11/23 15

16. ELECTRICAL BURNS Initial Treatment Delayed Effects 27/11/23 16

17. CHEMICAL BURNS Alkali Acids 26/11/23 17

18. THANKING YOU 26/11/23 18