Burns & cosmetic surgery

IT IS USEFUL FOR 3 YEAR BASIC B.Sc.(N) & 2 YEAR GNM STUDENTS.

1. BURN INJURIES & ITS MANAGEMENT BY MR. AHMED SODHA M.Sc.(N) – M.S.N. 4/1/2011 1

2. BU R NS 4 / 1 / 2011 WOUNDS CAUSED BY EXPOSURE TO: EXCESSIVE HEAT CHEMICALS FIRE/STEAM RADIATION ELECTRICITY

3. BU R NS 4 / 1 / 2011  RESULTS IN 10-20 THOUSAND DEATHS ANNUALLY  SURVIVAL BEST AT AGES 15-45  SURVIVAL BEST BURNS COVER LESS THAN 20% OF TBA

4. TYPES OF BURNS 4 / 1 / 2011  THERMAL EXPOSURE TO FLAME OR A HOT OBJECT  CHEMICAL EXPOSURE TO ACID, ALKALI OR ORGANIC SUBSTANCES  ELECTRICAL RESULT FROM THE CONVERSION OF ELECTRICAL ENERGY INTO HEAT. (EXTENT OF INJURY DEPENDS ON THE TYPE OF CURRENT, THE PATHWAY OF FLOW, LOCAL TISSUE RESISTANCE, AND DURATION OF CONTACT)  RADIATION RESULT FROM RADIANT ENERGY BEING TRANSFERRED TO THE BODY.

5. CHEMICAL BURN 4 / 1 / 2011

6. E L E C T R I C A L B U R N 4 / 1 / 2011

7. BURN WOUND ASSESSMENT 4 / 1 / 2011  CLASSIFIED ACCORDING TO DEPTH OF INJURY AND EXTENT OF BODY SURFACE AREA INVOLVED  BURN WOUNDS DIFFERENTIATED DEPENDING ON THE LEVEL OF DERMIS AND SUBCUTANEOUS TISSUE INVOLVED SUPERFICIAL (FIRST-DEGREE) DEEP (SECOND-DEGREE) FULL THICKNESS (THIRD AND FOURTH DEGREE)

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10. SUPERFICIAL BURNS (FIRST DEGREE)  EPIDERMAL TISSUE ONLY AFFECTED  ERYTHEMA, BLANCHING ON PRESSURE, MILD SWELLING NO VESICLES OR BLISTER INITIALLY  NOT SERIOUS UNLESS LARGE AREAS INVOLVED  I.E. SUNBURN 4 / 1 / 2011

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14. DEEP (SECOND DEGREE) *INVOLVES THE EPIDERMIS AND DEEP LAYER OF THE DERMIS FLUID-FILLED VESICLES –RED, SHINY, WET, SEVERE PAIN HOSPITALIZATION REQUIRED IF OVER 25% OF BODY SURFACE INVOLVED I.E. TAR BURN, FLAME 4 / 1 / 2011

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18. FULL THICKNESS (THIRD/FOURTH DEGREE)  DESTRUCTION OF ALL SKIN LAYERS  REQUIRES IMMEDIATE HOSPITALIZATION  DRY, WAXY WHITE, LEATHERY, OR HARD SKIN, NO PAIN  EXPOSURE TO FLAMES, ELECTRICITY OR CHEMICALS CAN CAUSE 3 RD DEGREE BURNS 4 / 1 / 2011

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21.  Calculation of Burned Body Surface Area 4 / 1 / 2011

22. TOTAL BODY SURFACE AREA (TBSA) 4 / 1 / 2011  SUPERFICIAL BURNS ARE NOT INVOLVED IN THE CALCULATION  LUND AND BROWDER CHART IS THE MOST ACCURATE BECAUSE IT ADJUSTS FOR AGE  RULE OF NINES DIVIDES THE BODY – ADEQUATE FOR INITIAL ASSESSMENT FOR ADULT BURNS

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24. LUND BROWDER CHART USED FOR DETERMINING BSA 4 / 1 / 2011

25. RULES OF NINES 4 / 1 / 2011  HEAD & NECK = 9%  EACH UPPER EXTREMITY (ARMS) = 9%  EACH LOWER EXTREMITY (LEGS) = 18%  ANTERIOR TRUNK= 18%  POSTERIOR TRUNK = 18%  GENITALIA (PERINEUM) = 1%

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29. 4 / 1 / 2011 IN PATIENTS WITH SCATTERED BURNS, A METHOD TO ESTIMATE THE PERCENTAGE OF BURN IS THE PALM METHOD. THE SIZE OF THE PATIENT’S PALM IS APPROXIMATELY 1% OF TBSA.  PALM METHOD

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31. VASCULAR CHANGES RESULTING FROM BURN INJURIES 4 / 1 / 2011  CIRCULATORY DISRUPTION OCCURS AT THE BURN SITE IMMEDIATELY AFTER A BURN INJURY  BLOOD FLOW DECREASES OR CEASE DUE TO OCCLUDED BLOOD VESSELS  DAMAGED MACROPHAGES WITHIN THE TISSUES RELEASE CHEMICALS THAT CAUSE CONSTRICTION OF VESSEL  BLOOD VESSEL THROMBOSIS MAY OCCUR CAUSING NECROSIS  MACROPHAGE: A TYPE OF WHITE BLOOD THAT INGESTS (TAKES IN) FOREIGN MATERIAL. MACROPHAGES ARE KEY PLAYERS IN THE IMMUNE RESPONSE TO FOREIGN INVADERS SUCH AS INFECTIOUS MICROORGANISMS.

32. FLUID SHIFT 4 / 1 / 2011  FLUID SHIFT OCCURS AFTER INITIAL VASOCONSTRICTION, THEN DILATION  BLOOD VESSELS DILATE AND LEAK FLUID INTO THE INTERSTITIAL SPACE  KNOWN AS THIRD SPACING OR CAPILLARY LEAK SYNDROME  CAUSES DECREASED BLOOD VOLUME AND BLOOD PRESSURE OCCURS WITHIN THE FIRST 12 HOURS AFTER THE BURN AND CAN CONTINUE TO UP TO 36 HOURS [MAJOR BURNS >30%TBSA]

33. FLUID IMBALANCES 4 / 1 / 2011  FLUID IMBALANCES OCCUR AS A RESULT OF FLUID SHIFT AND CELL DAMAGE  HYPOVOLEMIA  METABOLIC ACIDOSIS  HYPERKALEMIA  HYPONATREMIA  HEMOCONCENTRATION (ELEVATED BLOOD OSMOLARITY, HEMATOCRIT/HEMOGLOBIN) DUE TO DEHYDRATION

34. FLUID REMOBILIZATION 4 / 1 / 2011  OCCURS AFTER 24 HOURS  CAPILLARY LEAK STOPS  SEE DIURETIC STAGE WHERE EDEMA FLUID SHIFTS FROM THE INTERSTITIAL SPACES INTO THE VASCULAR SPACE  BLOOD VOLUME INCREASES LEADING TO INCREASED RENAL BLOOD FLOW AND DIURESIS  HYPOKALEMIA OCCUR

35. CURLING’S ULCER 4 / 1 / 2011  ACUTE ULCERATIVE GASTRO DUODENAL DISEASE  OCCUR WITHIN 24 HOURS AFTER BURN  DUE TO REDUCED GI BLOOD FLOW AND MUCOSAL DAMAGE  TREAT CLIENTS WITH H2 BLOCKERS, MUCOPROTECTANTS, AND EARLY ENTERAL NUTRITION  WATCH FOR SUDDEN DROP IN HEMOGLOBIN

36. 4 / 1 / 2011 MUCOPROTECTANTS - SALIVATION INDUCING AGENT

37. PHASES OF BURN CARE 4 / 1 / 2011  EMERGENT (24-48 HRS)  ACUTE  REHABILITATIVE MANAGEMENT:-

38. 4 / 1 / 2011  EMERGENT OR IMMEDIATE RESUSCITATIVE FROM ONSET OF INJURY TO COMPLETION OF FLUID RESUSCITATION • FIRST AID • PREVENTION OF SHOCK • PREVENTION OF RESPIRATORY DISTRESS • DETECTION AND TREATMENT OF CONCOMITANT INJURIES • WOUND ASSESSMENT AND INITIAL CARE ACUTE FROM BEGINNING OF DIURESIS TO NEAR COMPLETION OF WOUND CLOSURE • WOUND CARE AND CLOSURE • PREVENTION OR TREATMENT OF COMPLICATIONS, INCLUDING INFECTION • NUTRITIONAL SUPPORT REHABILITATION FROM MAJOR WOUND CLOSURE TO RETURN TO INDIVIDUAL’S OPTIMAL LEVEL OF PHYSICAL AND PSYCHOSOCIAL ADJUSTMENT • PREVENTION OF SCARS AND CONTRACTURES • PHYSICAL, OCCUPATIONAL, AND VOCATIONAL REHABILITATION • FUNCTIONAL AND COSMETIC RECONSTRUCTION • PSYCHOSOCIAL COUNSELING

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40. P LASTIC S URGERY

41. WHAT IS PLASTIC SURGERY? THE NAME IS TAKEN FROM THE GREEK WORD “PLASTIKOS”, WHICH MEANS TO FORM OR MOLD! PLASTIC SURGERY IS A SPECIAL TYPE OF SURGERY THAT INVOLVES BOTH A PERSON'S APPEARANCE AND HIS OR HER ABILITY TO FUNCTION. IT INTENDS TO IMPROVE PATIENTS' APPEARANCE, SELF-IMAGE, AND CONFIDENCE THROUGH BOTH RECONSTRUCTIVE AND COSMETIC PROCEDURES.

42. W HY DO PEOPLE GET P LASTIC S URGERY ? 1. TO IMPROVE THE APPEARANCE. SOME PEOPLE A RE ADDICTED TO COSMETIC SURGERY TO CORRECT A PHYSICAL DEFECT OR TO ALTER A PART OF THE BODY THAT MAKES THEM FEEL UNCOMFORTABLE TO FEEL BETTER ABOUT THE WAY THEY LOOK

43. THERE ARE TWO MAIN KINDS OF PLASTIC SURGERY : RECONSTRUCTIVE SURGERY - IS USUALLY EMPLOYED FOR MEDICAL PURPOSES, AND SOME COMMON EXAMPLES INCLUDE: CLEFT LIP SURGERY BREAST RECONSTRUCTION SURGERY FOR THOSE WHO HAD MASTECTOMY CONTRACTURE SURGERY FOR BURN SURVIVORS COSMETIC SURGERY - IS DONE MOSTLY FOR AESTHETIC ENHANCEMENT AND INCLUDES: DIFFERENT TYPES OF COSMETIC SURGERY INCLUDE: TUMMY TUCK (ABDOMINOPLASTY) LIPOSUCTION BREAST LIFT CHEEK AUGMENTATION BREAST REDUCTION/ENLARGEMENT (AUGMENTATION MAMMAPLASTY) *

44. WHICH ARE THE MOST COMMON PLASTIC SURGERIES ? TUMMY TUCK EYELID SURGERY LIPOSUCTION BREAST AUGMENTATION BREAST RECONSTRUCTION BREAST IMPLANT BREAST LIFT BOTOX

45. GETTING A TUMMY TUCK TUMMY TUCK ( ABDOMINOPLASTY ) HELPS TO REDUCE THE APPEARANCE OF A PROTRUDING ABDOMEN, LOOSE SKIN. STRETCH MARKS IN THE ABDOMINAL AREA. MANY PEOPLE TURN TO A TUMMY TUCK AS A RESULT OF PREGNANCY. THE ALSO TURN AS E RESULT OF AGE OR OBESITY.

46. EYELID SURGERY IS PERFORMED ON ADULTS OF ANY AGE TO CORRECT PROBLEMS ASSOCIATED TO AGING OR TO RECEIVE TREATMENT FOR INHERITED TRAITS. THEY MAY HAVE LOOSE SKIN HANGING DOWN FROM THE UPPER EYELIDS AND POSSIBLY IMPAIRING VISION A PUFFY APPEARANCE TO THE UPPER EYELIDS THAT MAKE THE EYES LOOK TIRED EXCESS SKIN AND FINE WRINKLES OF THE LOWER EYELIDS, DARK CIRCLES UNDER THE EYES EYELID SURGERY CAN NORMALLY FIX THESE TYPES OF PROBLEMS, BUT SOMETIMES AN EYELID SURGERY MAY BE NEEDED IN COMBINATION WITH ANOTHER TREATMENT.

47. GUIDE TO GETTING LIPOSUCTION LIPOSUCTION (LIPOPLASTY) IS THE ELIMINATION OF UNWANTED FAT. EVERY YEAR, HUNDREDS OF THOUSANDS OF AMERICAN MEN AND WOMEN UNDERGO LIPOSUCTION PROCEDURES TO ELIMINATE UNWANTED AND PERSISTENT POCKETS OF FAT IN THE: ABDOMEN HIPS THIGHS BUTTOCKS ARMS

48. BREAST AUGMENTATION BREAST IMPLANTS ARE USED DURING AUGMENTATION TO INCREASE THE SIZE OF THE BREAST. TO INCREASE SHAPE OF THE BREAST. TO RESTORE BREAST VOLUME LOST AFTER WEIGHT REDUCTION OR PREGNANCY.

49. P ROS AND CONS OF PLASTIC SURGERY COSMETIC SURGERY IS PURSUED TO ENHANCE THE MAGNIFICENCE OF THE PERSON. PLASTIC SURGERY IS TO LOOK ENERGETIC AND TO PLEASE HIMSELF. THERE IS A DEVELOPMENT OF SELF-ESTEEM IN THE PERSON IF THE PLASTIC SURGERY IS SUCCESSFUL LEAVES SOME MARKS OR SPOTS ON THE BODY WHICH CAN BE RECTIFIED BY PERFORMING ANOTHER PLASTIC SURGERY RISKS DEPEND ON THE TYPE OF PLASTIC SURGERY. (BREAST AUGMENTATION, BLEEDING OF GEL) THE RISKS OF LIPOSUCTION INCLUDE DISCOLORATION, DEPIGMENTATION, NUMBNES S, BRUISING AND PAIN. FACELIFT PLASTIC SURGERY INVOLVES VARIOUS SIDE EFFECTS: NERVE DAMAGE WHICH MAKES THE PERSON’S FACE INSENSIBLE. THE PATIENT ALSO SUFFERS FROM MILD SIDE EFFECTS: FEELING PAIN IN THE AFFECTED PART AND INFLAMMATION. BENEFITS DRAWBACK

50. T HEREFORE , PLASTIC SURGERY HAS TWO SIDES – ONE IS BENEFIT SIDE AND THE OTHER ONE IS THE DRAWBACK SIDE AND THE PATIENT HAS TO EXPERIENCE BOTH THE SIDES .

51. T HANK YOU !