Initial care for burn..pptx by Dr. Md. Emraan Hossain

Management of burn

1. MANAGEMENT OF BURNS Dr. Md. Emraan Hossain FCPS final part trainee(ortho)

2. Pre-hospital care Ensure rescuer safety.  Stop the burning process.   Check for other injuries. Cool the burn wound.   Give oxygen Elevate Analgesia

3. Hospital care A, airway control; B, breathing and ventilation; C, circulation; D , disability – neurological status; E, exposure with environmental control; F, fluid resuscitation.

4. The criteria for acute admission to a burns unit Suspected airway or inhalation injury Any burn likely to require fluid resuscitation Any burn likely to require surgery Patients with burns of any significance to the hands, face, feet or perineum

5. Patients whose psychiatric or social background makes it inadvisable to send them home Any suspicion of non-accidental injury Any burn in a patient at the extremes of age Any burn with associated potentially serious sequelae, including high-tension electrical burns and concentrated hydrofluoric acid burns.

6. Determinants of outcome of a burn patient ● Percentage surface area involved ● Depth of burns ● Presence of an inhalational injury ● Age and comorbidities of the patient

7. ASSESSMENT OF THE BURN WOUND Wallace rule of nines. In this schematic each body part is assigned a burn percentage: each upper limb is 9%, head is 9%, lower limbs are 18% each, posterior torso and buttocks is 18% and the anterior torso 18% (chest 9% and abdomen 9%). The remaining 1% is assigned to the genitalia.

8.  Lund and Browder chart  Lund and Browder chart for children, where at birth the head represents 18% and the lower limbs 13.5% each. For each year 1% is subtracted from the head, with 0.5% being added to each lower limb until the age of 10

9. Depth of burn Superficial-thickness burn Burn depth: Epidermis Appearance: Erythema, minimal swelling, pain Healing: 7–14 days, heals without scar

10. Superficial-partial-thickness burn Burn depth: Papillary dermis Appearance: Wet, pink, blisters, moderate pain Healing: 2–4 weeks

11. Deep-partial-thickness burn Burn depth: Reticular dermis Appearance: Less wet, red, ± blisters, minimal pain, Blanching minimal or non-existent   Healing: 3–8 weeks with severe scar formation, need graft

12. Full-thickness burn Burn depth: Epidermis, Dermis, (Escher formation) Appearance: Dry, white, insensate Healing: Need graft

13. Recognition of the potentially burned airway ● A history of being trapped in the presence of smoke or hot gases ● Burns on the palate or nasal mucosa, or loss of all the hairs in the nose ● Deep burns around the mouth and neck ● Hoarseness/change in voice

14. Initial management Early elective intubation is safest Delay can make intubation very difficult due to development of laryngeal edema Be ready to perform an emergency cricothyroidotomy if intubation is delayed

15. Fluid resuscitation Children > 10% TBSA / Adults > 15% TBSA Hartman or ringer lactate without dextrose fluid of choice Monitor urinary output

16. The modified Parkland formula is the most commonly Monitoring of resuscitation TBSA% burn × weight (kg) × 4 = volume in mL The first half is given in 8 hours and the second over 16 hours to complete the 24-hour resuscitation time frame.

17. In children maintenance fluid must also be given.  dextrose–saline given as follows: 100 mL/kg for 24 hours for the first 10 kg 50 mL/kg for the next 10 kg 20 mL/kg for 24 hours for each kilogram over 20 kg body

18. Muir and Barclay formula -colloids the basic formula is: TBSA% × weight (kg) × 0.5 = one portion; six portions are given in total over 36 hours: give one infusion 4 hourly for 12 hours  then one infusion 6 hourly for 12 hours the final infusion to be given over 12 hours.

19. Other measures Monitoring the patient Catheterization - Monitor urine output Tetanus toxoid / H2 blockers NGT - Aspiration & Enteral feeding Antibiotics - Culture TPN - If necessary Intensive nursing care

20. Dressing Silver sulphadiazine cream (1%). Mafenide acetate cream. Silver sulphadiazine and cerium nitrate.  Acticoat

21. Escharotomy Circumferential full-thickness burns to the limbs and torso require emergency surgery. The burn has a tourniquet-like effect compromising respiration (torso) and peripheral circu lation (limbs). The tourniquet effect of this injury is treated by incising the whole length of full-thickness burns

22. Thank you