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  1. 1. BURNS MANAGEMENT Dr. Mansoor Khan, MBBS, FCPS-I, PGY2 Khyber Teaching Hospital, Peshawar
  2. 2. “Coagulative necrosis of tissue due to extremes of temperature, chemicals or irradiation”
  3. 3. Carelessness(40%), Accidents(35%), Fit or faint(5%),Alcohol(5%), Psychiatric(5%) Scalds account for 60% of burns in children Flame accounts for 50% of burns in adults Contact(10%),Electrical(5%),Chemical(3%)
  4. 4. SCALDS
  5. 5. FLAME
  6. 6. CONTACT
  7. 7. ELECTRIC
  8. 8. CHEMICAL
  10. 10. RADIATION
  11. 11. Jackson’s burn wound model
  12. 12. Jackson’s burn wound model
  13. 13. S K I N
  14. 14. FIRST DEGREE BURNS Epidermal layer, Pink, painful, and edematous Heals 3-5 days w/o scarring Causes: Flame, Sun, Flash from explosion
  15. 15. SUPERFICIAL SECOND DEGREE Epidermis and papillary region of dermis, Blisters, bullae, serous fluid Cherry red moist appearing, Painful, sensation intact, Edematous Heals in 7-28 days with minimal scarring Cause: flame, flash, scald, contact
  16. 16. Epidermis and reticular region of dermis Blisters, bullae, serous fluid, Pale ivory moist appearing Painful, sensation intact, Edematous, Heals in 7-28 days with variable scarring Cause: flame, flash, scald, contact DEEP SECOND DEGREE
  17. 17. THIRD DEGREE FULL THICKNESS Extends into subcutaneous tissue, White, yellow, brown leathery Appearance, Thrombosed vessels, loss of elasticity, marked edema Possible escharotomy, Painless to touch, Requires grafting Causes: flame, electricity, chemicals, prolonged exposure May take 2-3 days to fully present true depth
  18. 18. FOURTH DEGREE 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
  19. 19. Total body surface area burned Palmar Surface of Patient’s Hand =1% Wallace’s “Rule of Nines” Lund and Browder Charts
  20. 20. Lund-Browder chart
  21. 21. Management of the Burns Patient Prevention First Aid Measures Emergency treatment/triage Acute/on-going phases Reconstruction/rehabilitation
  22. 22. First Aid Measures for Burns Remove patient from cause. Put out flames “stop, drop and roll”. Blanket or douse with water Remove clothing in scalds Airway, protect c/spine, give oxygen Calm and reassure patient
  23. 23. COOL THE BURN SURFACE Cold running water or packs between 8 and 25 deg C for 30 mins. 15 deg C is ideal temp Temperatures below 5 deg may deepen burn Watch for HYPOTHERMIA! Wrap patient in clean sheet or towel and keep warm
  24. 24. Emergency treatment/triage ABCDE Secondary Survey Triage Area,depth Minor vs Major Analgesia ?Resuscitate ?Monitoring ?Admit Dressing
  25. 25. Burns are extremely painful Morphine 0,05-0,1 mg/kg as starting dose Avoid oral or im routes Entonox Ketamine
  26. 26. Tetanus Prophylaxis Antibiotics
  27. 27. Parkland formula 4 mL/kg body weight per percentage burn TBSA half the volume is given in the first 8 hours postburn, with the remaining volume delivered over 16 hours
  28. 28. Burns Surgery Escharotomy Tangential Excision Excision Excision to deep fascia Repair-direct, graft or flap Reconstruction
  29. 29. Escharotomy Circumferential deep burns to limbs, chest and abdomen Incisions Depth of incision No anaesthetic except for kids
  30. 30. Excision/direct closure
  31. 31. Skin grafting:
  32. 32. Skin grafting:
  33. 33. Reconstruction
  34. 34. THANKS