Pediatric burn injuries require specialized management due to children having limited physiologic reserves. Scald burns are most common in young children and abuse must be ruled out. Fluid resuscitation follows the Parkland formula and aims to maintain blood pressure, heart rate, and urine output. Wounds are debrided and covered to prevent infection while excision and grafting are used for deeper burns. Inhalation injuries require pulmonary support and burn patients are at high risk for infections due to immunosuppression. Hypermetabolism persists for months requiring aggressive calorie and protein supplementation.
This Presentation is about burn in children it's defination ,causes , classification , methods of estimation of TBSA of burn , diagnose , medical , surgical and nursing management and complications.
This Presentation is about burn in children it's defination ,causes , classification , methods of estimation of TBSA of burn , diagnose , medical , surgical and nursing management and complications.
Brief description about what are burns, structure of skin, how we can classify burns based upon mechanism and differential diagnosis ,pathophysiology of burn, rule of 9, general and systemic response to burns, complications, fluid resuscitation, parkland formula, monitoring of resuscitation
I had made a comprehensive presentation that covers the types of burns,causes,method to calculate the percentage of burns,symptoms&signs and management of burns.Hope it will be very much useful for medical students and emergency care physicians.
This topic is oriented mainly on the Bailey & Love - 26th edition.
This will be of immense help for the MBBS - Students for the Theory as well as Clinical application.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
2. 50% of burns - pediatric population,
17% - < 5 years
Infants and children increased susceptibility to death-
as they have limited physiologic reserves & the
patterns of injury are very different from adults.
3. Types of Burn Injuries
Scald Burns
More likely child abuse
< 5 years
Thorough history should include the type and
consistency of the causative liquid.
oil and thick soups - higher heat capacity and more
viscouscause longer contact at higher
temperatures more damage
water of 140° C – deep burns in 3 seconds of contact &
160° C - 1 second
4. Abuse - glove or stocking like, and/or symmetric burns
to the buttocks, legs, or perineum.
Concomitant fractures and retinal hemorrhages,
delays in seeking treatment or inconsistencies in the
patient history.
full evaluation by social services with referral to
appropriate state or government agencies regardless of
the depth or extent of burn.
5.
6. Thermal Burns
> 5 years.
~ 50% of all burn admissions.
flame or contact with hot objects
90% - minor and outpatient management with good
outcomes.
larger burns - mortality influenced by - size, age , +/-
inhalation injury.
extent of soft tissue injury duration of exposure ,
presence and type of clothing material
7. Electrical Burns
Rare (2% - 3%) but devastating
Mejority - electrical cords and outlets,
Minority - lightening.
AC > DC
AC -cyclic flow of electricity tetanic contractions
increased tissue damage
Children propensity to chew on cords or insert
objects into outlets.
8. Wet or moist skin, including the mucous membranes
around the mouth, has negligible
resistanceconsiderable soft tissue trauma.
Nerves, blood vessels, and muscles - least resistance,
as compared to bone, fat, and tendons.
lack of overt skin damage may mask more significant
underlying soft-tissue damage.
9. Chemical Burns
Most common - strong bases in common household
products.
Alkali drain cleaners (sodium hydroxide) – denature
cutaneous lipids.
Severity - type and concentration & duration of exposure.
Initial treatment - copious irrigation with tepid water for >
15 minutes.
Never neutralize the acid or base as exothermic reaction
worsens tissue injury.
10. Depth & Extent of Burn injury
Superficial Burns/First degree burns :
significant pain, erythematous changes, lack of
blistering.
Damage to epidermis only, sparing the dermis and
dermal structures.
blanch on examination & heal within 2 to 3 days after
the damaged epidermis desquamates.
eg. - sun burns.
Scarring is rare
11. Superficial Partial-Thickness Burns / 2nd degree burns
entire epidermis and superficial dermis.
fluid-containing blisters at the dermal-epidermal junction.
After debridement, the underlying dermis is erythematous,
wet-appearing, painful, and blanches with pressure.
deeper dermis is left undamaged - heal within 2 weeks
without hypertrophic scarring.
No need for skin grafting
12.
13. Deep Partial-Thickness Burns / 2nd degree burns
clinically similar to third-degree burns.
As blood vessels of the dermis are partially damaged
blister base - mottled pink and white appearance
do not easily blanch ,
less painful than superficial burns due to nerve injury.
Treatment - excision and grafting.
Need surgical intervention,
May develop hypertrophic scars and/ or contractures.
14.
15. Full-Thickness Burns /3rd degree burns
complete involvement of all skin layers and require
definitive surgical management.
white, cherry red, brown, or black in color, and do not
blanch with pressure.
dry and often leathery
typically insensate because of superficial nerve injury.
16.
17. Fourth-degree burns - full-thickness + the
underlying subcutaneous fat, muscle, and
tendons.
May need amputation and/or extensive
reconstruction with grafting.
18.
19.
20. Zones of Injury
Burn wounds continue to evolve for days and the
inflammatory process may last for several months.
Divided into :
1) zone of coagulation : necrotic tissues closest to the
injury site
2) zone of stasis : area of ongoing injury, located between
the zones of coagulation and hyperemia, Poor perfusion of
this zone initially viable tissue in this area to further
necrosis and deeper wounds.
3) zone of hyperemia : normal, uninjured skin with a
physiologic increase of blood flow in response to local
tissue injury.
21. Management
Estimating the Extent of the Burn
An accurate assessment & Total body surface area
(TBSA) of burn minimize morbidity and mortality.
Overestimation cause over resuscitation with resultant
complications, inappropriate transfer to burn centers,
Newer methods for (TBSA) are being researched -
computerized imaging, two- and three-dimensional
graphics, and body contour reproductions.
22. Current methods for (TBSA)
1) Adults : “rule of nines,” by Palaski and Tennison (palm
and fingers of one hand account for 1% of the normal
body surface area).
This calculation often overestimates, especially in
children.
BSA is distributed differently in children and infants
due to proportionally larger heads and smaller
extremities.
25. Early Management of Burn Injuries
After removing or extinguishing the source washed with
tepid water.
Chemical burns - flushed copiously to remove the inciting
agent and prevent further tissue damage.
Ice or iced water- increase tissue damage , hypothermia &
mortality, in patients with more extensive burns.
Approximately 10% of all burn patients present with
additional traumatic injuries
severe burn shock or trauma loss of airway due to altered
mental status or supraglottic obstruction from edema
formation.
26. Signs of inhalation injury : facial burns, singed nasal hairs,
carbonaceous sputum, hypoxia, and history of entrapment
in an enclosed space.
Evaluation of circulation and resuscitation in greater
than 10% TBSA because these injuries are characterized by
a systemic inflammatory response that may lead to
hemodynamic lability.
Electrical injuries compartment syndromes , multiorgan
system involvement, Cardiac dysrhythmias , direct muscle
necrosis , Seizures and spinal cord transections &
respiratory arrest secondary to injury of the brainstem or
tetany of the respiratory musculature.
27. The majority of these burns can safely be treated with
minor debridement, oral hydration, topical wound
care, and outpatient follow-up.
Those patients requiring supplemental nutrition or
hydration, or who fail outpatient treatment, may need
continued care in an inpatient setting
if there is a suspicion for inhalation injury, inpatient
treatment with intravenous resuscitation and potential
transfer to a burn center should be considered.
28.
29. Before transfer : -
wounds covered with clean, dry material or
nonadherent gauze.
wet dressings - avoided to prevent hypothermia and
subsequent complications in patients with large burn
wounds.
Tetanus prophylaxis with appropriate pain control
before transport.
In extensive burns, a Foley catheter should be inserted
to help guide fluid management.
30. Resuscitation
General Principles
>10% total BSA - IV fluid resuscitation & urinary
catheter.
In major injury - nasogastric tube to decompress the
stomach.
During transport - maintain body temperature.
31. Fluid Resuscitation
Burn leads to intravascular volume depletion
Major losses occur during the first 24 hrs – crystalloids used.
Myocardial depression - 24-“36 hrs after injury.
The goal of resuscitation is to maintain adequate intravascular
volume to support tissue perfusion and thereby preserve organ
function.
The adequacy of resuscitation - based on observation of blood
pressure, heart rate, and urine output.
Fluid to maintain normal blood pressure, heart rate, and hourly
urine output of 1 mL/kg/hr in the infant and young child and 0.5
mL/kg/hr in the child >12 years of age or >50 kg in weight.
32. Parkland formula - crystalloid-based formula - with
RL - based on the BSA of burn and the patient's body
weight. Maintenance fluids (5% dextrose in lactated
Ringer solution)
= (4ml/kg+ BSA of burn) + Maintainance fluids
(For adults and children who weigh >40 kg,
maintenance fluids are not included in the estimate of
fluid requirements.)
Half of this - in the first 8 hrs after injury, and other
half is given in the following 16 hrs.
33. After the first 24 hrs, - maintenance requirements + to
replace ongoing losses.
The hourly evaporative fluid loss from wounds can be
estimated as:
= ( 25 + Burn surface area) x total BSA
The evaporative losses are primarily free water.
However, to avoid rapid changes in sodium concentration
in children, this loss is replaced with - 5% dextrose in 0.2%
normal saline.
loss of serum protein occurs in > 40% BSA burns.
When the injury is larger, the loss is replaced in the second
24 hrs after injury with 5% albumin.
34. ultimate goal – to maintain normal blood pressure,
heart rate, urine output, and serum sodium
35. Hypoalbuminemia- Causes :
Increased losses of albumin : d/t drainage from burn
wounds, and inflammatory mediators triggered capillary
leakage
Reduced Albumin production in critical illness due to an
increase in the production of acute phase proteins.
Dilutional hypoalbuminemia in the immediate
postresuscitation phase d/t increased intravascular vol.
Albumin is given - to avoid exacerbating acute lung injury,
diarrhea, feeding intolerance, impaired wound healing,
and the resultant complications.
36. in critically ill patients- 25% albumin should be added
if the serum level is below 3 mg/dL.
37. Management of Inhalation Injury :
aggressive pulmonary toilet, mucolytics, early
identification and treatment of infection and
supportive care.
nebulized heparin to reduce atelectasis and improved
pulmonary function,
Prophylactic antibiotics & corticosteroids are not used
supplemental oxygen & advanced modes of assisted
ventilation and hyperbaric oxygen therapy.
Stridor - racemic epinephrine neb
38. 12% - require intubation
70% of those intubated have sustained inhalation
injury .
39. Wound Care
General Principles
Objective - to avoid infection and protect the wound from
further injury.
Small (<2 cm) blisters - left intact, larger blisters and full-
thickness wounds should be debrided and covered with a
topical agent.
Debridement - under general anesthesia or deep sedation.
Ketamine - profound cutaneous analgesia.
Even in the absence of debridement, burns are painful, and
patients usually require opioid analgesia.
40. Agents that may cause additional tissue damage are
avoided,
circulation of the wound is protected by avoiding
hypotension, hypoxemia, and hypothermia and by
excluding the use of adrenergic agents.
Maintain sterile precautions & environment.
41.
42.
43.
44. Surgical Care
Excision and closure – reduce the extent of injury & risk of
wound infection.
Tangential excision until viable tissue is identified
Advantage - best cosmetic and functional result,
Disadvantage- bleeding
Deep excision of the wound to the level of the fascia -
minimal blood loss and is used when wounds are deep, full
thickness, and infected, or when large areas are excised.
The cosmetic results are poor, and lymphatic drainage is
impaired after this type of excision.
45. usual approach- first 3-4 days after injury .
Autografts & Allografts
Integra Life Sciences Corporation provides a
temporary epidermis as an outer layer of silastic and an
inner layer matrix for the growth of a neodermis.
This non antigenic matrix provides a scaffold for a new
dermis upon which a thin epidermal graft may be
placed
46.
47. Invasive infection:
The criteria for diagnosis by American Burn Association
guidelines,
1 )Inflammation of the surrounding uninjured skin
2 )Histologic examination that shows invasion by the
infectious organism into adjacent viable tissue
3 )Isolation of an organism from the blood in the absence of
other infection
4 ) Signs of the systemic inflammatory response syndrome
(such as hyperthermia, hypothermia, leukocytosis,
tachypnea, hypotension, oliguria, or hyperglycemia at a
previously tolerated level of carbohydrate intake) and
mental status changes
48. Other Infections
the associated immunocompromise status may set the
stage for infection at any site.
high incidence of urinary tract infections and
pneumonia, appendicitis, but often do not present
with classic features due to a suppressed inflammatory
response.
A high index of suspicion is necessary to detect these
infections.
49. Sinusitis
d/t nasogastric feeding tubes and nasotracheal intubation,
especially in patients with inhalation injury.
Treatment - removal of all tubes and catheters, initiation of
appropriate antibiotic therapy, and drainage.
Bacterial Endocarditis :
Immune compromise, recurrent bacteremia, and the
frequent use of central venous catheters in the patient with
burn injury are risk factors
50. . Antibiotic therapy is based upon blood culture
results and should continue for 4 - 6 weeks
52. Key Points
Initial evaluation of the patient includes
determination of depth of injury and extent of surface
area involved. These are trauma patients and may have
other injuries in addition to the burn.
Fluid resuscitation in the first 24 hrs is based on a
formula to calculate the amount of lactated Ringer
solution to infuse. The formula is only a guide;
adjustments are made based on vital signs and urine
output.
53. Silver sulfadiazine is the topical agent most commonly
used for burn wounds.
Early excision of the wound is now standard of care in
the burn-injured patient
Hypermetabolism is very prominent- Proteins and
calories must be provided to address these needs,
beginning on the day of injury. Hypermetabolism
persists for 9- 12 months post-injury.