This document discusses types and degrees of burns, including thermal, electrical, chemical, and radiation burns. It describes the anatomy of the skin and degrees of burn damage from superficial to full thickness. Treatment approaches are outlined, including immediate care, fluid resuscitation based on percentage of total body surface area burned, wound treatment techniques, surgery, reconstruction, and complications. The focus is on clinical assessment and management of burn patients.
An extensive presentation on the anatomy, physiology, classification and management of various degree of burns. I made this in the final year of my Anesthesia residency and I have tried to add the maximum information as possible to make this a useful source for anyone.
Surgical management of burn injuries by Varun Harish.
From #CodaZero Live, Varun Harish provides an overview of the surgical management of burn injuries.
He talks us through how surgeons make decisions regarding burn management, including the importance of early assessment and intervention.
Burns evolve, what you see at the beginning is going to be very different in 24 hours and different again in three days.
Importantly, the management and principles of intervention differ for minor burns compared to severe burns.
For smaller burns, the golden rule is two weeks. If there is a good chance that the burn will heal in two weeks, intervention is avoided. If this is not the case, intervention in the way of a skin graft or other surgical procedure is usually the best option.
Varun details how the management priorities shift for larger burns. Larger burns significantly increase the chances of infection, making it important to intervene earlier rather than later.
Tune in to an interesting talk on the Surgical management of burn injuries by Varun Harish.
wound management briefing training course including wounds, wound healing & wound types, wound closure, wound covers, wound dressings and marketing plan for new product launch, wound assessment types and measures.
for HCP , wound care specialists, nursing, and wound care and health associations
An extensive presentation on the anatomy, physiology, classification and management of various degree of burns. I made this in the final year of my Anesthesia residency and I have tried to add the maximum information as possible to make this a useful source for anyone.
Surgical management of burn injuries by Varun Harish.
From #CodaZero Live, Varun Harish provides an overview of the surgical management of burn injuries.
He talks us through how surgeons make decisions regarding burn management, including the importance of early assessment and intervention.
Burns evolve, what you see at the beginning is going to be very different in 24 hours and different again in three days.
Importantly, the management and principles of intervention differ for minor burns compared to severe burns.
For smaller burns, the golden rule is two weeks. If there is a good chance that the burn will heal in two weeks, intervention is avoided. If this is not the case, intervention in the way of a skin graft or other surgical procedure is usually the best option.
Varun details how the management priorities shift for larger burns. Larger burns significantly increase the chances of infection, making it important to intervene earlier rather than later.
Tune in to an interesting talk on the Surgical management of burn injuries by Varun Harish.
wound management briefing training course including wounds, wound healing & wound types, wound closure, wound covers, wound dressings and marketing plan for new product launch, wound assessment types and measures.
for HCP , wound care specialists, nursing, and wound care and health associations
A complete review for all medical students and doctors working in burn unit in any hospital. #Emergency #BurnProtocol #protocol #Burns #Abhishek #MUSTKNOW #knowledge #Medical #Health
Burn is coagulative necrosis of the skin’s tissues, usually caused by excessive heat
Excess heat causes rapid protein denaturation and cell damage
Wet heat (scald) travels more rapidly into tissue than dry heat (flame)
A surface temperature of over 60˚C produces immediate cell death as well as vessel thrombosis
The dead skin tissue is known as Eschar
- 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
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
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Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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
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.
6. Anatomy of the skin
• Two main layers – the epidermis &
dermis
• Subcuteneous fat
• Structures under the subcutaneous
tissue
7. Superficial partial thickness burns
• Not deeper than papillary dermis
• Blistering and/or loss of epidermis
• Underlying dermis is pink and moist
• Capillary return is clearly visible when blanched
• Little or no fixed capillary staining
• Pinprick sensation is normal
• Heal without scarring within 2 weeks
8. Deep partial-thickness burns
• Deeper parts of the reticular dermis
• Epidermis is usually lost
• Not as moist as in superficial burns
• Abundant fixed capillary staining
• Color is not blenched with pressure
• Sensation may be reduced
• Takes 3 or more wks to heal without surgery
• May heal with hypertrophic scarring
9. Full thickness burns
• Whole dermis is destroyed
• Skin is hard and leathery feel
• No capillary return
• Thrombosed vessels can be seen under the skin
• Completely anaesthesized
• Healing takes longer
• Needs surgery
• Scarring (+)
10.
11. • 4th
degree burns – involvement of underlying structures s/a muscle,
tendon , fascia or bone
12. Immediate care of a burn patient
• Prehospital care
• Hospital care
• Airway
• Breathing
• Fluid resuscitation
13. Prehospital care
• Ensure the rescuer safety
• Stop the burning process
• Check for the other injuries
• Cool the burn wound
• Provides analgesia and delays the microvascular damage
• Minimum of 10 mins which is effective up to 1 hr
• More important in scalds
• Elevate
• Give Oxygen
14. Hospital care
• Check whether airway , breathing and status of circulations
• Note the percentage of TBSA
• Check for additional injuries
• The depth of burns
• Check for the airway burns
15. Airway
• Can completely occlude the upper airway by swelling
• Secure the airway until the swelling has subsided
• Symptoms of laryngeal oedema – late symptoms
• Check for clues of airway burns ( by history & signs)
• Time frame of burn to airway occlusion is usually 4 to 24 hrs, but may
be up to 5 days
16. Breathing
1) Inhalational injury
Trapped in fire > 2 mins
Soot in nose or oropharynx
Progress increase in resp effort & rate
Anxious and confuse b/c of reduced O2 concentration
Secure the airway
Physiotherapy
Nebulisers
Warm humidified oxygen
Continuous or intermittent PPV
May need ICU management
17. 2) Thermal burn injury to lower airway
• More occur with steam
3) Metabolic poisoning
• Fire in enclosed space
• ABGA
• High flow 100% oxygen for > 24 hrs
4) Mechanical block to breathing
• Full thickness burn in chest if circumferential
18. Criteria for admission to burn unit
• Suspected airway or inhalational injury
• Likely to require fluid resuscitation
• Likely to require surgery
• Include critical areas
• Social or psychological background
• Extremes of age
• Suspect of non accidental injury
• Associated with serious sequle
20. Size of burn – 3 ways
• In infants or children – patient one hand is equal to 1% of TBSA
• Rule of nine is used for rough assessment
• Lund & Browder chart to get more accurate one
21.
22. Assessing the depth of burns
• By history taking
• Inspection
• Capillary refill
• Sensation
23. Inflammatory and circulatory changes in
burns
• Burnt skin activate a web of inflammatory cascade
• Stimulation of pain fibers & alteration of proteins by heat
• Neuropeptide release & activation of complement system
• Activation of Hageman factor – activation of protein driven cascades
24. At the cellular level,
• Activation of complement
• Degranulation of mast cells & coats the proteins altered by heat
• Attracts the neutrophils & release of primary cytokines s/a TNF
• These inflammatory factors alter the permeability of blood vessels
• Damaged collagen & these escaped proteins can create the oncotic
pressure in the burned tissue
• Further increase in flow of water
25. • The overall effect is to produce the net flow of water, solutes and
proteins from intravascular to extravascular compartment
• 10 – 15% burn can cause shock
• 25% of TBSA – the inflammatory reaction can cause the fluid loss in
vessels remote from the area of burn
26. Why important to measure the % of
TBSA
• Dictates the extent and impact of inflammatory reaction
• Proportionate to the amount of fluid needed to control shock
27. Fluid Resuscitation
• The principle of fluid resuscitation is that the intravascular volume
must be maintained to provide sufficient circulation to perfuse not
only the vital organs but also to the peripheral tissues especially the
burned skin
• Intravenous resuscitation is needed in …
• Oral resuscitation – fluid should not be salt free
• The volume of fluid resuscitation is constant proportional to the area
of body burned
• The fluid loss is maximum in the first 8 hrs
28. Types of resuscitation fluid
• Crystalloid
• Ringer’s latate
• Dextrose saline ( in children)
• Hypertonic saline
• Less t/s oedema
• Colloid
• Human albumin solution
• Inward oncotic pressure
• Proteins should be given after the first 12 hrs of burns
29. The Formulae
• In children
• Parkland formula
• %TBSA x BW (kg) x 4 = volume of fluid in ml
• ½ within 1st
8 hr & another ½ in next 16 hr
• Muir and Barclay formula
• For colloid
• 0.5 x %TBSA x BW (kg) = one portion
• 4/4/4, 6/6 & 12 hr
30. Monitoring of Resuscitation
• Urine output is the best and easiest
• 0.5 – 1 ml / hr
• If not – increase the infusion rate
• IV 10 ml / kg bolus is needed when
• If > 2 ml / kg
• Hct
• Transoesophageal USG
• Central catheters
31. Treating the Burn Wound
I. Deep burn of small area
• Excision of the burn skin f/b immediate skin graft
II. Escherotomy
• Circumferential full thickness burns
• They can exert tourniquet effect
• Incising the whole length of full thickness burns
• Can cause significant amt of blood loss
32. III. Exposure therapy or open dressing technique
• Cleaning of wound
• Excised the necrotic tissue
• Puncture the blisters
• No covering or dressing
• The advantage is that the scab is formed in 24 hrs
33. IV. Closed dressing technique or 3 layers dressing
• Antibiotic cream
• Thin layer gauze
• Thick layer absorbant cotton
• Bandage or plaster
• Drawbacks are
34. V. semi-open dressing technique
•Apply silver sulfadiazine cream to wound
•Thin layer of gauze
•Continue repeated until the wd heal
35. VI. Deep burns of large area
•Skin cover is necessary
•Temporary
• Allograft, xenograft, amnion or synthetic cover
•Permanent
• Autograft, autograft of meshed skin, autograft of keratinocyte
36. • The dressing should be
• Easy to apply
• Non adherent
• Reduce pain
• Simple to manage
• Locally available
• Choice of dressing can determine
• Surgery or no surgery
• Scar or no scar
• Heavily contaminated wd
• Debridment under GA
• More chronic contamination…
37. • Permeable wd dressings
• Allows to dry
• Prevent adherent to clothes or sheets
• Vaseline impregnated gauze
• Hydrocolloids
• Biological dressings
• Early debridment and grafting is the key to effective Rx in deep partial
thickness burns and full thickness burns
38. Additional aspects of treating the burn patient
1. Analgesia (acute & subacute)
2. Energery balance & nutrition
3. Monitoring & control of infection
4. Nursing care
5. Physiotherapy
6. Psychological
39. Surgery in acute burn wound:
• Any full thickness burn & deep partial thickness burns except ..
• Any depth – reassess after 48 hr
• The essence of burn surgery is “control”
• To reduce bld loss….
• Skin graft should be apply whatever possible
• Post op care (Hb%,elevation, splint)
40. Delayed Reconstruction & Scar
Management
• Eyelids must be grafted before exposure keratitis occur
• Single band – Z plasty
• Wider ones – transposition flap
• Tissue expansion – burn alopecia
• Larger ones – graft or flaps
• Itch – pharmacological Rx
• Hypertrophic scars or keloid scars - …
41. Non thermal burn injuries
• Electrical burns
• Low tension
• High tension
• Mostly deep burns
• May induce cardiac arrhythmias or sudden cardiac arrest
• Look for and treat myoglobiuria
42. • Chemical burn
• Damage by corrosion or poisoning
• Corpious larvage with water
• Identify the chemical and assess the risk of absorption
• Radiation burn
• If ulcerate needs excision
• Deep burns
• Cold injuries
• Industrial
• Frosbite
44. • Late complications
• Burns scar contracture
• Disability
• Psychological
• Complications of scar
• Cosmetic
• Complication of involvement of special areas
• Other complications
• Stress hyperglycaemia
• Stress ulcer