Burn injuries can result from thermal, electrical, chemical or radiation sources and are classified based on depth and extent of tissue damage. The pathophysiology of burns involves local and systemic effects. Locally, burns cause coagulation and stasis zones in tissues and edema. Inflammatory mediators are released locally and systemically. For large burns (>30% TBSA), systemic effects include hypovolemia, reduced cardiac output, myocardial dysfunction, renal failure, gastrointestinal atrophy and immune suppression. Understanding the pathophysiology is important for guiding resuscitation and management of burn patients.
Burns Pathophysiology, Evaluation and ManagementAnkit Sharma
09 x 2
Genitalia - 01
Total Body Surface Area - 100
63
Evaluation
History
Mechanism of injury
Time of injury
Associated inhalational injury
Past medical history
Medications
64
Evaluation
Examination
Primary survey
Airway, Breathing, Circulation
Secondary survey
Head to toe examination
Assessment of TBSA involved
Depth of burn
Associated injuries
65
Evaluation
Investigations
Hematological
This document provides an overview of burns, including:
1) Burns are injuries caused by direct contact with heat, chemicals, electricity, radiation or flame. Thermal burns are the most common type.
2) Burn classifications include depth of burn (1st-4th degree), type of burn (thermal, chemical, electrical etc.), and percentage of total body surface area burned.
3) Burn pathophysiology involves local effects like edema formation and systemic effects like hypovolemia, increased vascular permeability, immune dysfunction and hypermetabolism.
This document provides information about burns, including:
- Definitions and classifications of burn depth and severity. Major causes of burns include scalds, flames, electricity, chemicals and cold.
- Risk factors like age, comorbidities, and socioeconomic factors that influence burn risks.
- High burn mortality rates in Southeast Asia, with over 300,000 burn patients annually in Bangladesh.
- Guidelines for burn management including first aid, fluid resuscitation calculated using the Rule of Nines, and treatment depending on severity.
The document discusses different types of burns including thermal, chemical, and electrical burns. It describes how burns are assessed based on depth and percentage of total body surface area affected. First, second, and third degree burns are defined based on the level of skin layers involved. Complications from burns can include fluid shifts causing hypovolemia, infection, and multi-organ dysfunction. Burn management involves wound assessment, fluid resuscitation to address fluid imbalances, and treatment depending on severity.
The document discusses burns, including definitions, causes, classifications, assessment, and management. Burns are injuries caused by heat, chemicals, electricity, or radiation. They can range from superficial to full thickness. Assessment involves determining burn severity and extent using methods like the Rule of Nine. Management consists of three phases - emergent, acute, and rehabilitation. The emergent phase focuses on fluid resuscitation to prevent shock based on established formulas.
This document discusses the management of burn injuries. It begins with an introduction noting that scalds are the most common burn in children from accidents with hot liquids. Classification of burns is then described based on percentage of total body surface area burned and depth of burn. Pathophysiology involves inflammation, hypovolemia, and potential inhalation injury. Assessment involves determining burn size, depth, and severity. Management involves stabilizing the airway, providing fluid resuscitation, controlling the environment, and considering surgery depending on the depth and extent of the burn. Complications can include shock, renal failure, and infection.
Peioperative Anaesthesia Management of Burn Patients.pptxRedwan38
This document discusses the perioperative anesthesia management of burn patients. It begins by describing burn depth classifications from first to fourth degree. It then discusses assessing burn severity using total body surface area calculations. Fluid resuscitation is discussed, noting formulas like Parkland that aim for specific urine outputs. The stages of thermal injuries from initial edema to diuresis are outlined. It details the localized and systemic effects of burns, involving many organ systems. Specific considerations for anesthetizing burn patients are provided, such as increased drug doses. Common burn-related operations and the importance of postoperative analgesia are also summarized.
Burns Pathophysiology, Evaluation and ManagementAnkit Sharma
09 x 2
Genitalia - 01
Total Body Surface Area - 100
63
Evaluation
History
Mechanism of injury
Time of injury
Associated inhalational injury
Past medical history
Medications
64
Evaluation
Examination
Primary survey
Airway, Breathing, Circulation
Secondary survey
Head to toe examination
Assessment of TBSA involved
Depth of burn
Associated injuries
65
Evaluation
Investigations
Hematological
This document provides an overview of burns, including:
1) Burns are injuries caused by direct contact with heat, chemicals, electricity, radiation or flame. Thermal burns are the most common type.
2) Burn classifications include depth of burn (1st-4th degree), type of burn (thermal, chemical, electrical etc.), and percentage of total body surface area burned.
3) Burn pathophysiology involves local effects like edema formation and systemic effects like hypovolemia, increased vascular permeability, immune dysfunction and hypermetabolism.
This document provides information about burns, including:
- Definitions and classifications of burn depth and severity. Major causes of burns include scalds, flames, electricity, chemicals and cold.
- Risk factors like age, comorbidities, and socioeconomic factors that influence burn risks.
- High burn mortality rates in Southeast Asia, with over 300,000 burn patients annually in Bangladesh.
- Guidelines for burn management including first aid, fluid resuscitation calculated using the Rule of Nines, and treatment depending on severity.
The document discusses different types of burns including thermal, chemical, and electrical burns. It describes how burns are assessed based on depth and percentage of total body surface area affected. First, second, and third degree burns are defined based on the level of skin layers involved. Complications from burns can include fluid shifts causing hypovolemia, infection, and multi-organ dysfunction. Burn management involves wound assessment, fluid resuscitation to address fluid imbalances, and treatment depending on severity.
The document discusses burns, including definitions, causes, classifications, assessment, and management. Burns are injuries caused by heat, chemicals, electricity, or radiation. They can range from superficial to full thickness. Assessment involves determining burn severity and extent using methods like the Rule of Nine. Management consists of three phases - emergent, acute, and rehabilitation. The emergent phase focuses on fluid resuscitation to prevent shock based on established formulas.
This document discusses the management of burn injuries. It begins with an introduction noting that scalds are the most common burn in children from accidents with hot liquids. Classification of burns is then described based on percentage of total body surface area burned and depth of burn. Pathophysiology involves inflammation, hypovolemia, and potential inhalation injury. Assessment involves determining burn size, depth, and severity. Management involves stabilizing the airway, providing fluid resuscitation, controlling the environment, and considering surgery depending on the depth and extent of the burn. Complications can include shock, renal failure, and infection.
Peioperative Anaesthesia Management of Burn Patients.pptxRedwan38
This document discusses the perioperative anesthesia management of burn patients. It begins by describing burn depth classifications from first to fourth degree. It then discusses assessing burn severity using total body surface area calculations. Fluid resuscitation is discussed, noting formulas like Parkland that aim for specific urine outputs. The stages of thermal injuries from initial edema to diuresis are outlined. It details the localized and systemic effects of burns, involving many organ systems. Specific considerations for anesthetizing burn patients are provided, such as increased drug doses. Common burn-related operations and the importance of postoperative analgesia are also summarized.
This document provides information about burn injuries including:
1. Definitions of burn depth including first, second, and third degree burns. Common causes of burns are also listed.
2. The pathophysiology of burns is described affecting several body systems like hemodynamic changes, electrolyte imbalance, renal and pulmonary function, hematologic and GI systems, and decreasing immunity.
3. Burn severity is determined by depth, extent of total body surface area burned, age, and location of burns on the body. Common classifications of burns and methods to estimate burn extent are also summarized.
This document provides an overview of burns, including definitions, classifications, pathophysiology, management, and complications. It defines burns as thermal injuries to the skin and tissues. Burns are classified based on depth and extent of damage. First, second, and third degree burns are described. Hospitalization is generally recommended for burns over 10% of total body surface area. The pathophysiology involves fluid shifts, cardiac, metabolic, immunologic, and renal effects. Burn management includes airway control, fluid resuscitation, wound care, infection prevention, pain relief, and nutrition. Complications can include shock, infection, renal failure, and scarring.
This document provides information on burns, including:
- The definition and causes of burns including thermal, electrical, chemical and radiation burns.
- The degrees of burns from first to fourth degree based on depth of tissue damage.
- Methods for estimating the percentage of total body surface area burned including the Rule of Nines.
- Criteria for burn admission to hospital care based on factors like surface area, depth and location of burns.
- Complications that can result from severe burns like infection, shock and organ damage.
- The importance of first aid like cooling the burned area in water to minimize further tissue injury.
This document discusses burns and their physiotherapy management. It begins by defining burns as tissue injury caused by thermal, electrical, or chemical agents. It then covers burn classification, pathophysiology, complications, and assessment considerations. Burns are classified based on depth of tissue damage as epidermal, superficial partial thickness, deep partial thickness, or full thickness. Complications can include infection, pulmonary issues, fluid and electrolyte imbalances, and scar contractures. A thorough assessment examines burn depth, size, location, and patient factors.
Physiotherapy plays an important role in the management of burn injuries. It focuses on positioning, splinting, and scar management to prevent contractures and promote wound healing. Positioning aims to maintain joints in functional positions opposite to the direction of potential contracture. Splinting is used during the acute inflammatory phase and following skin grafting to maintain positioning. Physiotherapy also addresses scar management through pressure therapy, stretching, and exercises to improve range of motion and function.
The presentation is about the definition and type of burns classification and total body surface area involved. Fluid therapy in adults and children. Various formulae of calculating fluid requirement.
Protocols for burn centre management and critical care. Most elaborated description of burn management. Latest guidelines and Protocols, relevant investigation and management.
This document discusses burns, including their classification, pathophysiology, management, and special considerations for inhalation injuries and airway management. Some key points include:
- Burns are classified by depth and total body surface area affected. Deep second and third-degree burns require grafting or flaps for healing.
- Burns cause local tissue damage and systemic inflammatory responses impacting circulation, immunity, metabolism, and other organ systems.
- Initial management focuses on airway protection, fluid resuscitation, pain control and wound care. Admission criteria include burns over 15% of total body surface area or those involving special areas.
- Inhalation injuries are suspected with certain histories and symptoms and require early intubation
1. A burn is an injury to the skin or flesh caused by heat, electricity, chemicals, friction or radiation. The severity depends on the temperature and duration of exposure.
2. About 2.4 million people suffer burns annually in the US, with 700,000 cases requiring medical treatment. The main causes are thermal, electrical, chemical and radiation burns.
3. Burns are classified by depth and extent of the affected body surface area. Depth is classified as superficial, partial-thickness, or full-thickness. Extent is classified using methods like the Rule of Nines or Lund and Browder chart.
1) The document discusses the histology and layers of skin, classification and pathophysiology of burns by depth, and treatment approaches for burns. It covers first, second, third, and fourth degree burns.
2) Treatment involves addressing airway issues, IV fluids, antibiotics, dressing changes, and skin grafting for deep burns. Local treatment aims to protect burns from infection until healing.
3) Deep dermal burns require close monitoring to prevent infection from destroying epithelial remnants and converting them to full thickness burns. Early excision and grafting can prevent contractures compared to waiting a month for natural eschar separation.
This document discusses the assessment and management of burn injuries. It begins with an introduction to common causes of burns in children and adults. It then covers risk factors, types of burns, effects of burns, and classifications of burns based on depth and percentage of total body surface area affected. The pathophysiology of burns is explained. Assessment involves determining burn size, depth, and severity. Management involves initial first aid at the scene, and then hospital care which focuses on cooling burns, giving oxygen, and elevating injured areas. Causes of death from severe burns are also outlined.
This document discusses burns, including their definition, classification, causes, clinical features, and management. Burns are injuries caused by heat, flames, scalds, or chemicals and can range from superficial first degree burns to full thickness third degree burns that destroy all skin layers. Burn management involves initial first aid, medical care including fluids and antibiotics, surgical procedures such as skin grafting, and nursing care like wound dressing and pain management to prevent complications and promote healing.
The statement that "the position of comfort is the position most likely to lead into contractures" is applicable to every burn patient who has sustained a serious injury. Burn injuries can range from superficial to full thickness burns and require careful treatment and positioning to prevent contractures and promote healing. Occupational therapists play an important role in managing burns through techniques like positioning, splinting, edema management, desensitization, exercise, and education on prevention of further injury.
The document discusses burn classifications and management. It describes the three main types of burns as thermal, chemical, and electrical. Thermal burns are the most common and caused by heat sources. Burn depth is classified as superficial, partial thickness, or full thickness. Initial burn management focuses on the ABCs - securing the airway, assessing breathing and circulation. Fluid resuscitation is crucial to prevent shock in large burns. Ongoing nursing care involves wound care, infection prevention and managing complications.
This document defines and classifies different types of burns, including thermal, electrical, chemical, and radiation burns. It describes burns based on depth, with first degree involving the epidermis, second degree also involving the dermis and causing blisters, third degree being full thickness and causing charring, and fourth degree extending into underlying tissues. Burns are also classified based on percentage of total body surface area affected as minor, moderate, or major. The pathophysiology of burns is described, including increased vascular permeability, fluid shifts leading to hypovolemia, and increased risk of infection, renal failure, and multiorgan dysfunction. Infections from bacteria such as Streptococcus and Pseudomonas are common complications. Causes
This document discusses the classification, causes, pathophysiology, and management of burns. It classifies burns based on severity (mild, moderate, major) and depth (superficial partial-thickness, deep partial-thickness, full-thickness). Thermal burns can be caused by scalds, flames, electricity, chemicals, and radiation. Initial management involves cooling the burn, removing clothing, cleaning the area, providing pain relief and antibiotics. Definitive treatment includes fluid resuscitation, monitoring vitals and urine output, wound dressings, skin grafting, and intensive nursing care to prevent infection and organ failure.
1) Burns are classified based on depth of skin penetration and can be first, second, or third degree. First degree burns only affect the epidermis while third degree burns extend through the entire dermis.
2) The Parkland formula is used to calculate fluid resuscitation for burns, with lactated Ringer's solution given over the first 24 hours in a amount of 4 ml per kg of body weight per percent of total body surface area burned.
3) Common complications of burns include pneumonia, sepsis, acute renal failure, graft loss, and burn scar contractures. Early signs of sepsis include fever, hyperventilation, and hypotension.
This document discusses the classification, assessment, and management of burns. It begins by classifying burns based on their depth, percentage of total body surface area affected, and severity. Assessment involves determining the depth, size, and extent of burns. Management consists of prehospital care like cooling burns and giving oxygen, as well as hospital care including airway control, fluid resuscitation, and dressing burns. The goal of treatment is to control the airway, provide breathing support, resuscitate fluid losses, and care for the burn wound.
The document discusses the management of burns. It covers assessment of burns including classifying burns based on depth and percentage of total body surface area affected. It also discusses the pathophysiology of burns and complications like inhalation injury. Management involves airway control, fluid resuscitation proportional to burn size, infection control and dressing wounds. The goal of treatment is to prevent shock, infection and further tissue damage.
1) Burns can result from direct contact with flames, hot liquids, gases, chemicals, electricity, or radiation. They cause tissue injuries by denaturing proteins.
2) Burn injuries affect the skin, which acts as a protective barrier and regulates temperature and fluid balance. Deeper burns extend beyond the epidermis into the dermis.
3) Proper evaluation and treatment of burn injuries requires assessing burn depth, size, inhalation injury, and associated complications affecting various organ systems. Early fluid resuscitation is critical.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Kat...rightmanforbloodline
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler Community Health Nursing A Canadian Perspective, 5th Edition TEST BANK by Stamler Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Study Guide Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Studocu Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Course Hero Community Health Nursing A Canadian Perspective, 5th Edition Answers Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Course hero Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Studocu Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Study Guide Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Ebook Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Questions Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Studocu Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Stuvia
This document provides information about burn injuries including:
1. Definitions of burn depth including first, second, and third degree burns. Common causes of burns are also listed.
2. The pathophysiology of burns is described affecting several body systems like hemodynamic changes, electrolyte imbalance, renal and pulmonary function, hematologic and GI systems, and decreasing immunity.
3. Burn severity is determined by depth, extent of total body surface area burned, age, and location of burns on the body. Common classifications of burns and methods to estimate burn extent are also summarized.
This document provides an overview of burns, including definitions, classifications, pathophysiology, management, and complications. It defines burns as thermal injuries to the skin and tissues. Burns are classified based on depth and extent of damage. First, second, and third degree burns are described. Hospitalization is generally recommended for burns over 10% of total body surface area. The pathophysiology involves fluid shifts, cardiac, metabolic, immunologic, and renal effects. Burn management includes airway control, fluid resuscitation, wound care, infection prevention, pain relief, and nutrition. Complications can include shock, infection, renal failure, and scarring.
This document provides information on burns, including:
- The definition and causes of burns including thermal, electrical, chemical and radiation burns.
- The degrees of burns from first to fourth degree based on depth of tissue damage.
- Methods for estimating the percentage of total body surface area burned including the Rule of Nines.
- Criteria for burn admission to hospital care based on factors like surface area, depth and location of burns.
- Complications that can result from severe burns like infection, shock and organ damage.
- The importance of first aid like cooling the burned area in water to minimize further tissue injury.
This document discusses burns and their physiotherapy management. It begins by defining burns as tissue injury caused by thermal, electrical, or chemical agents. It then covers burn classification, pathophysiology, complications, and assessment considerations. Burns are classified based on depth of tissue damage as epidermal, superficial partial thickness, deep partial thickness, or full thickness. Complications can include infection, pulmonary issues, fluid and electrolyte imbalances, and scar contractures. A thorough assessment examines burn depth, size, location, and patient factors.
Physiotherapy plays an important role in the management of burn injuries. It focuses on positioning, splinting, and scar management to prevent contractures and promote wound healing. Positioning aims to maintain joints in functional positions opposite to the direction of potential contracture. Splinting is used during the acute inflammatory phase and following skin grafting to maintain positioning. Physiotherapy also addresses scar management through pressure therapy, stretching, and exercises to improve range of motion and function.
The presentation is about the definition and type of burns classification and total body surface area involved. Fluid therapy in adults and children. Various formulae of calculating fluid requirement.
Protocols for burn centre management and critical care. Most elaborated description of burn management. Latest guidelines and Protocols, relevant investigation and management.
This document discusses burns, including their classification, pathophysiology, management, and special considerations for inhalation injuries and airway management. Some key points include:
- Burns are classified by depth and total body surface area affected. Deep second and third-degree burns require grafting or flaps for healing.
- Burns cause local tissue damage and systemic inflammatory responses impacting circulation, immunity, metabolism, and other organ systems.
- Initial management focuses on airway protection, fluid resuscitation, pain control and wound care. Admission criteria include burns over 15% of total body surface area or those involving special areas.
- Inhalation injuries are suspected with certain histories and symptoms and require early intubation
1. A burn is an injury to the skin or flesh caused by heat, electricity, chemicals, friction or radiation. The severity depends on the temperature and duration of exposure.
2. About 2.4 million people suffer burns annually in the US, with 700,000 cases requiring medical treatment. The main causes are thermal, electrical, chemical and radiation burns.
3. Burns are classified by depth and extent of the affected body surface area. Depth is classified as superficial, partial-thickness, or full-thickness. Extent is classified using methods like the Rule of Nines or Lund and Browder chart.
1) The document discusses the histology and layers of skin, classification and pathophysiology of burns by depth, and treatment approaches for burns. It covers first, second, third, and fourth degree burns.
2) Treatment involves addressing airway issues, IV fluids, antibiotics, dressing changes, and skin grafting for deep burns. Local treatment aims to protect burns from infection until healing.
3) Deep dermal burns require close monitoring to prevent infection from destroying epithelial remnants and converting them to full thickness burns. Early excision and grafting can prevent contractures compared to waiting a month for natural eschar separation.
This document discusses the assessment and management of burn injuries. It begins with an introduction to common causes of burns in children and adults. It then covers risk factors, types of burns, effects of burns, and classifications of burns based on depth and percentage of total body surface area affected. The pathophysiology of burns is explained. Assessment involves determining burn size, depth, and severity. Management involves initial first aid at the scene, and then hospital care which focuses on cooling burns, giving oxygen, and elevating injured areas. Causes of death from severe burns are also outlined.
This document discusses burns, including their definition, classification, causes, clinical features, and management. Burns are injuries caused by heat, flames, scalds, or chemicals and can range from superficial first degree burns to full thickness third degree burns that destroy all skin layers. Burn management involves initial first aid, medical care including fluids and antibiotics, surgical procedures such as skin grafting, and nursing care like wound dressing and pain management to prevent complications and promote healing.
The statement that "the position of comfort is the position most likely to lead into contractures" is applicable to every burn patient who has sustained a serious injury. Burn injuries can range from superficial to full thickness burns and require careful treatment and positioning to prevent contractures and promote healing. Occupational therapists play an important role in managing burns through techniques like positioning, splinting, edema management, desensitization, exercise, and education on prevention of further injury.
The document discusses burn classifications and management. It describes the three main types of burns as thermal, chemical, and electrical. Thermal burns are the most common and caused by heat sources. Burn depth is classified as superficial, partial thickness, or full thickness. Initial burn management focuses on the ABCs - securing the airway, assessing breathing and circulation. Fluid resuscitation is crucial to prevent shock in large burns. Ongoing nursing care involves wound care, infection prevention and managing complications.
This document defines and classifies different types of burns, including thermal, electrical, chemical, and radiation burns. It describes burns based on depth, with first degree involving the epidermis, second degree also involving the dermis and causing blisters, third degree being full thickness and causing charring, and fourth degree extending into underlying tissues. Burns are also classified based on percentage of total body surface area affected as minor, moderate, or major. The pathophysiology of burns is described, including increased vascular permeability, fluid shifts leading to hypovolemia, and increased risk of infection, renal failure, and multiorgan dysfunction. Infections from bacteria such as Streptococcus and Pseudomonas are common complications. Causes
This document discusses the classification, causes, pathophysiology, and management of burns. It classifies burns based on severity (mild, moderate, major) and depth (superficial partial-thickness, deep partial-thickness, full-thickness). Thermal burns can be caused by scalds, flames, electricity, chemicals, and radiation. Initial management involves cooling the burn, removing clothing, cleaning the area, providing pain relief and antibiotics. Definitive treatment includes fluid resuscitation, monitoring vitals and urine output, wound dressings, skin grafting, and intensive nursing care to prevent infection and organ failure.
1) Burns are classified based on depth of skin penetration and can be first, second, or third degree. First degree burns only affect the epidermis while third degree burns extend through the entire dermis.
2) The Parkland formula is used to calculate fluid resuscitation for burns, with lactated Ringer's solution given over the first 24 hours in a amount of 4 ml per kg of body weight per percent of total body surface area burned.
3) Common complications of burns include pneumonia, sepsis, acute renal failure, graft loss, and burn scar contractures. Early signs of sepsis include fever, hyperventilation, and hypotension.
This document discusses the classification, assessment, and management of burns. It begins by classifying burns based on their depth, percentage of total body surface area affected, and severity. Assessment involves determining the depth, size, and extent of burns. Management consists of prehospital care like cooling burns and giving oxygen, as well as hospital care including airway control, fluid resuscitation, and dressing burns. The goal of treatment is to control the airway, provide breathing support, resuscitate fluid losses, and care for the burn wound.
The document discusses the management of burns. It covers assessment of burns including classifying burns based on depth and percentage of total body surface area affected. It also discusses the pathophysiology of burns and complications like inhalation injury. Management involves airway control, fluid resuscitation proportional to burn size, infection control and dressing wounds. The goal of treatment is to prevent shock, infection and further tissue damage.
1) Burns can result from direct contact with flames, hot liquids, gases, chemicals, electricity, or radiation. They cause tissue injuries by denaturing proteins.
2) Burn injuries affect the skin, which acts as a protective barrier and regulates temperature and fluid balance. Deeper burns extend beyond the epidermis into the dermis.
3) Proper evaluation and treatment of burn injuries requires assessing burn depth, size, inhalation injury, and associated complications affecting various organ systems. Early fluid resuscitation is critical.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Kat...rightmanforbloodline
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler Community Health Nursing A Canadian Perspective, 5th Edition TEST BANK by Stamler Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Study Guide Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Studocu Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Course Hero Community Health Nursing A Canadian Perspective, 5th Edition Answers Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Course hero Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Studocu Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Study Guide Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Ebook Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Questions Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Studocu Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Stuvia
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the 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 lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
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. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
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Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
2. OVERVIEW
▶ Part I
▶ Historical perspective
▶ Statistics
▶ Classification of Burns
▶ Pathophysiology
▶ Evaluation
▶ Part II
▶ Management
▶ Pre-hospital Care
▶ Resuscitation & Nutritional support
▶ Burn wound care
▶ Complications
▶ Rehabilitation
2
3. Definition
Injuries that result from direct contact or exposure to any physical, thermal,
chemical, electrical, or radiation source are termed as Burns.
3
5. Historical Perspective
▶ First direct evidence of treatment for burns
- Cave paintings of Neanderthal man
▶ 1500 BC : Egyptian Smith Papyrus – Resin
& Honey
▶ Ambroise Pare ( AD 1510 – 1590) :
Technique of early excision of burn wounds
5
7. Historical Perspective
▶ 19th century : Dupuytren’s
classification based on depth
▶ 1842 : Curling : Gastric &
Duodenal Ulceration
Thom
asBlizardCurling
BaronGuillaum
eDupuytren
7
8. Historical Perspective
▶ 1947 : Texas city disaster
▶ Truman G. Blocker Jr:
Multidisciplinary team
approach of Burns.
▶ First Burn Institute for
children in Galveston
8
11. Problem Statement : Global
An estimated 265000 deaths every year are caused by burns.
One of leading causes of disability-adjusted life-years (DALYs) lost in low- and
middle-income countries.
In 2004, nearly 11 million people worldwide were burned severely enough to
require medical attention.
WHO Apr 14
11
12. Problem Statement: US
: 486,000
: 3,275
: 40,000
Burn Injuries Receiving Medical Treatment
Fire/Smoke Inhalation Deaths
Hospitalizations Related to Burn Injury
Survival Rate : 96.8%
American Burn Association, 2016
12
13. Problem Statement : India
70 lakh burn injury cases annually
Over 10,00,000 people are moderately or severely burnt every year
1.4 lakh people die of burn every year.
Around 70% of all burn injuries occur in most productive age group (15-35
years).
Around 4/5 are women & children.
As many as 80% of cases admitted are a result of accidents at home (kitchen-
related incidents)
13
16. Thermal Injuries
▶ Most common
▶ Types : Dry & wet
Contact
▶Direct contact with hot object (i.e. pan or iron)
▶Anything that sticks to skin (i.e. tar, grease or
foods)
16
17. Thermal Injuries
▶Flame
▶Direct contact with flame (dry heat)
▶structural fires / clothing catching on fire
▶Scalding
▶Direct contact with hot liquid / vapours (moist
heat)
▶Cooking, bathing or car radiator overheating
▶Single most common injury in the paediatric pt
17
18. Electrical Burns
▶ Usually follows accidental contact with exposed object conducting electricity
▶ Electrically powered devices
▶ Electrical wiring
▶ Power transmission lines
▶ Can also result from Lightning
▶ Damage depends on intensity of current
18
19. Electrical Burns
▶ Severity depends upon:
▶ what tissue current passes through (Low voltage/ High voltage)
▶ width or extent of the current pathway
▶ AC or DC
▶ duration of current contact
▶ Tissues with the lowest resistance eg. nerves, blood vessels & muscles
▶ Heat generation during passage of the current injures the tissues
▶ Skin has a relatively high resistance, hence is mostly spared
19
20. Electrical Burns
▶ Low-tension injuries(<1000 V)
▶ Low energy burns Minimal damage to subcutaneous tissue
▶ Entry & Exit points – fingers small deep burns
▶ AC Tetany within muscles, cardiac arrest due to interference with
normal cardiac pacing
20
21. Electrical Burns
▶ High-tension injuries(>1000V)
▶ Flash/ Flame / Current
▶ Earthed high tension lines Arc
over the patient Flash burn
▶ Heating of the surrounding air
Explosion Flame burn
▶ Direct contact patient acts as
conduction rod huge subcutaneous
damage
21
22. Electrical Burns
▶ Lightning
▶ HIGH VOLTAGE!!!
▶ Injury may result from
▶Direct Strike
▶Side Flash
▶ Severe injuries often result
22
26. Chemical Burns
▶ Usually associated with industrial exposure
▶ Accidental mishandling of household cleaners
▶ Degree of tissue damage determined by
- Chemical nature of the agent
- Concentration of the agent
- Duration of skin contact
26
27. Chemical Burns
▶ Acids
▶ Immediate coagulation necrosis creating an eschar; self-limiting
▶ Bases (Alkali)
▶ Liquefactive necrosis with continued penetration into deeper tissue resulting
in extensive injury
Eg. Lime, potassium hydroxide, cement
27
29. Radiation Exposure
▶ Waves or particles of energy that are emitted from radioactive sources
▶ Alpha radiation
Large, travel a short distance, minimal penetrating ability
Can harm internal organs if inhaled, ingested or absorbed
▶ Beta radiation
Small, more energy, more penetrating ability
Usually enter through damaged skin, ingestion or inhalation
29
30. Radiation Exposure
▶ Gamma radiation & X-rays
Most dangerous penetrating radiation
May produce localized skin burns & extensive internal damage
30
31. Classification
Based on Depth
▶ I Degree - Epidermis
▶ II Degree - Epidermis+ Dermis
▶ III Degree - Epidermis+ Dermis +
Subcutaneous tissue
▶ IV Degree - Above + Muscles/bone
31
32. Classification
Degree 1st Degree
of Burn
2nd Degree
Partial Thickness
2nd Degree
Deep Burns
3rd Degree
Involvement Epidermis Epidermis + Dermis E+ D E+D+Subcut tissue E+D+S+muscles,
tendons & bone
Appearance
Severe Edema
Symptoms &
Signs
Pain ++ Pain ++++ Painful -less severe Painless,insensitive, No Edema
Healing 3-5 days ,
spontaneous
No Scarring
2 weeks, min
scarring, minimal
discolouration
2-6 weeks
Hypertrophic
scarring / formation
of contractures
No spontaneous
healing
No spontaneous
healing
4th D
e
3g
2r
e
e
35. Pathophysiology : Local Effects
▶ Zone of coagulation
▶ Necrotic area with cellular disruption
▶ Irreversible tissue damage
▶ Zone of stasis
▶Moderate insult with decreased tissue
perfusion
▶ Can survive or go on to coagulative
necrosis depending on wound
environment
36
JACKSON’s burn zones
36. Pathophysiology : Local Effects
▶ Zone of hyperemia
▶Viable tissue, not at risk for
further necrosis
37
38. Pathophysiology : Local Effects
▶ Edema in non-burned tissue
▶ Loss of capillary endothelial integrity
▶ Reduced transmembrane potentials of skeletal muscle at the site of
injury as well as away from the site of damage [-90mv -70 to -80mv]
▶ Increase in intracellular Na & water leading to edema
39
50. Pathophysiology : Systemic Effects
▶ Immune system
▶ Global depression in immune function
▶ Diminished production of macrophages
▶ Increased neutrophil count (dysfunctional) followed by decrease after 48-
72 hrs
▶ Impaired cytotoxic T cell activity
▶ Increase risk of infections
▶ Depressed Th function
51
51. Pathophysiology : Systemic Effects
▶ Hypermetabolic response
▶Phase I [ebb]
▶First 48 hrs
▶Decrease in
▶cardiac output
▶urine output
▶O2 consumption
▶BMR
▶Impaired glucose tolerance with hyperglycemia
52
52. Pathophysiology : Systemic Effects
▶ Hypermetabolic response
▶ Metabolic variables gradually increase within first five days post injury to reach a plateau
▶ Phase II [flow]
▶ Increase in metabolic rate
▶ Urine cortisol
▶ Serum catecholamines
▶ Basal energy expenditure
▶ Serum cytokines
▶ Hyperdynamic state – increase in cardiac output
▶ Insulin resistance
▶ Persists for upto 3 years
53
55. Pathophysiology : Systemic Effects
▶ Carbon Monoxide
▶ Most frequent cause of death in smoke induced inhalational injury
▶ Pathology : 0.1% of CO 50% Carboxy Hb
▶ Hb affinity of CO 200-250 times that of O2
▶ Mechanism: Competitive inhibition of Cyt P450
Free radical formation
(Xanthine dehydrogenase Xanthine Oxidase)
56
57. Pathophysiology
▶ Hydrogen cyanide
▶ Fires involving N2 containing
compounds
▶ Mechanism :
▶Inhibition of cellular oxygenation
with resultant tissue anoxia
▶Reversible inhibition of Cyt oxidase
(Fe 3+) by CN
58
58. Pathophysiology : Oropharynx
Heat
Denaturation of proteins
Complement Activation
Histamine release
Formation of Xanthine Oxidase
Converts Uric acid to urea
Release of O2 free radicals
Edema formation
Release of Eicosanoids
Attract PMNs to the site
(Amplify effects)
Massive Edema
59
59. Pathophysiology : Tracheo-bronchial areas
Chemical Injury to airway
Seperation of ciliated epi-cells from
BM
Increased Circulation to lung &
bronchial circulation
Edema formation
Diffuse transudate in early changes
Bronchoconstriction Fibrin casts
Obstruction of smaller airways
Culture media for infections
Pneumonia , Sepsis & Death
60
66. Palm Method
▶ Size of Patient’s palm 1% of TBSA
▶ Irregular wounds with scattered distribution.
67
67. OVERVIEW
▶ Part I
▶ Historical perspective
▶ Statistics
▶ Classification of Burns
▶ Pathophysiology
▶ Evaluation
▶ Part II
▶ Pre-hospital Care
▶ Resuscitation & Nutritional support
▶ Burn wound care
▶ Complications
▶ Rehabilitation
68
69. PHASES OF TPT
▶ Phase 1: Treatment at the scene and tpt to initial care facility
▶ Phase 2: Assessment and stabilization at initial care facility and tpt to
burn ICU.
70. PRE HOSPITAL MANAGEMENT
▶ Rescuer to avoid injuring himself
▶ Remove patient from source of injury
▶ Stop burn process
▶ Burning clothing; jewelry, watches, belts to be removed
▶ Pour ample water on burnt area (not ice/ ice packs – skin injury &
hypothermia)
71. PRE HOSPITAL MANAGEMENT
▶ Chemical burns:
▶ Remove saturated clothing
▶ Brush skin if agent is powder
▶ Irrigation with copious amount water to be started and continued in
hospital
▶ Electrical burns:
▶ Turn off the current
▶ Use non-conductor item to separate from source
72. PRE HOSPITAL MANAGEMENT
PRIMARYASSESSMENT
▶ A – B – C – Cervical spine immobilization
▶ Respiratory tract:
▶ Edema of upper airway sets in very fast
▶ Upper airway obstruction
▶ 100% humidified O2 if no obvious resp distress
73. PRE HOSPITAL MANAGEMENT
PRIMARYASSESSMENT
▶ ET intubation + assisted ventilation with 100% O2 if:
▶ Overt signs and symptoms of airway obstruction (Progressive hoarseness)
▶ Suspected inhalational injury (smoke/ carbon monoxide intoxication)
▶ Unconscious patient/ rapidly deteriorating patient
▶ Acute respiratory distress
▶ Burns of face & neck
▶ Extensive Burns (> 40% TBSA)
74. PRE HOSPITAL MANAGEMENT
PRIMARYASSESSMENT
▶ Pulse rate better monitor than BP
▶ Spinal immobilization:
▶ Explosion/ deceleration injury
▶ Cervical collar (Philadelphia collar)
75. PRE HOSPITAL MANAGEMENT
Ice/ice cold water causes numbness, intense vasoconstriction, hypothermia
causing further damage.
Do not break blisters.
Do not apply lotions, powders, grease, ghee, gentian violet, calamine lotion,
toothpastes, butter and other sticky agents over the burn wound.
Prevent contamination: Wrap burn part in clean dry sheet /cloth.
Assess for life threatening injuries.
76. PRE HOSPITAL MANAGEMENT
NO I/M or S/C inj (Capillary leakage results in unpredictable absorption)
I/V morphine to allay anxiety
Pain relief and reassurance
Withhold oral intake
77. PRE HOSPITAL MANAGEMENT
▶ Co-morbid conditions/ pre-existing illness
▶ Initiate rapid transfer to hospital
▶ Secure and protect the airway
▶ Cervical spine immobilization; if necessary
78. PRE HOSPITAL MANAGEMENT
SECONDARY ASSESSMENT
▶ Performed only if no immediate life threatening injury/ hazard present
▶ Thorough head to toe evaluation
▶ Medical history, medication, allergies, mechanism of injury
▶ Start IV line (not reqd in hospital <60 min away)
79. PRE HOSPITAL MANAGEMENT
SECONDARY ASSESSMENT
▶ RL infusion:
▶ ≥ 14 yrs
▶ 6-14 yrs
▶ ≤ 5yrs
– 500mL/hr
– 250mL/hr
– 125mL/hr
▶ Apply clean dressing/ sheet to protect area and minimize heat loss
▶ IV Tramadol to relieve pain
▶ No topical antimicrobial
80. HOSPITAL MANAGEMENT
INITIAL CARE FACILITY
▶ C – A – B
▶ Establish adequate airway
▶ ET intubation – impending airway edema (post initiation of IV therapy)
▶ Maintain cervical spine immobilization
81. INITIAL CARE FACILITY
▶ History
▶ Mechanism of injury
▶ Time of injury
▶ Surroundings (closed space/ chemicals)
▶ Physical examination
▶ Head to toe assessment
▶ Careful neurological examination (cerebral anoxia)
▶ Corneal fluorescent examination in facial burns
▶ Labs: CBC, electrolytes, BUN
▶ Pulmonary assessment: ABG, CXR, carboxyhemoglobin
82. INITIAL CARE FACILITY
▶ Pulse in extremities: manual/ doppler
▶ Loss of distal circulation
▶Pallor/coolness/absent pulse/loss capillary refill/decreased oxygen
saturation
▶ Pain on passive extension
▶ Deep pain at rest
▶ Absent pulse: emergency escharotomy to release constrictive, unyielding
eschar
83. ESCHAROTOMY
▶ Deep 2nd & 3rd degree circumferential burns
▶ Chest: To allow respiratory movement
▶ Limb: To restore circulation in limb with excess swelling under rigid eschar
▶ Bedside, IV sedation, cautery
▶ Midaxial incision into eschar, Across joints
▶ Caution at elbow, wrist, fibular head, medial ankle, neck
▶ Not in SC tissue Exposes SC fat
84.
85. ESCHAROTOMY
▶ Elevate limbs above level of heart
▶ Monitor pulses for 48 hrs
▶ Chemical escharotomy if pulses +nt but feeble.
▶ Useful in hand burns.
▶ Enzyme – collagenase
▶ Complications : bleeding, infection
▶ Antimicrobial prophylaxis must to prevent sepsis
86. INDICATIONS FOR ADMISSION
▶ >15% burns in adults
▶ 10% burns in children
▶ Airway and inhalation injury.
▶ Significant burn involving face, hands, feet and perineum.
▶ Extremes of age.
▶ Suspected non-accidental burns.
▶ Burns that require early surgery (deep partial thickness / full thickness)
▶ Patients deficient of nursing care by attendants at home
▶ Severe electric and acid burns that is likely to have serious sequelae
87. RECEPTION
• Resuscitation –ensure ABC
• Large gauge I.V catheter
• Central line Insertion
• Venesection
• Foleys catheter and NG tube placement
• Quick assessment of extent
• Tetanus prophylaxis (the only IM administered inj)
• Weigh the patient
88. Respiratory Care
Assess airway, respiration & breath sounds
Removal of pulmonary secretions
O2 Humidification
Chest physiotherapy, deep breathing & coughing
Frequent position changes and suction
Pharmacologic Considerations:
Bronchodilators and mucolytics
Circumferential chest burns can impair ventilation
Escharotomy may be required
89. Cardiovascular Care
▶ Increase capillary permeability
▶ “Capillary Leakage Syndrome”
▶ Fluid shift intravascular to interstitial space blistering and massive
edema
▶ Excessive insensible loss via burn wound 3-5 lit/d !!
▶ Finally hypovolemia untreated BURNS’ SHOCK
90. Severity of Burn Injuries
▶ Treatment of burns as per severity of injury
▶ Severity is determined by:
▶ Depth of burns
▶ TBSA involved
▶ Site - face, hands, feet, face or perineum
▶ Age
▶ Associated injuries
N Engl J Med 1996;335:1581 J Trauma 1994;36;59
94. Parkland Formula
Fluid of Choice
Lactated Ringer’s (RL)
NS can produce hyperchloremic acidosis
4 ml x % of burn x weight (Kg) in 24 hours
First ½ of total volume given in the first 8 hours
Remaining ½ of total volume given over following 16 hours
NEXT 24 HRS
Total volume ½ of first day
Colloids ( 0.5 ml / kg / % )
5 % glucose to make up the rest
95. Parkland Formula
Maximum applicable TBSA – 50%
Fully dilated capillaries
Maximum capillary permeability
No further mounting of inflammatory response
96. Adult Fluid Resuscitation
Evan’s formula:
Requirement for first 24 hrs
Colloids : 1ml/kg/% burn
Saline
D5
: 1ml/kg/% burn
: 2000ml
Requirement for second 24 hrs
½ of first 24 hrs
97. Adult Fluid Resuscitation
Brooke formula
Requirement for first 24 hrs
Colloids : 0.5ml / kg /% burn
RL
D5
: 1.5ml / kg / %burn
: 2000ml in adults
Requirement for second 24 hrs
½ of first 24hrs
98. Pediatric age group
Carvajal Formula
5000cc x m2 x % BSA initial + 2000cc x m2 maint /d
Change to 5%D+RL with albumin after 6 hrs
Urine output 1-2 cc/ kg/h
99.
100. Assessment of Adequacy of
Fluid Resuscitation
▶ Monitor
▶ Urinary Output
▶Adult: > 1 ml/ kg/ hr
▶ Daily Weight
▶ Vital Signs
▶Heart rate and blood pressure
▶CVP
▶Level of Consciousness
▶ Laboratory values
102. Nutritional Support
▶ Burn wounds consume large amounts of energy:
▶ Requires massive amounts of nutrition to promote wound healing
▶ Monitoring Nutritional Status
▶ Weekly albumin levels
▶ Daily weight
▶ EMR (Estimated metabolic requirement) (Curreri formula)
=25kcal x body weight (kg) + 40 kcal x % BSA
103. Routes of Nutritional Support
▶ High-protein & high-calorie diet
▶ Often requiring various supplements
▶ Routes:
▶ORAL (BEST)
▶Enteral
▶ Gut is the preferred alternative route
▶ G-tube or J-tube (Head injury/ surgery/ unconscious)
▶Parenteral
▶ TPN and PPN
▶ Associated with an increased risk of infections
104. Nutritional Support
Formulas to Predict Caloric Needs in Severely Burned Children
Age group Maintenance needs Burn wound needs
Infants (0-12 mo) 2100 KCal/ %TBSA/ 24hr 1000 KCal/ %TBSA/ 24hr
Children (1-12 yr) 1800 KCal/ %TBSA/ 24hr 1300 KCal/ %TBSA/24 hr
Adolescents (12-18 yr) 1500 KCal/ %TBSA/ 24hr 1500 KCal/ %TBSA/ 24hr
106. Burn Wounds
Risk for Infection
▶ Skin first line of defense
▶ Necrotic tissue bacterial growth
▶ Management
▶Burn wounds are frequently monitored for bacterial colonization
▶Wound swab cultures and invasive biopsies
107. Role of burn wound cultures
▶ Early cultures positive/ high counts early contamination of the burn wound
▶ Routine cultures aid in empiric antimicrobial coverage if the patient subsequently
becomes ill
▶ Increasing colony counts change topical antimicrobial agents.
▶ Colonization by virulent or resistant organisms predictor of impending invasive burn
wound infection.
▶ Wound colony counts >106 high risk of infectious & graft failure.
108. Burn Wound Care
Hydrotherapy
▶Shower, bed baths or clear water spray
▶Maintain appropriate water and room temperature
▶Limit duration to 20-30 minutes
▶Don’t burst blisters, aspirate them!!!
▶Trim hair around wound; except eyebrows
▶Dry with towel; pat dry, don’t rub!
▶Clean unburned skin and hair
109. Burn Wound Care
Antimicrobial Agent
▶ Silvadene (silver sulfadiazine)
▶ Broad spectrum; the most common agent used
▶ Painless & easy to use
▶ Doesn’t penetrate eschar
▶ Leaves black tattoos from silver ion
▶ Sulfamylon (mafenide acetate)
▶ Penetrates eschar
▶ Painful for approximately 20 minutes after application
▶ Metabolic acidosis
110. Burn Wound Care
Antimicrobial agent
▶ Bacitracin/ Neomycin/ Polymyxin B
- not broad spectrum, painless, easy to apply
▶ Nystatin(Mycostatin)
- antifungal
▶ Mupirocin(Bactroban)
- anti staphylococcal
111. Burn Wound Care
Betadine
Drying effect makes debridement of the eschar easier
Acticoat (antimicrobial occlusive dressing)
A silver impregnated gauze that can be left in place for 5 days
Moist with sterile water only; remoisten every 3-4 hours
112. Soak silver dressings and gauze
in WATER (not saline).
Apply the
silver dressing.
Wrap with moist gauze.
Secure with mesh, gauze or tape.
114. Closed Dressing
▶ Advantages
• Less wound desiccation
• Decreased heat loss
• Decreased cross
contamination
• Debriding effect
• More comfortable
• Disadvantages
• Time consuming
• Expensive
• Increase chances of
infection if not changed
frequently
115. Burn Wound Care
Cover with a Sterile Dressing
▶ Most wounds covered with several layers of sterile gauze dressings.
▶ Special Considerations:
▶ Joint area lightly wrapped to allow mobility
▶ Facial wounds may be left open to air
▶ Circumferential burns: wrap distal to proximal
▶ All fingers and toes should be wrapped separately
▶ Splints over dressings
116. Burn Wound Care
Debridement of the wound
▶ May be completed at the bedside or as a surgical procedure.
▶ Types of Debridement:
▶Natural
▶ Body & bacterial enzymes dissolve eschar; takes a long time
▶Mechanical
▶ Sharp (scissors), Wet-to-Dry Dressings or Enzymatic Agents
▶Surgical
117. Why excise the burn?
Burn wound is a focus for sepsis
Burn stimulates inflammatory mediators
Deep burns cannot heal without grafts
Possible effect on future scar quality
118
Non full-thickness burns may heal
spontaneously
Superficial burns heal with acceptable
scars
Excised burn wound must be closed
Major burn surgery is hazardous
but
121. Early excision of burns
▶Tangential excision to
viable tissue on day 2-3
▶Janzekovic (1970)
Jackson & Stone (1972)
▶ Current concept – within hours
▶ Hardly any bleed
▶ Upto 60% burns
122
123. TANGENTIAL BURN EXCISION
& EARLY SPLIT SKIN GRAFTING
124
▶ Early wound closure; shorter hospital stay
▶ No increase in morbidity
▶ Significant ↓ in mortality
▶ Reduced bacterial colonization
▶ Tissue preservation
▶ Maintenance of function
▶ Less scaring
124. Early burn surgery
Superior outcomes where suitably equipped
▶ mortality
▶ length of hospital stay
▶ morbidity during acute burn
▶ scar quality
125
125. Desirable surgical management
Excision of all non-shallow burns as soon as practicable in as few stages as
possible
Closure of excised wounds with autograft, allograft or artificial material
Definitive wound closure
126
126. Surgical Management
Skin Grafting
▶ Closure of burn wound
▶ Spontaneous wound healing would take months for even a small full-thickness
burn
▶ Eschar is removed as soon as possible to prevent infection
▶ Wound needs to be covered to prevent infection, loss of heat, fluid and
electrolytes
▶ Therefore, skin grafting is done for most full-thickness burns.
▶ Can be permanent or temporary
127. Burn Wound Closure
Permanent Skin Grafts
▶ Two types:
▶Autografts and Cultured Epithelial Autografts (CEA)
▶ Autograft
▶ Harvested from pt
▶ Non-antigenic
▶ Less expensive
▶ Decreased risk of infection
▶ Can utilize meshing to cover large area
▶ Disadvantage : lack of sites and painful
128. Burn Wound Closure
▶ Cultured Epithelial Autografts (CEA)
▶A small piece of pt’s skin is harvested and grown in a culture medium (PDGF
impregnated)
▶Takes 3 weeks to grow enough for the first graft
▶Very fragile; immobile for 10 days post grafting
▶Useful for limited donor sites
▶Disadvantage : very expensive; poor long term cosmetic results and skin
remains fragile for years
130. Burn Wound Closure
Temporary Skin Grafts
▶ Why temporary ??
▶ Available donor sites are used first, but in large burns not
enough donor sites.
▶While waiting for donor site to heal it can be reused as a temporary
covering.
132. Burn Wound Closure
Biosynthetic Temporary Skin Grafts
▶ Homograft
▶ Allograft
▶ Live or cadaver human donors
▶ Fairly expensive/ all the function of skin
▶ Best infection control of all biologic coverings
▶ Disadvantage :
▶ Disease transmission (HBV & HIV)
▶ Antigenic: body rejects in 2 weeks
▶ Not always available
▶ Storage problems
133. Biosynthetic Temporary Skin Grafts
▶ Heterograft
▶ Xenograft
▶ Graft between 2 different species
▶ Porcine most common
▶ Fresh, frozen or freeze-dried (longer shelf life)
▶ Amenable to meshing & antimicrobial impregnation
▶ Antigenic: body rejects in 3-4 days
▶ Fairly inexpensive
▶ Disadvantage : Higher risk of infection
134. Biosynthetic Temporary Skin Grafts
▶ Artificial Skins
▶Transcyte:
▶A collagen based dressing impregnated with newborn fibroblasts.
▶Integra:
▶A collagen based product that helps to form a “neodermis”
▶no anti-microbial property
▶ Synthetic
▶Any non-biologic dressing that will help prevent fluid & heat loss
▶Biobrane, Xeroform, OpSite or Beta Glucan collagen matrix
135. Biobrane
▶ Artificial dressing has elastic
property
▶ Bilayer fabric
▶ Inner layer - knitted nylon threads
coated with porcine collagen
▶ Outer layer - rubberized silicone
▶ Pervious to gases but not to liquids
and bacteria
▶ Epithelialization takes place under
the dressing in
partial thickness wound in 1-2 wks
136. Donor Site: Wound Considerations
▶ The donor site is often the most painful aspect for the post-operative pt
▶ brand new wound !!
▶ Variety of products are used for donor sites
▶Most are left in place for 24 hours and then left open to air
▶ Donor sites usually heal in 3 wks
138. Burn Wound Infection
▶ Focal/ multi focal/ generalized
▶ More the area of infection ↑chances of septicemia
▶ Common org- Strep, Staph & Pseudomonas
139. Monitoring Wound Infection
▶ Definite diagnosis wound biopsy
▶ More than 100,000 organisms is highly suggestive of burn wound infection
▶ Concomitant positive blood culture is a reliable indicator
▶ Children & burns > 30% TBSA are more likely to develop burn sepsis
140. Clinical Signs of Burn Wound Infection
▶ 2nd degree burn full-thickness necrosis
▶ Focal dark-brown or black discoloration
▶ Wound degeneration “neo-eschar” formation
▶ Unexpectedly rapid eschar separation
▶ Hemorrhagic discoloration of sub-eschar fat
▶ Erythematous or violaceous edematous wound margin
▶ Septic lesions in unburned tissue
▶ Crusted serrations of wound margin
143. Sepsis in burn pt concern for infection.
Age-dependent definition with adjustments for children.
The trigger includes at least three of the following:
I. Temperature >39° or <36.5°C
II. Progressive tachycardia
Adults >110 bpm
Children >2 SD above age-specific norms (85% age-adjusted max
heart rate)
Burn Sepsis
144. ▶ III. Progressive tachypnea
▶ Adults >25 /min not ventilated
Minute ventilation >12 L/min ventilated
▶Children >2 SD above age-specific norms
(85% age- adjusted max respiratory rate)
▶ IV. Thrombocytopenia (only 3 days after initial resuscitation)
▶ Adults <100 000/mcl
▶ Children <2 SD below age-specific norms
Burn Sepsis
145. ▶ V. Hyperglycemia (in the absence of pre-existing diabetes mellitus)
▶ Untreated plasma glucose >200 mg/dL or equivalent mM/L
▶ Insulin resistance – examples include
▶ >7 units of insulin/h intravenous drip (adults)
▶ Resistance to insulin (>25% increase in insulin requirements over 24 hours)
▶ VI. Inability to continue enteral feedings >24 hours
▶ Abdominal distension
▶ Enteral feeding intolerance (residual >150 mL/h in children or 2× feeding rate in adults)
▶ Uncontrollable diarrhoea (>2500 mL/d for adults or >400 mL/d in children)
Burn Sepsis
150. ▶ Begins day one and may last several years
▶ Nursing care
▶ Meticulous asepsis continues to be important
▶ Major areas of focus:
▶ Support for adequate wound healing
▶ Prevention of hypertrophic scarring & contractures
▶ Psychosocial Support
▶ Patient and family
▶ Promotion of maximal functional independence
Rehabilitation
151. Hypertrophic Scar Formation
▶ Excessive scar formation, which rises above the skin
▶ Management: Pressure Garments
▶ Elasticized garments that are custom fitted
▶ Maintains constant pressure on the wound
▶ Result: smoother skin & minimized scar appearance
▶ Pt Considerations:
▶ Must be worn 2-3 hours a day
▶ Up to 1-2 years
▶ Jobst garments, foam sponge, foam tape, silicon gel sheet
152. Contracture Formation
▶ Shrinkage and shortening of burned tissue
▶ Results in disfigurement
▶ Especially if burn injury involves joints
▶ Management is application of opposing force:
▶ Splints, proper positioning, mobilisation
▶Must begin at day one
▶Multidisciplinary approach is essential
153. Psychosocial Considerations
Alterations in Body Image
▶ Loss of Self-Esteem
▶ Returning to community, work or school
▶ Sexuality
▶ Supports Services
▶ Psychologist, social work & vocational counselors
▶ Local or national burn injury support orgs
▶ Psy Considerations
▶ Encourage pt & family to express feelings
▶ Assist in developing positive coping strategies
155. RAs (grafts)
▶Liposomal gene transfer Branski L, Pereira CT, Herndon DN, Jeschke MG. Gene therapy in
wound healing: Present Status and Future Directions. Gene Therapy, 2006 Aug 24
▶ cationic cholesterol-containing liposomal constructs
(best so far)
▶ Naked DNA application,
▶ Viral transfection,
▶ High-pressure injection
▶ Liposomal delivery
156. RAs (grafts)
▶ ARTIFICIAL SKIN SUBSTRATES
▶ Dermal matrices with epidermal components Boyce ST, Kagan RJ, Yakuboff KP, Meyer
NA, Rieman MT, Greenhalgh DG, Warden GD. Cultured skin substitutes reduce donor skin
harvesting for closure of excised, full-thickness burns. Ann surg, 2002 Feb; 235(2):269-279
▶ Amniotic wound coverage devices . Branski LK, Herndon DN, Masters OE, Celis M,
Norbury WB, Jeschke MG. Amnion in the treatment of pediatric partial-thickness facial
burns. Burns, 2007 Oct 4.
▶ Dermal component matrices Schulz JT 3rd, Tompkins RG, Burke JF.Artificial skin. Ann
Rev Med, 2000; 51:231-244
157. CONCLUSION
▶ Early, aggressive, controlled fluids
▶ Monitor urine output as a guide to resuscitation
▶ Prevent extension of injury
▶ Maintain high suspicion for inhalation injury & low thresh hold for intubation
▶ Always rule out co-incident trauma
▶ Frequent reassessment of extremities
▶ Seek out & treat CO poisoning
▶ Liberal use of analgesia
▶ Prevent hypothermia
▶ Provide for increased metabolic demands
158. BURNS !!!
Rule of Nines & Resuscitation with fluid
Nutrition
B Breathing
U Urinary output
R
N
S Shock & Silvadene
159. References
▶ Total Burn Care; David N Herndon 4th Ed
▶ Bailey And Love's Short Practice of Surgery 26th Ed 2013
▶ Schwartz’s Principles of Surgery, 10th Ed
▶ Sabiston Textbook of Surgery 19th ed 2012
160