The document provides information on the management of burns, including definitions, epidemiology, classification, assessment, and treatment approaches. It describes the pathophysiology of burns and potential complications. Management involves initial first aid including cooling, fluid resuscitation proportional to burn size, regular monitoring of urine output and electrolytes, and treatment of complications as needed. Inhalational injury requires special attention and evaluation including possible bronchoscopy.
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.
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
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.
The document provides an overview of skin anatomy and burn injuries, including:
- The skin has two layers, the epidermis and dermis, and performs several important functions.
- Burn injuries are classified by depth and extent, and can range from superficial first degree burns to full thickness third degree burns. Critical burns involve over 10% total body surface area or certain high risk areas.
- Burn management involves stopping the burning process, assessing airway and circulation, rapidly estimating burn extent, treating the wound, and providing IV fluid resuscitation based on the Parkland formula. Special considerations include pediatrics, geriatrics, inhalation injuries, and various burn depths.
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.
A burn is a type of injury to skin, or other tissues, caused by heat, cold, electricity, chemicals, friction, or radiation. Most burns are due to heat from hot liquids, solids, or fire. While rates are similar for males and females the underlying causes often differ.
Burns are classified by depth and extent of injury. Superficial burns only affect the epidermis while deep burns damage the dermis. Full thickness burns destroy the entire dermis. Management involves fluid resuscitation, wound care, prevention of infection and complications. Local wound care includes cleaning, silver sulfadiazine cream and dressing changes. For deep burns, debridement and skin grafting may be needed. Monitoring of vitals, urine output and blood work is important. Escarotomy may be required for circumferential full thickness limb burns to prevent limb loss.
This document discusses burns, including epidemiology, pathophysiology, assessment, and management. It notes that burns can be devastating and affect all body systems. Assessment involves determining burn size, depth, and other injuries. Major burns over 25% of total body surface area require fluid resuscitation, wound care, possible escharotomy, and potential grafting. Management aims to resuscitate fluid losses, control pain, prevent infection, and promote wound healing. Outcomes depend on early treatment and the depth and extent of the thermal injury.
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.
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
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.
The document provides an overview of skin anatomy and burn injuries, including:
- The skin has two layers, the epidermis and dermis, and performs several important functions.
- Burn injuries are classified by depth and extent, and can range from superficial first degree burns to full thickness third degree burns. Critical burns involve over 10% total body surface area or certain high risk areas.
- Burn management involves stopping the burning process, assessing airway and circulation, rapidly estimating burn extent, treating the wound, and providing IV fluid resuscitation based on the Parkland formula. Special considerations include pediatrics, geriatrics, inhalation injuries, and various burn depths.
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.
A burn is a type of injury to skin, or other tissues, caused by heat, cold, electricity, chemicals, friction, or radiation. Most burns are due to heat from hot liquids, solids, or fire. While rates are similar for males and females the underlying causes often differ.
Burns are classified by depth and extent of injury. Superficial burns only affect the epidermis while deep burns damage the dermis. Full thickness burns destroy the entire dermis. Management involves fluid resuscitation, wound care, prevention of infection and complications. Local wound care includes cleaning, silver sulfadiazine cream and dressing changes. For deep burns, debridement and skin grafting may be needed. Monitoring of vitals, urine output and blood work is important. Escarotomy may be required for circumferential full thickness limb burns to prevent limb loss.
This document discusses burns, including epidemiology, pathophysiology, assessment, and management. It notes that burns can be devastating and affect all body systems. Assessment involves determining burn size, depth, and other injuries. Major burns over 25% of total body surface area require fluid resuscitation, wound care, possible escharotomy, and potential grafting. Management aims to resuscitate fluid losses, control pain, prevent infection, and promote wound healing. Outcomes depend on early treatment and the depth and extent of the thermal injury.
Burn and scald injuries can be caused by heat, electricity, chemicals, or radiation. Thermal burns are the most common and are classified as superficial, partial thickness, or full thickness depending on the depth of tissue damage. A severe burn over 25% of the total body surface area can cause systemic effects like shock due to fluid loss, decreased blood pressure, and increased heart rate. Complications include infection, respiratory failure, renal failure, and contractures. The severity of the burn is estimated using methods like the Rule of Nines or Lund and Browder chart which divide the body into sections and assign a percentage of total body surface area to each.
This presentation will help you to find answers for all the questions related to definition, types, causes, treatment, management and nursing care to burns patient.
This document provides information on burns, including causes, assessment, treatment and prevention. Burns are injuries caused by heat, chemicals, electricity or radiation. Assessment involves checking the airway, breathing, circulation, disability and exposure. Treatment depends on the severity and depth of the burn, and may include cleaning, dressing and fluid replacement. Deeper burns require specialist care. Prevention strategies include smoke alarms, fire safety education, and safe cooking and electrical practices.
This document discusses burns and frostbite, including:
1) It defines burns as damaged tissue caused by heat, chemicals, electricity, sunlight, or radiation and describes first, second, and third degree burns.
2) It provides first aid instructions for heat burns, chemical burns, and electrical burns, such as running cool water over the affected area, stopping contact with the chemical, and not interfering if electrical current cannot be stopped.
3) It also discusses frostbite, describing prevention, signs of first, second and third degree frostbite, and first aid steps like sheltering the victim and avoiding refreezing or rubbing affected areas.
The document discusses the epidemiology, assessment, treatment and management of burns. It notes that the majority of burns in children are scalds, while flame burns are more common in adults. Assessment involves determining the percentage of total body surface area burned and burn depth. Treatment includes fluid resuscitation, wound care using dressings like silver sulfadiazine, and management of complications like inhalation injury and infection. Good outcomes depend on factors like percentage and depth of burns, and presence of an inhalation injury.
This document discusses the management of burn patients. It notes that in Australia from 1997-2005, the rate of burn-related deaths was 0.5 per 100,000 people and hospitalization rates for fire, burn, and scald injuries was 31.9 per 100,000 per year. During 2001-02, burns and scalds accounted for over 6,000 hospitalizations costing $132 million. The document then covers classifications of burns, first aid, fluid resuscitation protocols, monitoring burn patients, determining burn depth and wound management, as well as scar management. It emphasizes the importance of a multidisciplinary team approach in treating burn patients.
This document discusses various topics related to surgical infections including:
1) Factors that increase surgical infection risk such as complicated/longer operations, immunosuppressed patients, and implant use.
2) Classification of surgical infections based on outcome, time of onset, and wound contamination risk.
3) Determinants of infection including microbial pathogenicity and host defenses.
4) Prevention strategies like proper patient preparation, strict asepsis, and prophylactic antibiotics.
5) Types of surgical infections affecting soft tissue or body cavities.
This document discusses burns and scalds, including their causes, pathophysiology, assessment, treatment, and complications. The major points covered are:
- Burns are caused by dry heat (fire, electricity) or wet heat (scalds from hot liquids) and result in coagulative necrosis of tissue.
- Pathophysiology includes increased vascular permeability, fluid shifts from blood vessels to tissues, and potential for shock with large burns over 15% of body surface area.
- Assessment involves determining burn depth (superficial vs. partial vs. full thickness) and percentage of total body surface area burned, often using the Rule of Nine.
- Treatment principles are airway, breathing, circulation support along with
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.
The document discusses the metabolic response that occurs following injury or trauma to the body. It describes how there is an initial ebb phase characterized by shock, followed by a longer flow phase with increased metabolism and hormone levels. The metabolic response aims to restore homeostasis but can also cause organ damage. Factors like infection, nutrition, and inflammation can modify this response. Managing the response through fluid resuscitation, oxygen delivery, and minimizing stressors can improve outcomes.
Frostbite occurs when body tissues freeze due to prolonged exposure to cold temperatures, most commonly affecting the extremities. Superficial frostbite involves freezing of the skin and subcutaneous tissues, appearing waxy white and numb, while deep frostbite extends to muscles, tendons and bones. Risk factors include alcohol use, age, medical conditions, weather, injury and constrictive clothing. Symptoms may include pins and needles sensation, numbness, hard and pale skin, blisters and blackened skin. Treatment focuses on slowly rewarming the affected areas and preventing refreezing, along with pain medications, antibiotics and tetanus shots as needed. Surgery may be required for severe cases involving tissue death or
This document discusses surgical infections and the use of antibiotics. It defines surgical infections and describes various pathogens that commonly cause infections, including Streptococcus, Staphylococcus, gram-negative organisms, and Clostridia. It also discusses specific infections such as surgical site infections, necrotizing fasciitis, tetanus, and pseudomembranous colitis. The document concludes by outlining guidelines for antibiotic prophylaxis and treatment based on the classification of surgical wounds.
The document provides information on burn management, including the functions of skin, types of burn injuries, burn classification and assessment, initial patient treatment, airway management, fluid resuscitation, prevention of hypothermia, pain management, and management of inhalation injuries and carbon monoxide poisoning. Key aspects include classifying burns by depth and extent of injury to guide treatment, maintaining adequate fluid resuscitation based on the Parkland or Galveston formula to prevent hypovolemia, preventing hypothermia, and providing adequate pain management which is crucial for patient care and recovery.
This document discusses wound debridement for open fractures. It recommends:
1) Starting IV antibiotics within 1 hour, such as cefazolin, and continuing for 3-5 days to reduce infection rates.
2) Performing urgent debridement within 6 hours to remove all necrotic tissue from the skin, subcutaneous tissue, fascia, muscle and bone.
3) Irrigating the wound with saline using gravity flow, with a minimum of 3 liters for type 1 fractures up to 9 liters for type 3 fractures. Antiseptics are not recommended.
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
The document discusses various chest conditions including chest trauma, pneumothorax, haemothorax, flail chest, and pericardial tamponade. It describes the classification, clinical features, and management of these conditions. Specifically, it covers tension pneumothorax diagnosis and the need for immediate decompression. It also outlines procedures for inserting and managing chest drains.
POST-OPERATIVE WOUND COMPLICATIONS
Dear Viewers,
Greetings from “Surgical Educator”.
Today I have uploaded a video on “POST-OPERATIVE WOUND COMPLICATIONS”. I have discussed about seroma,hematoma,wound infection,wound dehiscence,entero-cutaneous fistula and necrotizing fasciitis- about which all surgeon’s must have a working knowledge. I have restricted my discussion to the essential minimum an undergraduate medical student must know. You can watch all my surgical teaching video casts in the following link:
Surgicaleducator.blogspot.com
Thank you for your support.
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.
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
Burns are a common cause of injury in children and can cause significant distress. Scalds from hot liquids are the most common type of burn in children under 5 years old. Early treatment including fluid resuscitation and wound care has improved survival rates. Major complications can include shock, infection, respiratory failure and long-term issues like scarring and contractures. Proper first aid and emergency care is crucial to prevent complications and improve outcomes for burned children.
Burn and scald injuries can be caused by heat, electricity, chemicals, or radiation. Thermal burns are the most common and are classified as superficial, partial thickness, or full thickness depending on the depth of tissue damage. A severe burn over 25% of the total body surface area can cause systemic effects like shock due to fluid loss, decreased blood pressure, and increased heart rate. Complications include infection, respiratory failure, renal failure, and contractures. The severity of the burn is estimated using methods like the Rule of Nines or Lund and Browder chart which divide the body into sections and assign a percentage of total body surface area to each.
This presentation will help you to find answers for all the questions related to definition, types, causes, treatment, management and nursing care to burns patient.
This document provides information on burns, including causes, assessment, treatment and prevention. Burns are injuries caused by heat, chemicals, electricity or radiation. Assessment involves checking the airway, breathing, circulation, disability and exposure. Treatment depends on the severity and depth of the burn, and may include cleaning, dressing and fluid replacement. Deeper burns require specialist care. Prevention strategies include smoke alarms, fire safety education, and safe cooking and electrical practices.
This document discusses burns and frostbite, including:
1) It defines burns as damaged tissue caused by heat, chemicals, electricity, sunlight, or radiation and describes first, second, and third degree burns.
2) It provides first aid instructions for heat burns, chemical burns, and electrical burns, such as running cool water over the affected area, stopping contact with the chemical, and not interfering if electrical current cannot be stopped.
3) It also discusses frostbite, describing prevention, signs of first, second and third degree frostbite, and first aid steps like sheltering the victim and avoiding refreezing or rubbing affected areas.
The document discusses the epidemiology, assessment, treatment and management of burns. It notes that the majority of burns in children are scalds, while flame burns are more common in adults. Assessment involves determining the percentage of total body surface area burned and burn depth. Treatment includes fluid resuscitation, wound care using dressings like silver sulfadiazine, and management of complications like inhalation injury and infection. Good outcomes depend on factors like percentage and depth of burns, and presence of an inhalation injury.
This document discusses the management of burn patients. It notes that in Australia from 1997-2005, the rate of burn-related deaths was 0.5 per 100,000 people and hospitalization rates for fire, burn, and scald injuries was 31.9 per 100,000 per year. During 2001-02, burns and scalds accounted for over 6,000 hospitalizations costing $132 million. The document then covers classifications of burns, first aid, fluid resuscitation protocols, monitoring burn patients, determining burn depth and wound management, as well as scar management. It emphasizes the importance of a multidisciplinary team approach in treating burn patients.
This document discusses various topics related to surgical infections including:
1) Factors that increase surgical infection risk such as complicated/longer operations, immunosuppressed patients, and implant use.
2) Classification of surgical infections based on outcome, time of onset, and wound contamination risk.
3) Determinants of infection including microbial pathogenicity and host defenses.
4) Prevention strategies like proper patient preparation, strict asepsis, and prophylactic antibiotics.
5) Types of surgical infections affecting soft tissue or body cavities.
This document discusses burns and scalds, including their causes, pathophysiology, assessment, treatment, and complications. The major points covered are:
- Burns are caused by dry heat (fire, electricity) or wet heat (scalds from hot liquids) and result in coagulative necrosis of tissue.
- Pathophysiology includes increased vascular permeability, fluid shifts from blood vessels to tissues, and potential for shock with large burns over 15% of body surface area.
- Assessment involves determining burn depth (superficial vs. partial vs. full thickness) and percentage of total body surface area burned, often using the Rule of Nine.
- Treatment principles are airway, breathing, circulation support along with
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.
The document discusses the metabolic response that occurs following injury or trauma to the body. It describes how there is an initial ebb phase characterized by shock, followed by a longer flow phase with increased metabolism and hormone levels. The metabolic response aims to restore homeostasis but can also cause organ damage. Factors like infection, nutrition, and inflammation can modify this response. Managing the response through fluid resuscitation, oxygen delivery, and minimizing stressors can improve outcomes.
Frostbite occurs when body tissues freeze due to prolonged exposure to cold temperatures, most commonly affecting the extremities. Superficial frostbite involves freezing of the skin and subcutaneous tissues, appearing waxy white and numb, while deep frostbite extends to muscles, tendons and bones. Risk factors include alcohol use, age, medical conditions, weather, injury and constrictive clothing. Symptoms may include pins and needles sensation, numbness, hard and pale skin, blisters and blackened skin. Treatment focuses on slowly rewarming the affected areas and preventing refreezing, along with pain medications, antibiotics and tetanus shots as needed. Surgery may be required for severe cases involving tissue death or
This document discusses surgical infections and the use of antibiotics. It defines surgical infections and describes various pathogens that commonly cause infections, including Streptococcus, Staphylococcus, gram-negative organisms, and Clostridia. It also discusses specific infections such as surgical site infections, necrotizing fasciitis, tetanus, and pseudomembranous colitis. The document concludes by outlining guidelines for antibiotic prophylaxis and treatment based on the classification of surgical wounds.
The document provides information on burn management, including the functions of skin, types of burn injuries, burn classification and assessment, initial patient treatment, airway management, fluid resuscitation, prevention of hypothermia, pain management, and management of inhalation injuries and carbon monoxide poisoning. Key aspects include classifying burns by depth and extent of injury to guide treatment, maintaining adequate fluid resuscitation based on the Parkland or Galveston formula to prevent hypovolemia, preventing hypothermia, and providing adequate pain management which is crucial for patient care and recovery.
This document discusses wound debridement for open fractures. It recommends:
1) Starting IV antibiotics within 1 hour, such as cefazolin, and continuing for 3-5 days to reduce infection rates.
2) Performing urgent debridement within 6 hours to remove all necrotic tissue from the skin, subcutaneous tissue, fascia, muscle and bone.
3) Irrigating the wound with saline using gravity flow, with a minimum of 3 liters for type 1 fractures up to 9 liters for type 3 fractures. Antiseptics are not recommended.
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
The document discusses various chest conditions including chest trauma, pneumothorax, haemothorax, flail chest, and pericardial tamponade. It describes the classification, clinical features, and management of these conditions. Specifically, it covers tension pneumothorax diagnosis and the need for immediate decompression. It also outlines procedures for inserting and managing chest drains.
POST-OPERATIVE WOUND COMPLICATIONS
Dear Viewers,
Greetings from “Surgical Educator”.
Today I have uploaded a video on “POST-OPERATIVE WOUND COMPLICATIONS”. I have discussed about seroma,hematoma,wound infection,wound dehiscence,entero-cutaneous fistula and necrotizing fasciitis- about which all surgeon’s must have a working knowledge. I have restricted my discussion to the essential minimum an undergraduate medical student must know. You can watch all my surgical teaching video casts in the following link:
Surgicaleducator.blogspot.com
Thank you for your support.
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.
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
Burns are a common cause of injury in children and can cause significant distress. Scalds from hot liquids are the most common type of burn in children under 5 years old. Early treatment including fluid resuscitation and wound care has improved survival rates. Major complications can include shock, infection, respiratory failure and long-term issues like scarring and contractures. Proper first aid and emergency care is crucial to prevent complications and improve outcomes for burned children.
Burns are a common cause of injury and distress in children. Scalds from hot liquids are the most frequent type of burn in children under 5. Early treatment focuses on stopping the burn, covering the wound, assessing airway/breathing/circulation, and rapid fluid resuscitation. Later treatment includes wound care, antibiotics if infected, physiotherapy to prevent contractures, and addressing nutritional/developmental needs. Complications can include shock, infection, contractures and long term scarring. Prognosis is poorer in young children.
This document discusses the pathophysiology and immediate care of burn injuries. It covers how burns damage the skin and can also affect the airway/lungs through inhalation of hot gases. Major metabolic effects include carbon monoxide poisoning and circulatory changes like fluid shifts from blood vessels into burned tissue. Immediate care focuses on airway control, respiratory support, fluid resuscitation based on burn size, and wound assessment to determine depth. Superficial and deep partial thickness burns may heal on their own while full thickness burns require skin grafts.
This document provides information on nursing management of patients with burns. It discusses assessment of burns including determining burn depth, size, and severity. It outlines management of minor burns including cleaning, dressing, and ensuring analgesia. Management of major burns involves establishing airway, ensuring breathing and circulation, administering intravenous fluids, and transferring patients to a burn center for specialized care. Immediate steps include stopping the burning process, assessing for inhalation injuries, and providing fluid resuscitation.
The document provides information on the management of burn injuries. It discusses goals of treatment which include preventing complications and maintaining vital signs. It also covers classifications of burns based on depth and surface area affected. Treatment involves fluid resuscitation, wound care including debridement and dressings, pain management, and skin grafts if needed. Complications can include shock, anemia, and renal or liver failure.
This document discusses modern burn care, which is divided into 4 phases:
1) Initial evaluation and resuscitation on days 1-3 involving accurate fluid resuscitation and evaluation of other injuries.
2) Initial wound excision and closure using staged operations to change the natural history of the disease during the first few days.
3) Definitive wound closure replacing temporary covers with permanent ones, and reconstruction of complex areas like the face and hands.
4) Rehabilitation, reconstruction and reintegration beginning during resuscitation but becoming more involved later in the hospital stay.
This document provides an overview of physiotherapy for burn patients. It discusses the types, causes, and classifications of burns including superficial, partial thickness, and full thickness burns. It also covers burn wound zones, complications of burns like infection and metabolic issues, and the general management of burns including first aid, hospital referral, early hospital management, and fluid replacement. The goal of physiotherapy is to prevent contractures and aid in rehabilitation.
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.
This document discusses burn management and provides details on epidemiology, etiology, pathophysiology, and emergency care for burns. It is divided into multiple sections:
1) Epidemiology in Egypt - Domestic burns account for 75% of injuries. Females experience more scald burns at home while males experience more electric and flame burns outdoors.
2) Etiology and types - Common causes are scalds, flames, flashes, and electrical burns. Water temperature and contact time determine scald depth.
3) Emergency management - Airway protection, oxygen supplementation, fluid resuscitation based on burn size, and wound assessment and cooling (if small burn) are priorities in the emergency setting.
Classification, Principles, assessment and management of burnalazarbekele47
The document provides an outline for principles of management of burn injuries. It begins with defining burns and discussing the epidemiology, types, classification, and pathophysiology of burns. It then covers assessment of burn wounds including depth and percentage of total body surface area burned. The document outlines primary survey and management of burns which includes airway management, as inhalation injuries often accompany severe burns. It discusses indications for hospitalization and monitoring of burn patients.
Thermal injuries include burns from heat, electricity, chemicals and radiation. Immediate priorities in management are airway control, stopping the burning process, and intravenous access and fluid resuscitation. Assessment of burns considers type, extent, depth, and potential for inhalation injury. Minor burns are treated with cooling, cleaning, covering and pain control while more severe burns require fluid resuscitation and potential referral to a burn unit. Inhalation injuries require airway protection and management of secretions. Electrical burns can deceptively involve deeper internal injuries than skin appearance suggests.
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.
The document discusses burns, including their causes, types, symptoms, assessment, and treatment. There are three types of burns - first, second, and third-degree - which damage increasing layers of skin. Burn assessment involves evaluating severity, location, and signs of infection or other injuries. Treatment focuses on pain management, wound care, nutrition, and grafting to aid healing and prevent complications.
Burns are caused by direct contact with or exposure to thermal, chemical, electrical or radiation sources. The document discusses the classification, pathophysiology and clinical manifestations of burns. It covers the different types of burns according to etiology, depth and severity. Assessment methods like the Rule of Nine and Palm Method are also described. Common signs include pain, fluid loss, edema, respiratory issues and potential psychological impacts.
This document provides information on burns, including:
- Burns account for approximately 180,000 deaths annually worldwide and most occur in low- and middle-income countries.
- The most common causes of burns are fire/flame, scalds, hot objects, electricity, and chemicals. Burns can range from superficial to full thickness.
- Management of burns involves reviving the patient, restoring fluid and electrolyte balance, repairing the burn wound, and rehabilitating the patient. The parkland formula is used to guide initial fluid resuscitation.
This document provides information on burns including incidence, types, size, depth, severity classification, complications, medical and surgical management, and nursing care. The most common causes of burns are flames, hot liquids, and contact with hot objects. Burn size, depth, and location determine severity and treatment. Nursing assessment focuses on extent of injury and risk for complications like infection and respiratory issues. Emergent care includes airway support, IV fluids, and wound care. Later phases focus on monitoring, pain management, nutrition, and rehabilitation.
Burns can be caused by heat, cold, electricity, chemicals, friction or radiation. They are classified by depth and extent of the burn. First degree burns affect the outer layer of skin while fourth degree burns damage deeper tissues. Burn management involves three phases - emergent, acute, and rehabilitative care. The emergent phase focuses on assessment, wound care, and fluid resuscitation. The acute phase emphasizes infection prevention, wound grafting, pain management, and exercise. Rehabilitation aims to minimize scarring and functional loss through exercise, pressure garments, and psychological support.
This document summarizes the pathophysiology and management of different types of burns. It describes the classification of burns based on depth and extent of injury. Thermal burns are the most common and can be caused by flame, scald, or contact with hot objects. Chemical and electrical burns cause tissue destruction through different mechanisms. The pathophysiology of burns involves fluid shifts, hypermetabolism, and immune dysfunction. Burn management focuses on airway protection, fluid resuscitation according to the Parkland formula, wound care, pain control, and infection prevention.
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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
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2. OUTLINE
CASE SCENARIO
DEFINITION
EPIDEMIOLOGY
AETIOLOGY / RISK FACTORS
ANATOMY
PATHOPHYSIOLOGY/PATHOLOGY
SIGNS AND SYMPTOMS
CLASSIFICATION OF BURNS
FACTORS THAT AFFECT THE DEGREE OF BURNS
ESTIMATION OF EXTENT OF BURNS
MANAGEMENT
CRITERIA FOR REFERRAL
COMPLICATION
CAUSES OF DEATH IN BURNS
3. An 18 year old female sustained burns from a gas explosion in the
kitchen whilst cooking. The burns involved the entire chest up to
the umbilicus and the anterior part of both upper limbs. There
was presence of blisters and blanching of the areas of burns. The
incidence happened around 4pm but she was able to report to the
hospital at about 6pm.
1.What is inhalational injury?
2. What are the risk factors for inhalational injury?
3. What are your differential diagnoses?
4. Give one(1) reason each to support your differential
diagnoses? 5. How will you manage the lady
4. DEFINITION
Burns is defined as coagulative necrosis of the layers of the skin
and other tissues.
Or it can also be defined as damage to the tissue as a result of
injury by various aetiological agents such as thermal (dry and
moist heat), electrical, chemical ( acidic, alkaline, and organic
chemical) and radiation.
These agents causes coagulative necrosis of the tissues with the
exception of alkaline chemicals which causes liquefactive necrosis
with the ability for deeper injury.
5. EPIDEMIOLOGY
Scalds which refers to injury resulting from moist heat has in
the last few decades overtaken flame burns as the common
type of burn injury in the west African sub region. These
injuries occur commonly as domestic accidents with children
and women constituting a majority of the casualties. Burns are
the fifth most common cause of non-fetal childhood injuries.
Commonest site of scald injury occur in the kitchen accounting
to about 50% with the 2nd most common been the bathroom e.g
water heaters.
6. Continuation.
Outcomes for burn patients have improved dramatically over
the past 20 years, yet burns still causes substantial morbidity
and mortality. In the United States, approximately 1.25 million
people with burns present to the emergency department each
year. Among these 63,000 have minor injuries and an additional
6,000 sustain major burn injuries that require hospital
admission.
7. AETIOLOGY / RISK FACTORS
The causative agents of burns can be classified into the following:
THERMAL BURNS
o Dry heat (flame, gas explosion & flash burns)
o Wet heat (hot water, hot soups & hot liquids)
ELECTRICAL BURNS
o Flash burns, flame burns and contact burns.
o Low voltage < 1000Volts.
o High Voltage > 1000 Volts
o Type of current = AC/DC with AC being more dangerous
8. CHEMICAL BURNS
o Acids (sulphuric acid, nitric acid)
o Alkalis (caustic soda, industrial cleaners, cement)
o Organic compounds (phenols, solvents, petroleum products)
RADAITION BURNS
o Thermal radiation
o Radiofrequency energy
o Ionizing radiation
o Ultraviolet(UV) radiation- Sunburn
9. Risk factors
Gender (Females). Higher risk for females is associated with
open fire cooking, or inherently unsafe cookstoves, which can
ignite loose clothing. Self-directed or interpersonal violence are
also factors.
Age. Children are more vulnerable to burns. This is due to
improper adult supervision and child maltreatment.
10. continuation
Socioeconomic factors. People living in low-and middle-income
countries are at higher risk for burns than people living in
higher income countries.
Occupation that increases exposure to fire
Alcohol abuse and smoking
Use of kerosene as a fuel source for non-electric domestic
appliances.
Inadequate safety measures for LPG and electricity.
12. Pathology
The local consequence of exposure to excessive temperature is a
graded tissue injury radiating from the point of contact. The
Jacksonian model of three-dimensional concentric histopathological
zones apparently describes this. The zone of necrosis in the center is
irreversibly damaged. Next to this is the zone of ischemia or stasis
where vascular spasms and intravascular micro-thrombi result in
compromised perfusion with potential to progressive conversion to
tissue death. The outermost zone which is most remote from the
inciting agent is the zone of inflammation or hyperemia manifesting
with the classical signs of inflammation and expected to make
complete recovery in 7-10 days
14. PATHOPHYSIOLOGY
Aside from the local effect of burn which results from heat transfer
and ischemia, large surface area burns are associated with systemic
physiologic derangements which are potentiated by mediators
liberated by the damaged tissue as well as neuro-endocrine organs.
These mediators activate inflammatory responses leading to increased
capillary hydrostatic pressure, generalized leakage of intravenous
fluid, electrolytes and proteins, decreased cardiac output and
suppression of the immune system. Major burn injury is therefore a
systemic disease affecting every system of the body irrespective of
remoteness from site of injury.
15. CONTINUATION
Systemic changes
Oedema maximum at 18-24hrs
Hypovolaemia
Inhalational injury. Inhalation injury is most deserving of immediate
recognition and expeditious intervention.
Renal changes
Respiratory tract changes
GI changes
Central nervous system changes
Haematological changes
Metabolic changes
16. Inhalational injury
The history is usually indicative of exposure to fire or smoke in a closed space
and the clinical features include facial burns, singed nasal vibrissae,
hoarseness, wheezing and the production of carbonaceous sputum and
probably loss of consciousness at the timeofinjury. Fibre-optic bronchoscopy
with its potential for enormous therapeutic benefits is the gold standard for
definitive diagnosis. Whereas heat is dispersed in the upper airways, the soot,
carbon monoxide, hydrogen cyanide and other toxic products of smoke reach
the bronchi and alveoli to evoke inflammatory changes. Increased vascular
dilatation and permeability lead to erythema, exudation and airway oedema.
This may cause patchy broncho-alveolar obstruction and impairment of
oxygenation. The ciliated epithelial cells are separated from the basement
membrane and there may be ulceration with consequent granulation tissue
formation. Proteins in the exudates coalesce to form fibrin casts, which
adhere to the bronchi and interfere with the function of the ciliated cuboidal
cells. Destruction of the ciliated cells lead to replacement with squamous
cells and scar tissue. There may thus be laryngeal obstruction, atelectasis,
respiratory infections, acute lung injury, acute respiratory distress syndrome
and respiratory failure.
18. CLASSIFICATION OF BURNS
Partial thickness burns
o Superficial partial thickness burns
May be difficult to diagnose initially, Involves the epidermis and superficial
layers of dermis .Usually very painful . There are blisters (bullae) formation and
blanching- suggests viable dermis , Appears red or pinkish , Heals by 1-2 weeks
o Deep partial thickness burns
o Involves the epidermis and dermis. Relatively less painful with mottling. Heals
by 3-4 weeks
19. continuation
Full thickness burns
o Involves epidermis, dermis, deep tissues, bones and nerves. Usually insensate
(not painful) with charring. May also appear waxy and
translucent/pale/white. Visible thrombosed veins beneath translucent skin is
characteristic. Heals by 2-3 months
24. FACTORS THAT AFFECT THE DEGREE OF BURNS
Temperature of heat source
Duration of exposure
Consequent inflammatory response
Skin thickness
25. ESTIMATION OF EXTENT OF BURNS
Estimation of percent body surface area can be done using:
o Wallace’s rule of nine
o Lund and Browder chart
Wallace’s rule of nine
Named after Dr Alexander Wallace, who first published the method
The palm is 1% and may be used to estimate the extent of injury
Usually a quick way of estimation although not accurate
Wallace rule is preferred for adults
26. continuation
Lund and Browder’s chart
o Created by Dr Charles Lund and Dr Newton Browder
o More useful for children
o Relatively accurate compared to Wallace rule
o Takes into consideration the age of the patient, i.e. the %BSA
decreases for the head region and increases for the extremities
as the child ages
27.
28.
29. continuation
Superficial burns of 20% body surface area and above in adults or of
10% and above in children is considered major injury because the
associated fluid exudation in the first 48h post-burns may be severe
enough, to produce shock. Furthermore, burn wound infection easily
supervenes in such large areas of acute skin loss with a high risk of
septicemia. Major injuries of this nature should be admitted to
hospital. Similarly, 10% deep burns or above in adults and 5 % deep
burns and above in children also constitute major injury.
30. MANAGEMENT
The principle of management are to revive, restore, repair and to
rehabilitate the patient.
First aid
Resuscitation
History
Examination
Investigations
Treatment
31. FIRST AID
This is the first and foremost care that must be given at the site/venue where the
burns took place
The following principles can be used as a guide
FLAME BURNS
o stop the burning process, Call the National Fire Service on 192 and
national ambulance on 193. Take patient away from the source of flames.
Extinguish flames by rolling the patient on the bare ground i.e STOP,
DROP, ROLL. Remove all hot charred clotting/jewellery as quickly as
possible. If clothing is stuck, cut around the area. Lay the casualty down,
protecting the burned areas from contact with the ground if possible to
prevent contamination. Reassure and transport to hospital
32. Cooling the burn surface
Cool with cold running water for at least 20mins
Check for ABC while cooling and be ready to resuscitate.
DO NOT use ice block or iced water. Extreme cold causes
vasoconstriction, it also deepens injury, risk of hypothermia.
Cooling the surface of wound is an extremely effective analgesia
Cover the injury with a clean gauze or non fluffy material to prevent
contamination
A clean plastic bag or kitchen film may be used
DO NOT put oil, shear butter or any creams on the wound
33. ACID BURNS
Protect your hands and body
Move the patient away from the source
Prompt irrigation with copious water. Should be started within
10mins of contact with the substance
Trim finger nails (some may hide in there)
34. ALKALI BURNS
Less immediate damage than acid
More long-term damage as they liquefy tissue and penetrate
more deeply
Irrigate for longer period- at least 1 hour
35. ELECTRIC BURNS
Don’t panic
First switch off the power source (make sure you’re safe)
Remove victim from power source with a non conductor (dry board or
wood/plastic)
Clear airway
Protect the cervical spine (usually for those who fell and hit the ground)
Start CPR if needed
Check for injuries
Always call for help
36. COAL TAR/BITUMEN
Rapid cooling
Use of cooking oil
DO NOT use any petroleum product e.g.- kerosene, petrol, etc.
which can cause tissue damage and systemic toxic effects
37. RESUSCITATION
Before management of the burn wound can begin, the patient
should be properly and completely evaluated. Often, this is
brief effort, particularly in patients with small,uncomplicated
wounds. In those with larger burns evaluation of the wound is
often of secondary importance. As described by the American
College of Surgeon Committee on Trauma,evaluation of burn
patient is organized into a primary survey and secondary survey.
38. continuation
Primary survey which involves the following systematic methodology.
o Timely resuscitation is important every burns patient
o This can followed as ABCDEF
o A - Airway maintenance and C- spine control
o B - Breathing and ventilation
o C - Circulation with bleeding control
o D - Disability and neurological status
o E - Exposure and environmental control
o F - Fluid resuscitation
39. FLUID RESUSCITATION
Adults with more than 20% TBSA superficial burns and children
with more than 10% TBSA superficial burns or half the values
when the burns are deep require intravenous fluid replacement
to correct the plasma loss and prevent hypovolaemic shock.
Various formulae used in administering fluids are only
estimates, the amount of fluid given should be guided by the
patient's response to treatment as determined by his general
condition (fluid overload, heart failure, kidney failure) and the
hourly urine output. (1-2ml/kg/hr for children).
40. continuation
There are two formulas for the estimation of the amount of fluid intake
for the first 24hrs that is modified Brooke and the Parkland formula, but
the most commonly used formula is the Parkland formula.
The fluid of choice is ringers lactate, but normal saline, human plasma
protein fraction (albumin 4.5%) and dextran 110 may also be used.
Modified Brooke formula is 2mls x TBSA x weight.
Parkland formula is 4mls x TBSA x weight.
50% is the maximal TBSA used even if the TBSA is more than 50%
Half the calculated volume is given within the 1 st 8-hours from the time
of burns.
The 2nd half of the calculated volume is given over the remaining 16-
hours.
41. continuation
The normal daily fluid maintenance is added for children
On the 2nd day (the 2nd 24hrs), half the total volume
calculated for the first 24hrs is given + the daily maintenance
fluid for children.
In patients in whom depth of burns is deep with loss of red
cells, blood may be used as part of the requirement if necesary
42. Secondary survey
History
o Cause of burns- rule out domestic violence in children.
How???
o Time of burns , Place of burns (whether in an enclosed
space) due to inhalational injury and carbon monoxide
intoxication.
o Ask of any complications if patient is conscious e.g.-
cough, difficulty breathing, chest pains, etc.
o Ask of any other injuries sustained (whilst trying to escape
or falling from a height). Helpful if patient is conscious
o Any chronic medical condition
o Current medications/drug history and allergies
43. Examination
Head to toe examination- examine all systems
This should not be limited to only the area of burns
Look out for other injuries including fractures, abrasions
Look out for possible signs of inhalational – singeing of hair in
nostril, soot around the nasal region and mouth, etc.
Persons with facial burns should undergo a careful examination
of the cornea prior to the development of lid swelling that can
compromise examination.
45. INVESTIGATIONS
FBC- to be repeated weekly if patient on admission.
Blood grouping and cross matching- if patient needs transfusion
Sickling- routine if status not known
BUE/CR – to assess renal function and electrolytes. Can be repeated on as
needed basis
LFT- to assess protein and albumen levels. Can be repeated every 2 weeks or
as needed. May also indicate liver damage as a complication
Random blood sugars
CXR- if complications such as inhalational injury or pneumonia is suspected
ECG- crucial in electrical burns
46. TREATMENT
Analgesia
Wound care
Antibiotic therapy
Prophylaxis for Curling’s ulcers
DVT prophylaxis
Tetanus prophylaxis
Nutritional support
Physiotherapy
47. Analgesia
Paracetamol – available as oral, IV and suppository. Adults 500 mg – 1g 6-8hourly.
Children 6-12 years 250-500 mg 6-8 hourly.
Ibuprofen Adults 200 – 800 mg 6-8 hourly. Children 10-15 mg/kg 6-8 hourly
/Diclofenac oral Adults 50mg 8 hourly or 100 mg 12 hourly. Children more than 12
years 50 mg 12 hourly. Not recommended for children less than 12
years./Naproxen EC oral Adults 250-500 mg 12 hourly. Children- not indicated.- not
recommended in severe burns due to Curling’s ulcers but can be used in minor
burns
Tramadol- available as IV, IM and oral
Morphine- available as IV, IM and oral
Pethidine – available as IM or IV
NB: the choice of analgesia will depend on individual patient factors
48. Wound care
This is often done after resuscitation
The wound is cleaned with water and antiseptic under sedation or adequate
analgesia
Blisters can be left alone if patient will be transferred to a high centre
Blisters can also be de-roofed to help estimate percentage body surface area
All debris and devitalized tissue are debrided/removed
Topical antibacterial creams can be used • Silver sulfadiazine (dermazin, silver
derma, flamazine) • Mupirocin (supirocin, bactroban) • Povidone iodine
Wound is preferably covered with Vaseline gauze to prevent material from sticking
into the wound- exclude facial wounds Dressing- typical dressing for burns -
Vaseline gauze -Soff ban -Crepe bandage -Occasionally – POP application if
indicated
49. Antibiotic therapy
Antibiotics are not routinely recommended in most adult burns where
contamination is not suspected
All children with burns should however be placed on antibiotics
All burns managed outside a burns unit may also consider antibiotics since
those environments are often not sterile
The choice of antibiotics should be individualised
Commonly used: Cefuroxime, metronidazole, flucloxacillin, clindamycin,
ceftriaxone, etc.
When available, wound culture can be done to guide antibiotic choice
50. Prophylaxis for Curling’s ulcer
Proton pump inhibitors are often used
o Omeprazole
o Esomeprazole
Antacids may be added for symptomatic relief
o Magnesium tricilicate /Aluminium hydroxide mixtures (e.g.-
Nugel suspension)
51. DVT Prophylaxis
For major burns with prolonged hospitalization
Any of the following can be used if indicated and available
o Heparin
o Enoxaparin (Clexane)
o Dalteparin (Fragmin)
They are usually given subcutaneous (SC)
52. Tetanus Prophylaxis
Tetanus vaccine – can be given to those without previous
tetanus immunization history
Human tetanus immunoglobulin- anti-tetanus serum(ATS)- if
available. NB-Give only after resuscitation
Both are given IM
53. Nutritional support
High protein diets recommended- eggs, beans, fish, etc.
Parenteral amino acids if available – Astymin-3
Dietician or nutritionist should be involved if available
Add haematinics if no active infection ongoing- , Iron III
polymaltose, Ferrous sulphate, Folic acid, etc.
Add Vitamin C to improve wound healing
54. Physiotherapy
Starts right from the beginning of the burn injury
Exercises to the underlying joints before each dressing
Splinting when necessary
Encouraging the patient to use affected limbs in every day
activities
Mobilize out of bed as early as possible
55. CRITERIA FOR REFERRAL
Burns more than 10% TBSA
Burns involving the face, hands, feet, genitalia, perineum and major
joints
3rd degree (full thickness) burns in any age group
Electrical burns including lightening injury
Chemical burns Inhalational injury
Burns in patients with co-morbid medical conditions that could
complicate management, prolong recovery or affect mortality
Burned children without qualified personnel or equipment for their care
Burn injury in patients who will require special social, emotional and
rehabilitative interventions.
56. COMPLICATIONS
Early complications of burns are the pathophysiological changes that would
affect every system of the body when the appropriate resuscitation is
inadequate or delayed.
Hypovolaemic Shock
Infections
Gastrointestinal problems Acute gastric dilatation, Paralytic ileus, Curling's
ulcers, Liver damage
Cardio-respiration problems Respiratory obstruction Tracheo-bronchitis
Pneumonia, atelectasis
Genito-urinary problems Renal failure Cystitis, pyelonephritis, Calculi
Vascularproblems Thrombophlebitis, Deep venous thrombosis Pulmonary
embolism
Anemia Disseminated intravascular coagulation (DIC)
57. continuation
Late complications of burns are usually related to consequences of
poor healing of the burn wound and include
Unstable scars and chronic burn wounds.
Burn scar hypertrophy and Keloids
Burn scar contractures and deformities
Dyschromic scars (hypo-, hyper-, & de-pigmentation)
Burn Scar metaplasia and Marjolin's ulcers
Loss of body parts.
Psychiatric problems including PTSD
58. CAUSES OF DEATH IN BURNS
Hypovolemic shock
Renal failure
Sepsis
Laryngeal oedema/inhalational injury
Curling’s ulcers --- upper GI bleeding/perforation