Antibiotics and analgesics

1. Management of burn
wounds
Submitted by
Shanza Asmat Roll 36
Submitted to Dr. Zahid
Surgery clinic 3

2. Burn wounds
 A burn is an injury to the skin or other organic tissue primarily caused by heat or due to
radiation, radioactivity, electricity, friction or contact with chemicals.
 The extent of injury is influenced by temperature of the heat source, duration of contact
and tissue conductance.
 Burn wounds could be due to
Thermal burns:-
Thermal (heat) burns occur when some or all of the cells in the skin or other tissues are
destroyed by:
hot liquids (scalds)
hot solids (contact burns), or
flames (flame burns)
Electrical burns:-
When animal comes in contact with electric current.
Chewing on electrical cord is the most common cause.

3.  Such burns may present as external current marks, singed hair or feathers,
metallization of the skin, or occasionally internal electroporation injury
resulting in muscle necrosis, hemolysis, injury to brain and spinal cord, or
skeletal fractures or immediate death due to respiratory paralysis.
 Chemical burns
A chemical burn is a serious condition caused by corrosive substances (either an
acid or an alkali) like oxidizers, solvents, and other toxic substances. The burns
may be on the skin, eyes, in the lungs, or in the digestive system depending on
whether it is a solid, liquid, or gas.
Acids like ammonia, battery acid, oxidizers, aspirins, insect repellents (boric
acid), and many other cleaners.
Alkali such as lye, lime, metal cleaners, degreasers, fertilizers, bleach.

4. Classification of burns
1. Superficial (first degree) burns:-
Superficial (first-degree) burns affect only the epidermis.
The area is painful, thickened, erythematous, and desquamated.
• Healing occurs rapidly (within 3–6 days) by epithelialization from stratum
germinativum(epidermis deepest layer). • Superficial partial-thickness burns are
moist, blanch with pressure, and are sensitive to pain.They usually heal within 3
weeks because of epithelialization from deeper portions of the skin appendages.
Healing is usually complete and occurs without grafting.
2- Deep partial thickness ( second degree) burns:-
Cause major destruction of the dermis. Subcutaneous edema and notable
inflammation occur, and the hair does not remove easily. Progressive damage during
the first 24 hours results from the heat of injury and the release of proteolytic
enzymes,prostaglandins, and vasoactive substances. Although these burns frequently
heal without grafting, healing takes months, and scarring may be extensive. Healing
occurs by reepithelialization from deep adnexa and wound margins.

5.  Full thickness ( third degree) burns
 Full-thickness (third-degree) burns form a dark brown, insensitive, leathery
eschar. All skin structures are destroyed,and hair removes easily. Third-degree
burns are less painful than first- or second-degree burns as nerves have been
destroyed. • Superficial vascular thrombosis and deep vascular permeability
cause subcutaneous edema and necrosis. Healing occurs by contraction and
reepithelialization unless the wound is reconstructed.
 Fourth degree burns:-
Burns that extend beyond the dermis are sometimes classified as fourth-degree
burns. They have the same characteristics as third-degree burns but with
additional tissue damage extending into the muscle and bone. Healing by
reconstruction is usually required.

7. Physical Examination
 Complete physical exam before burn wound treatment is done
 The patient condition should be stabilized first
 Burn wounds is evaluated for edema, pain, blister formation, presence of
infection
 Evaluate TPR
 Check cornea damage or not( lacrimation)
 Coughing indicates smoke inhalation
 Evaluate %TBSA affected
 Lab exam may show hemoglobinuria, anemia, hypokalemia
 Animal with deep burns involved 30-50% of TBSA should be euthanized.

8. Burn Wound Management
 Emergent phase/ on scene care
 Intermediate phase
 Rehabilitation phase
1. Emergency procedures at the Burn Scene
 Extinguish flames
 Cool the burn
 Remove restrictive objects
 Irrigate chemical burns

9. Intermediate phase
 Fluid administration
To avoid hypovolemic shock
For this Ringer lactate or hypertonic saline solution should be administered.
The amount of isotonic fluid administered during first 24 hours may be administered by the
% TBSA burned.
Four mL lactated ringers solution × percentage total body surface area (%TBSA) burned
× patient’s weight in kilograms = total amount of fluid given in the first 24 hours
 Anelgesics may be applied topically or generally to combat pain during wound
management.
 Removal of dead tissue is essential to the control of sepsis and promotion of a viable vascular bed
suitable for surgical closure.
 Loose and obviously devitalized tissue in partial-thickness burns may be removed with scissors,
hydrotherapy, or gauze sponge abrasion.
 With full-thickness burns, sharp excision to muscle fascia is necessary.
 Early burn excision is recommended to minimize secondary infections and systemic effects (e.g.,
endotoxins and blood loss).
 Small burn wounds can be excised and closed primarily.
 Closure is achieved by skin advancement or skin flaps. Larger wounds may be allowed to heal by
contraction and epithelialization, or they may be grafted.

10. Wound dressings
 Wound dressings most dressings have a beneficial effect on wounds, silver
sulfadiazine delivers the best protection against wound colonization and infection.
Silver sulfadiazine is bactericidal with activity against gram-positive and gram-
negative bacteria and Candida spp.
 • However, aloe vera is associated with faster rates of reepithelization in partial-
thickness burns.
 Paraffin gauze dressings have been shown to be associated with short healing
times in superficial burns, and silver-based dressings are of most benefit in deeper
burns.
 Nanocrystalline silver dressings (Acticoat) have stronger antibacterial activity and
are associated with less pain and reduced frequency of bandage changes. • Clip
the wound and surrounding hair before gently lavaging with an antiseptic solution
(e.g., 0.05% chlorhexidine diacetate).
 • Cover the wound with a topical aloe vera compound or silver sulfadiazine, and
then apply a hydrophilic bandage.
 • After the first 24 hours, apply watersoluble, 1% silver sulfadiazine cream
(Thermazene, Silvadene) to the wound once or twice daily or a slow-release silver
sulfadiazine dressing once every 3 to 7 days .

11. Rehabilitation phase
 Involves nutritional and metabolic management
 High energy diet is recommended.

12. Smoke inhalation injury
 Smoke inhalation injury is the damage to the body associated with breathing
in superheated air or steam, other harmful gases, vapors, and particulate
matter resulting from thermal combustion.
 If smoke inhalation,then place animal in open air
 Nasal or tracheal insufflation of humified 100% oxygen
 Administer broncho dilators.