This document discusses the initial management and assessment of major burns. It covers three key areas:
1) Assessment of burn area, which is important for calculating fluid resuscitation. The palm method, Wallace rule of nines, and Lund-Browder chart are described as methods to estimate burn percentage.
2) Fluid resuscitation regimens, with the Parkland formula being most commonly used. Goals are replacing fluid losses and maintaining urine output.
3) Evaluating burn depth and the need for escharotomies to relieve pressure in circumferential burns. Burn depth is difficult to determine and depends on factors like bleeding, sensation, and blanching response.
pediatric emergency its from important topics in pediatric and in this show we will discuss the most important things like shock and its types with special overview on hypovomlemic shock and its treatment and anaphylactic shock also with its treatment then transfered to other important one which is status asthmaticus and its treatment and then status epiliptucs and poisning
pediatric emergency its from important topics in pediatric and in this show we will discuss the most important things like shock and its types with special overview on hypovomlemic shock and its treatment and anaphylactic shock also with its treatment then transfered to other important one which is status asthmaticus and its treatment and then status epiliptucs and poisning
En ésta oportunidad, la Dra Karoll Ximena Concha Sepúlveda, jefa de residentes del servicio de anestesiología del Hospital Provincial de Neuquén, nos brinda una interesante actualización sobre el manejo del dolor en el paciente gran quemado, transmitiendo su experiencia adquirida durante su rotación por el Hospital de Urgencia Asistencia Pública (HUAP) principal centro de atención de urgencias médicas de adultos de la Región Metropolitana de Santiago, Chile.
Gran quemado pediátrico Congreso Sociedad Chielna de Cirugía Pediátrica valdi...Sebastian Villegas
Conferencia realizada en la seccional de Cirugía Plástica Pediátrica del 43 Congreso Chileno de Cirugía Pediátrica, en la mesa redonda "Tratamiento de quemados críticos"
complete information about the fluid resuscitation in burn patients, types of care given to the patient in the hospital after burning accidents, fluid replacement therapy, medical management, nursing management.
Burns management presentation by 2nd yr MSC nursing studentSigymol John
this ppt deals with the management part of burns, mainly divided as pre-hospital care, emergent phase,acute phase and rehabilitation phase along with nursing management,nursing diagnosis and interventions.
this slide is selection important part of thermal burn topic in
Tintinalli's Emergency Medicine
with this presentation you can have a great present in your collage.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
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Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...
Manejo inicial gran quemado ii
1. ABC of burns
Initial management of a major burn: II—assessment and resuscitation
Shehan Hettiaratchy, Remo Papini
Assessment of burn area
Assessment of burn area tends to be done badly, even by those
who are expert at it. There are three commonly used methods
of estimating burn area, and each has a role in different
scenarios. When calculating burn area, erythema should not be
included. This may take a few hours to fade, so some
overestimation is inevitable if the burn is estimated acutely.
Palmar surface—The surface area of a patient’s palm (including
fingers) is roughly 0.8% of total body surface area. Palmar surface
are can be used to estimate relatively small burns ( < 15% of total
surface area) or very large burns ( > 85%, when unburnt skin is
counted). For medium sized burns, it is inaccurate.
Wallace rule of nines—This is a good, quick way of estimating
medium to large burns in adults. The body is divided into areas
of 9%, and the total burn area can be calculated. It is not
accurate in children.
Lund and Browder chart—This chart, if used correctly, is the
most accurate method. It compensates for the variation in body
shape with age and therefore can give an accurate assessment
of burns area in children.
It is important that all of the burn is exposed and assessed.
During assessment, the environment should be kept warm, and
small segments of skin exposed sequentially to reduce heat loss.
Pigmented skin can be difficult to assess, and in such cases it
may be necessary to remove all the loose epidermal layers to
calculate burn size.
Resuscitation regimens
Fluid losses from the injury must be replaced to maintain
homoeostasis. There is no ideal resuscitation regimen, and
many are in use. All the fluid formulas are only guidelines, and
their success relies on adjusting the amount of resuscitation
fluid against monitored physiological parameters. The main
aim of resuscitation is to maintain tissue perfusion to the zone
of stasis and so prevent the burn deepening. This is not easy, as
too little fluid will cause hypoperfusion whereas too much will
lead to oedema that will cause tissue hypoxia.
The greatest amount of fluid loss in burn patients is in the
first 24 hours after injury. For the first eight to 12 hours, there is
a general shift of fluid from the intravascular to interstitial fluid
compartments. This means that any fluid given during this time
will rapidly leave the intravascular compartment. Colloids have
no advantage over crystalloids in maintaining circulatory
volume. Fast fluid boluses probably have little benefit, as a rapid
rise in intravascular hydrostatic pressure will just drive more
fluid out of the circulation. However, much protein is lost
through the burn wound, so there is a need to replace this
oncotic loss. Some resuscitation regimens introduce colloid
after the first eight hours, when the loss of fluid from the
intravascular space is decreasing.
Burns covering more than 15% of total body surface area in
adults and more than 10% in children warrant formal
resuscitation. Again these are guidelines, and experienced staff
can exercise some discretion either way. The most commonly
used resuscitation formula is the Parkland formula, a pure
crystalloid formula. It has the advantage of being easy to
Adult Child
Back
= 18%
Back
= 18%
Head = 9%
(front and back)
Head = 18%
(front and back)
Right arm
= 9%
Perineum
= 1%
Perineum
= 1%
Left arm
= 9%
Left arm
= 9%
Right leg
= 18%
Right arm
= 9%
Right leg
= 13.5%
Left leg
= 18%
Left leg
= 13.5%
Chest = 18%
Chest = 18%
Wallace rule of nines
% Total Body Surface Area Burn
Be clear and accurate, and do not include erythema
(Lund and Browder)
REGION PTL
%
FTL
Head
Neck
Ant. trunk
Post. trunk
Right arm
Left arm
Buttocks
Genitalia
Right leg
Left leg
Total burn
AREA
A = 1
/2 OF HEAD
B = 1
/2 OF ONE THIGH
C = 1
/2 OF ONE LOWER LEG
Age 0
91
/2
23
/4
21
/2
1
81
/2
31
/4
21
/2
5
61
/2
4
23
/4
10
51
/2
41
/2
3
15
41
/2
41
/2
31
/4
Adult
31
/2
43
/4
31
/2
A
13
1
1
1
22
11
/2 11
/2
11
/2 11
/2
13
/413
/4
B B
C C
A
13
22
11
/2
21
/2 21
/2
11
/2
11
/2 11
/2
13
/413
/4
B B
C C
Lund and Browder chart
This is the fifth in a series of 12 articles
Clinical review
101BMJ VOLUME 329 10 JULY 2004 bmj.com
2. calculate and the rate is titrated against urine output. This
calculates the amount of fluid required in the first 24 hours.
Children require maintenance fluid in addition to this.
The starting point for resuscitation is the time of injury, not the
time of admission. Any fluid already given should be deducted
from the calculated requirement.
At the end of 24 hours, colloid infusion is begun at a rate of
0.5 ml×(total burn surface area (%))×(body weight (kg)), and
maintenance crystalloid (usually dextrose-saline) is continued at
a rate of 1.5 ml×(burn area)×(body weight). The end point to
aim for is a urine output of 0.5-1.0 ml/kg/hour in adults and
1.0-1.5 ml/kg/hour in children.
High tension electrical injuries require substantially more
fluid (up to 9 ml×(burn area)×(body weight) in the first 24
hours) and a higher urine output (1.5-2 ml/kg/hour).
Inhalational injuries also require more fluid.
In Britain Hartman’s solution (sodium chloride 0.6%,
sodium lactate 0.25%, potassium chloride 0.04%, calcium
chloride 0.027%) is the most commonly used crystalloid.
Colloid use is controversial: some units introduce colloid after
eight hours, as the capillary leak begins to shut down, whereas
others wait until 24 hours. Fresh frozen plasma is often used in
children, and albumin or synthetic high molecular weight
starches are used in adults.
The above regimens are merely guidelines to the probable
amount of fluid required. This should be continuously adjusted
according to urine output and other physiological parameters
(pulse, blood pressure, and respiratory rate). Investigations at
intervals of four to six hours are mandatory for monitoring a
patient’s resuscitation status. These include packed cell volume,
plasma sodium, base excess, and lactate.
Burns units use different resuscitation formulas, and it is
best to contact the local unit for advice.
Escharotomies
A circumferential deep dermal or full thickness burn is inelastic
and on an extremity will not stretch. Fluid resuscitation leads to
the development of burn wound oedema and swelling of the
tissue beneath this inelastic burnt tissue. Tissue pressures rise
and can impair peripheral circulation. Circumferential chest
burns can also cause problems by limiting chest excursion and
impairing ventilation. Both of these situations require
escharotomy, division of the burn eschar. Only the burnt tissue
is divided, not any underlying fascia, differentiating this
procedure from a fasciotomy.
Incisions are made along the midlateral or medial aspects of
the limbs, avoiding any underlying structures. For the chest,
longitudinal incisions are made down each mid-axillary line to
the subcostal region. The lines are joined up by a chevron
incision running parallel to the subcostal margin. This creates a
mobile breastplate that moves with ventilation. Escharotomies
are best done with electrocautery, as they tend to bleed. They
are then packed with Kaltostat alginate dressing and dressed
with the burn.
Although they are an urgent procedure, escharotomies are
best done in an operating theatre by experienced staff. They
should be discussed with the local burns unit, and performed
under instruction only when transfer is delayed by several
hours. Initially, at risk limbs should be elevated and observed.
Assessment of burn depth
The depth of burn is related to the amount of energy delivered
in the injury and to the relative thickness of the skin (the dermis
is thinner in very young and very old people).
Parkland formula for burns resuscitation
Total fluid requirement in 24 hours =
4 ml×(total burn surface area (%))×(body weight (kg))
50% given in first 8 hours
50% given in next 16 hours
Children receive maintenance fluid in addition, at hourly rate of
4 ml/kg for first 10 kg of body weight plus
2 ml/kg for second 10 kg of body weight plus
1 ml/kg for > 20 kg of body weight
End point
Urine output of 0.5-1.0 ml/kg/hour in adults
Urine output of 1.0-1.5 ml/kg/hour in children
Worked examples of burns resuscitation
Fluid resuscitation regimen for an adult
A 25 year old man weighing 70 kg with a 30% flame burn was
admitted at 4 pm. His burn occurred at 3 pm.
1) Total fluid requirement for first 24 hours
4 ml×(30% total burn surface area)×(70 kg) = 8400 ml in 24 hours
2) Half to be given in first 8 hours, half over the next 16 hours
Will receive 4200 ml during 0-8 hours and 4200 ml during 8-24 hours
3) Subtract any fluid already received from amount required for first
8 hours
Has already received 1000 ml from emergency services, and so needs
further 3200 ml in first 8 hours after injury
4) Calculate hourly infusion rate for first 8 hours
Divide amount of fluid calculated in (3) by time left until it is 8 hours
after burn
Burn occurred at 3 pm, so 8 hour point is 11 pm. It is now 4 pm, so
need 3200 ml over next 7 hours:
3200/7 = 457 ml/hour from 4 pm to 11 pm
5) Calculate hourly infusion rate for next 16 hours
Divide figure in (2) by 16 to give fluid infusion rate
Needs 4200 ml over 16 hours:
4200/16 = 262.5 ml/hour from 11 pm to 3 pm next day
Maintenance fluid required for a child
A 24 kg child with a resuscitation burn will need the following
maintenance fluid:
4 ml/kg/hour for first 10 kg of weight = 40 ml/hour plus
2 ml/kg/hour for next 10 kg of weight = 20 ml/hour plus
1 ml/kg/hour for next 4 kg of weight = 1×4 kg = 4 ml/hour
Total = 64 ml/hour
Escharotomy in a
leg with a
circumferential
deep dermal burn
Line of
escharotomies
Diagram of
escharotomies for
the chest
Clinical review
102 BMJ VOLUME 329 10 JULY 2004 bmj.com
3. Classification of burn depths
Burns are classified into two groups by the amount of skin loss.
Partial thickness burns do not extend through all skin layers,
whereas full thickness burns extend through all skin layers into
the subcutaneous tissues. Partial thickness burns can be further
divided into superficial, superficial dermal, and deep dermal:
x Superficial—The burn affects the epidermis but not the
dermis (such as sunburn). It is often called an epidermal burn
x Superficial dermal—The burn extends through the epidermis
into the upper layers of the dermis and is associated with
blistering
x Deep dermal—The burn extends through the epidermis into
the deeper layers of the dermis but not through the entire
dermis.
Estimation of burn depth
Assessing burn depth can be difficult. The patient’s history will
give clues to the expected depth: a flash burn is likely to be
superficial, whereas a burn from a flame that was not rapidly
extinguished will probably be deep. On direct examination,
there are four elements that should be assessed—bleeding on
needle prick, sensation, appearance, and blanching to pressure.
Bleeding—Test bleeding with a 21 gauge needle. Brisk
bleeding on superficial pricking indicates the burn is superficial
or superficial dermal. Delayed bleeding on a deeper prick
suggests a deep dermal burn, while no bleeding suggests a full
thickness burn.
Sensation—Test sensation with a needle also. Pain equates
with a superficial or superficial dermal burn, non-painful
sensation equates with deep dermal injury, while full thickness
injuries are insensate. However, this test is often inaccurate as
oedema also blunts sensation.
Appearance and blanching—Assessing burn depth by
appearance is often difficult as burns may be covered with soot
or dirt. Blisters should be de-roofed to assess the base. Capillary
refill should be assessed by pressing with a sterile cotton bud
(such as a bacteriology swab).
x A red, moist wound that obviously blanches and then rapidly
refills is superficial
x A pale, dry but blanching wound that regains its colour
slowly is superficial dermal
x Deep dermal injuries have a mottled cherry red colour that
does not blanch (fixed capillary staining). The blood is fixed
within damaged capillaries in the deep dermal plexus
x A dry, leathery or waxy, hard wound that does not blanch is
full thickness. With extensive burns, full thickness burns can
often be mistaken for unburnt skin in appearance.
Most burns are a mixture of different depths. Assessment of
depth is important for planning treatment, as more superficial
burns tend to heal spontaneously whereas deeper burns need
surgical intervention, but is not necessary for calculating
resuscitation formulas. Therefore, in acute situations lengthy
depth assessment is inappropriate. A burn is a dynamic wound,
and its depth will change depending on the effectiveness of
resuscitation. Initial estimates need to be reviewed later.
Shehan Hettiaratchy is specialist registrar in plastic and reconstructive
surgery, Pan-Thames Training Scheme, London; Remo Papini is
consultant and clinical lead in burns, West Midlands Regional Burn
Unit, Selly Oak University Hospital, Birmingham.
The ABC of burns is edited by Shehan Hettiaratchy; Remo Papini;
and Peter Dziewulski, consultant burns and plastic surgeon, St
Andrews Centre for Plastic Surgery and Burns, Broomfield Hospital,
Chelmsford. The series will be published as a book in the autumn.
Competing interests: RP has been reimbursed by Johnson & Johnson,
manufacturer of Integra, and Smith & Nephew, manufacturer of Acticoat
and TransCyte, for attending symposiums on burn care.
BMJ 2004;329:101–3
Epidermis
Superficial
Superficial
dermal
Deep
dermal
Full
thickness
Dermis
Subcutaneous
Diagram of the different burn depths
Full thickness burn in a black patient. In a white patient with extensive
burns, such full thickness burns can easily be mistaken for unburnt skin
Assessment of burn depth
Burn type
Superficial
Superficial
dermal
Deep
dermal
Full
thickness
Bleeding on
pin prick
Brisk Brisk Delayed None
Sensation Painful Painful Dull None
Appearance Red,
glistening
Dry, whiter Cherry red Dry, white,
leathery
Blanching to
pressure
Yes, brisk
return
Yes, slow
return
No No
Key points
x Accurate assessment of burn area is crucial to calculate
resuscitation formula
x Resuscitation formulas are only guidelines—monitor the patient
x Discuss resuscitation with a burns unit
x Be aware of the need for escharotomies
x Burn depth is difficult to estimate and changes with resuscitation
Further information
x Clarke J. Burns. Br Med Bull 1999;55:885-94
x Herndon D. Total burn care. 2nd ed. London: WB Saunders, 2002
x Kao CC, Garner WL. Acute burns. Plast Reconstr Surg 2000;105:
2482{93
x Yowler CJ, Fratianne RB. The current status of burn resuscitation.
Clin Plast Surg 2000;1:1-9
x Collis N, Smith G, Fenton OM. Accuracy of burn size estimation
and subsequent fluid resuscitation prior to arrival at the Yorkshire
Regional Burns Unit. A three year retrospective study. Burns 1999;
25: 345-51
x Burnsurgery.org (see www.burnsurgery.org)
Clinical review
103BMJ VOLUME 329 10 JULY 2004 bmj.com