practical management of burns.

1. DEPARTMENT OF SURGERY
SURG CDR AMITABH MOHAN
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4.  265 000 deaths every year
 Women in our region have the highest rate of burns
 27% of global burn deaths and nearly 70% of
fatalities in the region
 India - 70 lakh people burnt every year
 Non-fatal burn injuries are a leading cause of
morbidity though Preventable
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5. Thermal
 Scald
 Flame
Chemical
Electrical
Radiation
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6.  Classified
 Depth of injury
 Extent of body surface area involved
 Burn wounds differentiated depending on
the level of dermis and subcutaneous tissue
involved
1. superficial (first-degree)
2. deep (second-degree)
a Partial
b Full
3. full thickness (third and fourth degree)
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7.  Epidermal tissue only
affected
 Erythema, blanching on
pressure, mild swelling
no vesicles or blister
sunburn
 Heals in 7 days- generally
no scaring
 Topical emolient
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8.  Involves the
epidermis and
superficial layer of
the dermis
 Fluid-filled vesicles
–red, shiny, wet,
severe pain
 Heals in 14-21 days
 red raw surface will
be very painful
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9.  Destruction of all
skin layers
 Requires
immediate
hospitalization
 Dry, waxy white,
leathery, or hard
skin, no pain
 Will need skin
grafts
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10.  Superficial  Deep
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12.  Wallace rule of nine
 Adult
 Paediatric
 Palm Method
 Lund and Browder chart
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17.  Minor Burn
exclusion
 area > 5% of body surface
 deep
 infected
 problem area - face,
hands, perineum, feet
 inhalation injury
 other injury or underlying
medical problem
 suspected non-accidental
injury
 Major Burn
 Deep burn, BSA>10%
under 10yrs age.
 Deep burn, BSA>20%
over 10 yrs age.
 FTB with affected
BSA>5%.
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18. Rescue
Resuscitate
Refer
Resurface
Rehabilitate
Reconstruct
Review
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19.  Stop the burning process
 “Stop and drop”
 Cover with Blanket
 Do not pull clothes
 Cut clothes
 Shift to hospital
 Avoid hypothermia
 Remove constricting clothing and jewelry
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20. Rescue
Resuscitate
Refer
Resurface
Rehabilitate
Reconstruct
Review
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21.  Details of the incident
 Cause of the burn
 Time of injury
 Place of the occurrence (closed space, presence
of chemicals, noxious fumes)
 Likelihood of associated trauma (explosion,…)
 Pre-hospital interventions
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22.  ATLS: ABC & Secondary Survey
 Airway/ Breathing Control
 Air way
 Breathing
 Circulation
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23.  History & Physical:
Inhalational injury
 Fire in a closed space
 Full-thickness burns to
face, neck
 Singed nasal hair
 Carbonaceous sputum
 Carbonaceous particles in
oropharynx
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24.  Intubate patient as
early as possible
before airway
swelling.
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25.  Indications for intubation:
 Oropharyngeal erythema/ swelling on direct
visualization
 Change in voice, harsh cough
 Stridor
 Dyspnea, tachypnea
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26.  Circumferential full-thickness
burns may impair ventilation
 Blast injuries can cause
pneumothorax, lung contusions
 Noxious chemical (plastic) can
cause a chemical pneumonitis
 Carbon monoxide poisoning (if
COHb > 15-40% ventilate)
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28.  IV Access
 Wide bore cannula
 Calculate TBSA and Depth
IV FLUID
 Examine for other injuries
 Catheterize
 Tetanus prophylaxis
 Clean the wound
 Dressing
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30.  Fluid in next 24 hrs
 Volume of fluid infused per hour roughly
reduced by 50%
 Urine output 0.5 ml/kg/hr
 Fluid infused
 5% dextrose
 RL / NS
 Colloid ?
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31.  Electric Burns
 7 ml /kg /% of Burn
 Alkalinize the urine
 Soda bicarbonate - 1-2 mEq/kg
 Mannitol at 1 gm / KG
 Urine output - up to 2-3
mL/kg/h
 Acetazolamide - alkalinizes the
urine
 Myoglobinuria
 Fasciotomy
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32.  Paediatric
 Use Parkland formula +
MAINTENANCE fluid
 Maintenance fluid, hourly
rate
 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
 Urine output -1.0-1.5
mL/kg/hr
 Maintenance fluid given is
D5W/ iso-p ( limited
glycogen stores).
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33.  Inotropes ?
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34. Tetanus Immunization
Analgesics
No aspirin
Strict surgical asepsis
ANTIBIOTICS ?
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35. Airway compromise?
Respiratory distress?
Circulatory compromise?
Intubation, 100% O2
IV access, fluids
Multiple trauma?
Yes No
Evaluate &
treat injuries
Burns >15%, or
complicated burns?
Yes No
Burn care, tetanus prophylaxis, analgesia
IV access; fluid
replacement
Circumferential full
thickness burns?
Escharotomy
Yes
Yes
No
No
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36. Full-thickness > 5% BSA
Deep Partial Thickness burns
>10% TBSA
Paediatric > 5% burn
 Burns that involve the face, hands, feet,
genitalia, perineum, or major joints
 Full thickness burns in any age group
 Electrical burns
 Inhalation burns
 Chemical burns
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37. Depth of Burns
Extent of Burns
Location of Burns
Age of Client
Risk Factors
Major vs Minor Burns
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38. FORMULA
 AGE + % of Burn
 Burn Index
 Deep burn / total burn X 100
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41.  Topical antiseptics
 Silver
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42.  Collagen sheet
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43.  Silver dressing
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44.  Amnion
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46. 1 2
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47.  After burn wounds are cleaned, topical
antibiotics are applied
 Multiple layers of gauze applied over the
topical agents on the burn wound
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48. • Children have nearly 3 times BSA:BM ratio
• Children <2yr have thinner layers of skin
• Burn that may appear partial thickness may
instead be a full thickness burn.
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49.  Fluid Resuscitation
 7ml/kg /hr
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50.  Early excision and
grafting
 Why
 When
 How
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51. Focus for sepsis
Stimulates inflammatory mediators
Cannot heal without grafts
Future scar quality
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52. Early
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53. Tangential excision Fascial excision
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54. Superior outcomes where suitably equipped
 mortality
 length of hospital stay
 morbidity during acute burn
 scar quality
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56.  When skin is damaged it either
 Heals on its own
or
 Needs donor skin or a graft
 This grafted skin provides comfort and
prevents fluid loss and infection
‘SAVES THE LIFE OF A BURN VICTIM’
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57.  Permanent skin cover:
 Autograft – From the victim’s unaffected
area
 Temporary skin cover:
 Homograft – Live Donor
 Allograft – Cadaver Donor
 Xenograft – Porcine Pigs and Bovine Cows
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58.  Most preferred donor skin
 Only the superficial layers
of the skin are harvested
 No matching is required
 Can be harvested in 45
minutes
 Should be harvested
within 6 hours after death
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59. People expired due to:
 HIV and Hepatitis negative
 Skin disease
 Cancer
 Active Jaundice
 Sexually transmitted disease
 Severe infection
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60. North india
 Dayanand medical College Ludhiana
South Zone
 St. John Medical College, Bangalore
South Zone
 Rotary Club of Chennai , Chennai
East Zone
 Sum Hospital, Bhubaneswar
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61.  Live Donor
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63.  Integra- Bovine collagen
 Alloderm- derived from donated human skin
 CEA (cultured epithelial autograft)-
unburned skin biopsied and sent to lab to grow
with epithelial growth factor added.
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