BURNS MANAGEMENT PPT BY DR SUJITH CHADALA MD GEN MED , PGPC , IDCCM

1. BURNS
Dr SUJITH CHADALA
MBBS ( OSM ) , MD GEN MEDICINE ( OSM )
PGPC ( JOHNS HOPKINS )
IDCCM ( FELLOWSHIP IN CRITICAL CARE )

2. Definition
• Defined as a wound caused by exogenous agent leading to
coagulative necrosis of the tissue

3. Causes
• Thermal burns –Dry heat, Moist heat ,Smoke & Inhalatonal injury
• Chemical burns – acids & alkali
• Electrical burns – high & low voltage
• Cold burns – frostbite
• Radiation

4. Thermal burns
• Heat changes molecular structure of tissue causing denaturation of
proteins
• Extent of burns damage depends on
-Temperature of agent
- Amount of heat
-Duration of contact

5. • Effects of burns influenced by
1.Intensity of energy
2.Duration of exposure
3.Type of tissue injured

6. Pathophysiology of Burns
• Fluid shift
- Period of inflammatory response
- Vessels adjacent to burn injury dilate  increased capillary hydrostatic pressure & capillary permeability
- Continous leak of plasma from intravascular space into interstitial space
- Associated imbalances of fluids ,electrolytes & acid –base occur
- Hemoconcentration
- Last 24-36 hrs

8. • Metabolic
- Hypermetabolic state
* Increased oxygen & calorie requirements
* Increase in core body temperature
• Immunologic
- Loss of protective barrier
- Increased risk of infection
- Suppression of humoral & cell mediated immune responses

9. ACUTE PHASE
• Clinical Shock
• External loss of plasma
• Loss of circulating red cells
• Burn edema

10. Body’s response to burns
• Emergent Phase (stage 1)
- - Pain response
- Catecholamine release
- Tachycardia, tachypnea, Mild hypertension
• Fluid Shift Phase (stage 2 )
- Length 18-24 hrs
- Begins after emergent phase (reaches peak in 6-8 hrs)
- Damaged cells initiate inflammatory response ( Increased blood flow to cells, Shift of fluid from
intravascular to extravascular space )

11. • Hypermetabolic Phase ( stage 3)
- Last for days to weeks
- Large increase in body’s need for nutrient as it repairs itself
• Resolution Phase( stage 4)
- Scar formation
- General rehabilitation & progression to normal function