Plastic surgeon objectives To understand the pathophysiology of burns To be aware of complications of burns To assess the size and depth of burns To understand the method for calculating fluids to be given in burn patient ID: 915724
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Slide1
BURN
Dr.
Yaseen
Abdullah
Plastic surgeon
Slide2objectives
To understand the
pathophysiology
of burns
To be aware of complications of burns
To assess the size and depth of burns
To understand the method for calculating fluids to be given in burn patient
To understand the techniques for treating burns
Slide3A
burn
is a type of injury to skin , or other tissues ,caused by
Heat (scald or fire)
ColdElectricity Chemicals Radiation
Slide4The
pathophysiology
of burn
Slide5Airway and lungs
Slide6Slide7Inflammation and circulatory changes
Slide8Slide9Slide10Immediate care of the burn patient
Slide11Pre hospital care
Ensure rescuer safety
Stop the burning process
Check for other injuries
Cool the burn woundGive O2
Elevate
Slide12Slide13Hospital care
Slide14Slide15Criteria for acute admission to a burn unit:
Suspected inhalational or airway injury
Any burn likely to require fluid resuscitation(15%)
Any burn likely to require surgery(circumferential)
Face , hand , feet , major joint or perineum burn Psychiatric patient non accidental burn
Electrical chemical burnsExtreme of age
Preexisting medical disorder
Slide16Airway and Inhalational injury
Slide17Airway(inhalational injury)
Slide18Slide19Slide20Slide21Breathing(inhalational injury)
Physiotherapy
Nebulizer
Warm humidified O2
Escharotomy when needed
Slide22If there is mechanical block to breathing from a circumferential chest
eschar
, then we have to do scoring cut through the burned skin to allow the chest to expand (
escharotomy
) This is not painful (burned nerves)
Slide23Circulation and fluid resuscitation
Partial and full thickness
burn victim of more than
15 %
of the total body surface area burned will have shock and require fluid resuscitationTBSA = total body surface area
Slide24Assessment of burn size (TBSA)
ACCURATE
Slide25The patient’s palm
Not the doctor’s palm
Slide26Rule of nines
Not
accurate but adequate for first approximation in
adult only
Each
upper limb is 9%
Each lower limb is 18%The torso is 18%
each
side
The head and neck is 9%
Genitalia is 1%
Slide27Lund
browder
chart
Is accurate method
غير مطلوب فقط الاسم
Slide28Assessment of burn depth
Slide29Slide30First degree(superficial burn)
Eg
. Sun burn
epidermis
Dry, red , painfulTreated with moisturizing cream for 5 days
Slide31Second degree (partial thickness)
Can be superficial or deep
Slide32Superficial partial thickness
Papillary dermis
Moist, pink , painful , capillary refill,
blister
Treated with moisturizing or antibiotic ointment for two weeks with no residual scarring
Slide33Slide34The blister of superficial partial thickness(2
nd
degree)burn
Slide35Deep partial thickness
Reticular dermis
Not moist , not blanch with pressure ,decreased sensation
Treated with excision and grafting
Lead to hypertrophic scar
Slide36Deep dermal burn , tangential excision
Taking skin graft
Skin graft over excised burn
Slide37Slide38Third degree(full thickness)
All the dermis is destroyed(reach to fatty layer)
Hard , leathery feel , variable color (normal to black) , no capillary refill ,
no sensation(painless)
Treated with excision and graftingHypertrophic scarring
Slide39Slide40Forth degree
Eg
. Electrical burn
Same as 3
rd degree with exposed tendon, bone or muscleMay require amputation
Slide41Slide42Circulation and fluid resuscitation
(
0.5 -1 ml/kg/hour
)
Slide43Slide44Slide45Treating the burn wound
Slide46escharotomy
Circumferential full thickness burn to the limb require emergency surgery .
The tourniquet effect of this injury is easily treated by incising the whole length of full thickness burn (
escharotomy
).
Slide47Slide48Topical antibiotic
In non infected burn , only topical antibiotic should be used (not systemic , because of poor circulation)
Silver
sulphadiazine
cream 1%:broad spectrumSilver nitrate solution 0.5% :need to be changed frequently , cause black staining
Mafenide acetate :painful , may cause acidosisCerium nitrate
Slide49Slide50Slide51Slide52Additional aspect in treating burned patient
Analgesia
Nutrition
Infection control
Nursing carePhysiotherapyPsychological support
Slide53Slide54Post burn contractures
Can be prevented by early physiotherapy and splinting
Slide55Surgery for the acute burn
(excision and graft)
Slide56Slide57Slide58Deep dermal burn , tangential excision
Taking skin graft
Skin graft over excised burn
Slide59Delayed reconstruction of burns
Slide60Hypertrophic scar management
Silicone gel
Massage
Pressure
Intra lesional steroid injection
Slide61Post burn contracture management
Early physiotherapy and splinting
Release and skin graft
Z
plasty
Slide62Physiotherapy and movement
Slide63Night Splinting in position of safety
Slide64Release and skin graft
Slide65Slide66Z plasty
Slide67Slide68Slide69Slide70Slide71Complication of electrical injury
C
ardiac arrest and myocardial damage
C
ompartment syndrome , amputationCrush syndrome ,myoglobinuria
, acidosis and renal failure
Slide72