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    Abc of Burns: Kanwal Khan Lecturer ZCPT

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    Kanwal Khan
    This document provides information on burns, including their causes, who is most at risk, assessment and classification of burn severity, management in ICU and rehabilitation. Young children under 4 years old comprise 20% of burn injuries, most commonly from scalds. Burns are classified by depth and extent of damage. ICU management focuses on airway, breathing, circulation, infection control and nutrition support. Rehabilitation aims to restore function, reduce scarring and contractures through exercises, splinting and scar management.

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    Abc of Burns: Kanwal Khan Lecturer ZCPT

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    Kanwal Khan
    45 views35 pages
    This document provides information on burns, including their causes, who is most at risk, assessment and classification of burn severity, management in ICU and rehabilitation. Young children under 4 years old comprise 20% of burn injuries, most commonly from scalds. Burns are classified by depth and extent of damage. ICU management focuses on airway, breathing, circulation, infection control and nutrition support. Rehabilitation aims to restore function, reduce scarring and contractures through exercises, splinting and scar management.

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    burn rehabilitation

    Original Title

    ABC of Burns

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    This document provides information on burns, including their causes, who is most at risk, assessment and classification of burn severity, management in ICU and rehabilitation. Young children under 4 years old comprise 20% of burn injuries, most commonly from scalds. Burns are classified by depth and extent of damage. ICU management focuses on airway, breathing, circulation, infection control and nutrition support. Rehabilitation aims to restore function, reduce scarring and contractures through exercises, splinting and scar management.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    45 views35 pages

    Abc of Burns: Kanwal Khan Lecturer ZCPT

    Uploaded by

    Kanwal Khan
    This document provides information on burns, including their causes, who is most at risk, assessment and classification of burn severity, management in ICU and rehabilitation. Young children under 4 years old comprise 20% of burn injuries, most commonly from scalds. Burns are classified by depth and extent of damage. ICU management focuses on airway, breathing, circulation, infection control and nutrition support. Rehabilitation aims to restore function, reduce scarring and contractures through exercises, splinting and scar management.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 35

    ABC OF BURNS

    Kanwal khan
    Lecturer
    ZCPT
    WHAT ARE BURNS???

    • Burns are characterized by severe skin damage, causing death of


    affected cells

    • Type of injury to flesh or skin caused by


    • Heat
    • Electricity
    • Chemicals
    • Friction
    • Radiation
    CAUSES OF BURNS

    • Causes of burns (left) and incidence of burns by age (right)


    WHO GETS BURNT?
    • Young children
    • aged up to 4 years
    • comprise 20% of all patients with burn injuries.

    • Most injuries (70%) are Scalds


    • due to spilling hot liquids
    • being exposed to hot bathing water.
    • can lead to large area burns.

    • flame burns are less common


    • Boys are more likely to be injured,
    • due to behavioral differences between boys and girls.
    WHO GETS BURNT?
    • Older children and adolescents—
    • 10% of burns happen to children between the ages of 5 and 14.
    • Teenagers are often injured from illicit activities
    • Fire works, accelerants and electrocution.

    • Working age—Most burns ( > 60%) occur in patients age 15-64.


    • mainly due to flame burns, and work related incidents.

    • Elderly people—Some 10% of burns occur in people aged over 65


    • Due to effects of ageing
    • (such as immobility, slowed reactions, and decreased dexterity)
    • mainly due to scalds, contact burns, and flame burns.
    AIMS OF BURN CARE
    • Restore form—
    • Return the damaged area to as close to normality as is possible

    • Restore function—
    • Maximize patient’s ability to perform pre-injury activities

    • Restore feeling—
    • Enable psychological and emotional recovery
    CARE OF A MAJOR BURN INJURY
    • Burn management can be divided up into seven phases—

    1. Rescue
    2. Resuscitate
    3. Retrieve
    4. Resurface
    5. Rehabilitate
    6. Reconstruct
    7. Review
    THE BODY’S RESPONSE TO BURN
    • Local response
    • Zone of coagulation—
    • This occurs at the point of maximum damage.
    • irreversible tissue loss due to coagulation of proteins.

    • Zone of stasis—
    • surrounding zone of decreased tissue perfusion.
    • tissue in this zone is potentially salvageable.
    • Additional insults—
    • such as prolonged hypotension, infection, or oedema
    • can convert into an area of complete tissue loss.

    • Zone of hyperaemia—
    • outermost zone
    • tissue perfusion is increased.
    • invariably recover unless there is severe sepsis or prolonged hypoperfusion.
    THE BODY’S RESPONSE TO A BURN
    • Systemic response
    • once the burn reaches 30%
    of total body surface area

    • cytokines and other


    inflammatory mediators are
    released
    MECHANISMS OF INJURY
    • Thermal injuries
    1. Scalds
    2. Flame
    3. Contact

    • Electrical injuries
    1. Electrocution

    • “entry” and “exit” points


    1. “true” high tension injuries
    2. “flash” injuries

    • Domestic electricity—
    • The alternating nature of domestic current can interfere with the cardiac cycle, giving rise to arrhythmias.
    MECHANISMS OF INJURY
    • Chemical injuries
    1. Industrial accidents
    2. Household chemical products
    • Acid or alkali
    • deep, corrosive agent cause coagulative necrosis until completely removed.

    • Non-accidental injury
    1. Sexual abuse
    2. Household abuse
    ASSESSMENT OF
    BURN AREA
    • Wallace rule of nines
    ASSESSMENT OF
    BURN AREA
    • Lund and Browder chart
    FIRST AID
    • Stop the burning process
    1. Remove the source

    • Cooling the burn


    1. Immersion or irrigation (don’t use ice water)
    2. Cool small areas

    • Analgesia
    1. Cooling and covering
    2. Opioids
    3. NSAIDS

    • Covering the burn


    1. Cooling hydro-gels, Burnshield
    2. Polyvinyl chloride film (cling film)
    3. blankets
    INITIAL ASSESSMENT OF A MAJOR BURN
    • Perform an ABCDEF primary survey
    • A—Airway
    • with cervical spine control
    • inspection of the oropharynx

    • B—Breathing
    • Mechanical restriction of breathing
    • Blast injury
    • Smoke inhalation or Carboxyhaemoglobin

    • C—Circulation
    • Check pulse and circulation (Peripheral and central)??
    • Intravenous access

    • D—Neurological disability
    • Responsiveness via GCS
    • confused because of hypoxia or hypovolaemia.

    • E—Exposure with environmental control


    • Examine the damage to accurate estimate of the burn area
    • Protect from hypothermia
    INITIAL ASSESSMENT OF A MAJOR BURN
    • F—Fluid resuscitation
    1. Urinary catheterization
    2. continuous fluid balance monitoring

    • 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
    CLASSIFICATION OF BURN DEPTHS
    Burns are classified into 2 groups by the
    amount of skin loss.

    1. Partial thickness burns do not extend


    through all skin layers,
    2. full thickness burns extend through all
    skin layers into the subcutaneous
    tissues.
    • Partial thickness burns can be further divided into
    • Superficial—affects the epidermis but not the dermis (such as sunburn).
    • It is often called an epidermal burn

    • Superficial dermal—extends through the epidermis into the upper layers of the dermis
    and is associated with blistering

    • Deep dermal—extends through the epidermis into the deeper layers of the dermis but
    not through the entire dermis
    ASSESMENT OF BURN TYPE
    ICU MANAGEMENT AND COMPLICATIONS

    • Airway burns OR inhalational injury

    • TREATMENT
    • Restricting fluids increases mortality
    • If in doubt, intubate
    • Give 100% oxygen until carbon monoxide toxicity excluded
    • Ventilatory strategies to avoid lung injury (low volume or pressure)
    • Aggressive airway toilet
    • Early surgical debridement of wounds
    • Early enteral feeding
    ICU MANAGEMENT AND COMPLICATIONS

    • Heart failure
    • circulating myocardial depressant factor
    • myocardial diastolic dysfunction
    • myocardial oedema.

    • TREATMENT
    • Inotropic Agents
    ICU MANAGEMENT AND COMPLICATIONS
    • Kidney failure

    • Early renal failure


    1. Delayed or inadequate fluid resuscitation
    2. Haemolysis.

    • Delayed renal failure


    1. sepsis and is often
    2. organ failure

    • TREATMENT
    • Early renal support (haemodialysis or haemodiafiltration)
    ICU MANAGEMENT AND COMPLICATIONS

    • Cerebral failure
    • Hypoxic cerebral insults
    • closed head injuries (DAI)

    • TREATMENT
    • Monitoring intracranial pressure
    ICU MANAGEMENT AND COMPLICATIONS

    • Nutrition
    • Hypermetabolic Response

    • TREATMENT

    • Reduce heat loss—environmental conditioning


    • Excision and closure of burn wound
    • Early enteral feeding
    • Recognition and treatment of infection
    SITES OF POTENTIAL INFECTION
    SIGNS OF WOUND INFECTION

    • Change in wound appearance:


    a) Discoloration of surrounding skin
    b) Offensive exudate

    • Delayed healing

    • Graft failure

    • Conversion of partial thickness wound to full thickness


    TREATMENT
    OF INFECTION
    BURNS RECONSTRUCTION
    • Techniques for use in acute phase of scar maturation
    • May diminish reconstructive needs
    • Use of escharotomies when crossing joints
    • Use sheet grafts when possible
    • Use aesthetic units to face and hands with medium thickness split skin grafts
    • Use of splints, face masks, and silicone inserts as soon as possible
    • Place seams following skin tension lines
    • Place grafts transversely over joints
    • Early pressure therapy
    • Early ambulation and exercise
    SURGICAL PROCEDURES
    • Techniques for burn reconstruction

    • Without deficiency of tissue


    • Excision and primary closure
    • Z-plasty

    • With deficiency of tissue


    • Simple reconstruction
    • Skin graft
    • Dermal templates and skin grafts
    • Transposition flaps (Z-plasty and modifications)
    • Reconstruction of skin and underlying tissues
    • Axial and random flaps
    • Myocutaneous flaps
    • Tissue expansion
    • Free flaps
    • Prefabricated flaps
    TREATMENT
    REHABILITATION AFTER BURN INJURY
    • Pain control
    1. Cooling and covering
    2. Opioids
    3. NSAIDS
    4. transcutaneous electrical nerve stimulation (TENS).

    • Inhalational injury

    • Normalisation of breathing mechanics


    • Positive expiratory pressure device
    • Intermittent positive pressure breathing
    • Sitting out of bed
    • Positioning

    • Improving the depth of breathing and collateral alveolar ventilation


    • Ambulation
    • Tilt table
    • Facilitation techniques
    • Inspiratory holds.
    REHABILITATION AFTER BURN INJURY

    • Movement and function


    • Contracture prevention
    • Rom exercises
    • Strengthening exercises
    REHABILITATION AFTER BURN INJURY

    • Oedema management
    • Compression—such as Coban oedema gloves
    • Movement—rhythmic, pumping
    • Elevation or positioning of limbs — for gravity assisted flow of oedema
    • Maximization of lymphatic function
    • Splinting does not control oedema but channel fluid to an immobile area.
    REHABILITATION AFTER BURN INJURY

    • Immobilisation
    REHABILITATION AFTER BURN INJURY
    • Scar management
    • Hypertrophic scarring
    • results from the build up of excess collagen fibres during wound healing
    • the reorientation of those fibres in non-uniform patterns.
    • Keloid scarring
    • extends beyond the boundary of the initial injury.
    • More common in people with pigmented skin than in white people.

    • Management
    • Pressure garments
    • massage
    • moisturising creams
    • Therapeutic ultrasound

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