Dr Shaheed Fadhul Consultant Plastic, Reconstruction Burn Salmaniya Medical Center

1. Dr Shaheed Fadhul Consultant Plastic, Reconstruction & Burn Salmaniya Medical Center

2. Definition Chronic disease initiated by thermal injury to the tissues. It takes long time to rehabilitate and reconstruct the deformities caused the injury.

3. Epidemiology 90 % are preventable. Most common Children >>> flame-related. Young adults ( 20-40yrs) >>> work-related. Males.

4. Etiology Sun Burns Scalds are the most common (~80%) Flame Burns (~13%) Contact Burns Electrical Burn Chemical Burns 2-5%

5. Emergency Care Care at the Scene Emergency Room Care Inpatient Care

6. Pre-hospital Care Stop Burning process Secure Airway Cover the wound with clean sheet or dressing gauzes. Transport to hospital.

7. Emergency Room Care Primary Survey Airway Breathing Inhalational Injury Early intubation Circulation Intravenous access fluid resuscitation. Secondary Survey

8. Secondary survey  Burn-specific secondary survey determination of the mechanism of injury, an evaluation for inhalation injury an examination for corneal burns, the consideration of the possibility of abuse Gastric decompression. a detailed assessment of the burn wound.

9. Burn Severity Degree of Burn. Percentage of Burn. Associated Injuries.

16. Extent of Burn

17. Fluid Resuscitation The modified Brooke or Parkland formulas Formula= weight x surface burn(%) x 4 Crystalloid Fluid e.g. RL or NS. Half of the total calculated 24-hour volume is administered in the first 8 hours post injury. The rest should be given over 16 hours.

18. Fluid Resuscitation Fluid resuscitation can only be loosely guided by formulas. Requires continuous reevaluation and adjustment of infusions based on resuscitation targets.

19. Monitoring of Burn patient Urine Output. Blood Pressure. Pulse. Temperature. Pulse Oxymetry. CVP. Arterial Lines ABG. ECG CXR NGT

21. Hospital Admission &Burn Center Transfer Second- or third-degree burns greater than 10% (TBSA) in patients <10 years>50 years Second- or third-degree burns greater than 20% TBSA in persons of other age groups Second- or third-degree burns that involve the face, hands, feet, genitalia, perineum, or major joints

22. Third-degree burns greater than 5% TBSA in persons of any age group Electrical burns, including lightening injury Chemical burns Inhalational injury

23. Burn injury + preexisting medical disorders. Any patients with burns and concomitant trauma . A lack of qualified personnel or equipment for the care of children. Suspected abuse or substance abuse

24. Inpatient management (1) initial evaluation and resuscitation, (2) initial wound care. (3) definitive wound closure, (4) rehabilitation and reconstruction.

25. Initial Wound Care Stop burning process Analgesia Tetanus prophylaxis. Escharotomy. Cover ( Dressing).

27. Wound dressing Should provide 4 benefits, including (1) prevention of wound desiccation, (2) control of pain, (3) reduction of wound colonization and infection, and (4) prevention of added trauma to the wound. The addition of a gauze wrap minimizes soiling of both clothing and unburned skin and protects the wound from the external environment.

30. Definite wound Care Early Excision ( Escherectomy). Skin Grafting Split thickness Full Thickness. Skin Substitutes.

31. Complications of Burn Acute Infection Wound infection Pneumonia Vascular catheter-related Infections. UTIs Sepsis Shock & MODS Deep Venous Thrombosis.

32. Chronic Disfigurement. Hypertrophic Scar formation. Contractures. Marjolin’s Ulcer. Heterotropic Ossification

36. Rehabilitation And Reconstruction

37. Thank You