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Burn, and Burn Management . Dr.Adnan Gelidan FRCS( C ), FACS Assistant Professor Of Surgery Plastic Surgery KSU . Definition . Injury By Chemical, Electrical, Or Thermal sufficient to cause disruption, denaturation , or even tissue death . Epidemiology . Males>Females 2 peaks at :

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burn and burn management

Burn, and Burn Management

Dr.AdnanGelidan FRCS( C ), FACS

Assistant Professor Of Surgery

Plastic Surgery KSU

definition
Definition
  • Injury By Chemical, Electrical, Or Thermal sufficient to cause disruption, denaturation, or even tissue death
epidemiology
Epidemiology
  • Males>Females
  • 2 peaks at :
    • 0-5yrs
    • 25-35yrs
  • 80% of burns are less than 20%TBSA
  • Pediatrics
    • Scald Burn >80%
    • Account for 45% of Hospital Admission
    • 33% are due to child ubuse
  • Three main risk factors:
    • Age greater than 60
    • Greater than 40% TBSA
    • Presence of inhalational injury
pathophysiology
Pathophysiology
  • Zone of coagulations
  • Zone of stasis
  • Zone of hyperemia
burn classification
Burn Classification
  • By thickness
  • By degree
  • By TBSA
1 st degree burn
1st Degree Burn
  • Damage to the epidermis only
  • No Need for admission
  • Heal with in 5 – 7 days
  • Needs only analgesia
2 nd degree burn
2nd degree Burn
  • Superficial Partial thickness
    • Epidermis and upper dermis
    • Painful
    • BLISTER
    • Heal with in 2 weeks
  • Deep partial thickness
    • Epidermis and most of the dermis
    • Treat like 3rd degree burn
    • Not painful
    • Rarely Blister
    • Prolonged inflammatory phase cause scarring
3 rd degree burn
3rd Degree Burn
  • Epidermis and total dermis
  • Not painful
  • No Blister
  • Marpel like appearance
  • Thrombosed Veins
  • Cause significant Scarring
  • Need surgery for treatment
4 th degree burn
4th Degree Burn
  • Injury Extend to the under-laying structures
    • Muscle, Fascia, Bone
    • Charring of the tissue
burn management
Burn Management
  • ABCs - Life preservation
  • History:
        • Agent of injury
        • Medical co-morbidities
  • Physical exam:
        • Inhalational component?
        • Estimation of depth
  • Determination: Severity of injury and triage/transfer
  • Irrigation and debridement of wounds
inhalation burn
Inhalation Burn
  • The mechanisms of inhalation injury can be divided into three broad areas
    • Inhalation of products of combustion
    • Carbon monoxide inhalation
    • Direct thermal injury to the upper aero-digestive tract
  • Sings Of Inhalation Burn
    • A flame burn occurring in a closed space
    • Singed nasal hairs
    • facial or oropharyngeal burn
    • expectoration of carbonaceous sputum
    • Signs of upper respiratory obstruction—such as crowing, stridor, or air hunger
burn management1
Burn Management
  • Non – Surgical
    • Tetanus Vaccine
    • Fluid
    • Nutrition
    • Physiotherapy
    • Dressing
  • Surgical
    • Escharotomy
    • Debridemant
    • Grafting
burn fluid resusitation
Burn Fluid Resusitation
  • BarklandFromula
    • Wt in Kg X TBSA % X 4cc
    • 1st ½ in the 1st 8 hrs and 2nd ½ in the next 16 hrs
    • Use R/L
  • Modified Brooke
    • Wt in Kg X TBSA % X 2cc
  • Hypertonic Saline
    • 250-300meq
    • Decrease the fluid requirement
    • Require regular Na monitoring
burn fluid resusitation1
Burn Fluid Resusitation
  • IVF indicated in burns > 15%TBSA
  • Any other burn can be managed by the maintinance IVF
  • Children will need the maintinance IVF add to there fluid resusitations
    • 100ml / kg / 24hr 1st 10 kg
    • 50ml / kg / 24hr 2nd 10kg
    • 20ml / kg / 24hr 3rd on kg
nutrition
Nutrition
  • High protein diet
  • VitC
  • Zinc
  • Multi-Vitamines
physiotherapy
Physiotherapy
  • Splints
  • Range Of motion Exercise
chemical burn
Chemical Burn
  • ATLS
  • Remove the etiology
    • Including cloth
  • Irrigation
  • Ensure no Inhalation, GI involvment, OccularInvolvment
  • Antidote if available
  • Burn Treatment
  • Acid Vs. Alkali
electrical burn
Electrical Burn
  • High Voltage Vs. Low Voltage
  • ATLS
  • Management
    • IVF add 30% to TBSA
    • Cardiac
    • Kidney
    • Air/Way
    • Fasciotomy
  • Burn Management