ABC - Extensive Injury and Burns

8/3/2019 ABC - Extensive Injury and Burns

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Clinical Example

The child A.Z., four years old, was burned with flame in a domestic environment on 30September 2001. After first aid in a regional hospital, the patient, receiving intravenoustherapy with isotonics, was transferred to our centre approximately 5 h post-burn. Thediagnosis on admission was second- and third-degree 40% TBSA burns in the trunk,head, and extremities. The third-degree burns, in the posterior part of the trunk andextremities, were calculated as 30% TBSA. Resuscitation was performed immediatelywith Ringers lactate according to the Carvajal formula, i.e. 3.6 ml/kg/% in 24 h with atotal Na+ load of 0.4 mEq/kg/%. The child successfully overcame the shock phase, with

a mean urinary rate of 1.5 ml/kg/h. In this phase we observed generalized oedema inthe head, which reduced after 48 h. On day 3 we observed the onset of the systemicinflammatory response syndrome (SIRS), with high values of temperature (> 39 C),cardiac rate (> 100/min), respiratory rate (> 28/min), and leucocytosis (12,000/mm3. Inthe expectation of severe life-threatening sepsis, we decided to begin antimicrobialtherapy as soon as possible and we therefore administered ceftazidime and amikacinintravenously. This scheme was applied because in recent times we have observed arapid development of gram-negative pathogens in our patients. Our action was correctbecause on day 7 post-burn the wound culture confirmed gram-negative pathogens


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Introduction

A burn can be caused by heat (flames, hotgrease, or boiling water), the sun (solarradiation), chemicals or electricity. When aburn breaks the skin, infection and loss of fluidcan occur; burns can also result in difficultybreathing. If a burn victim has troublebreathing, has burns on more than one part ofthe body, or was burned by chemicals, an

explosion, or electricity immediately. Burnscaused by flames or hot grease usually requiremedical attention as well, especially if thevictim is a child or an elderly person


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Burns are often categorized as first-,second-, or third-degree burns, dependingon how badly the skin is damaged. Each of

the injuries above can cause any of thesethree types of burn. But both the type ofburn and its cause will determine how theburn is treated. All burns should be treatedquickly to reduce the temperature of theburned area and reduce damage to theskin and underlying tissue (if the burn issevere).


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Risk Factors

Age - children and elderly

Drug use - Use of alcohol and illegal drugs increases risk of

burns.

Gender - Men are more than twice more likely to suffer burn

injuries than women. Seasonal Burns occur more often during holidays celebrated

with fireworks and school breaks.

Smoking

Socio-economicstatus People living in substandard or older

housing, as well as those in low income neighbourhoods aremore likely to experience burns.

Sun

Unsafe heating practices Use ofheated foods and

containers, hot water heaters set above 130 F, and unsafe

storage of flammable or caustic materials put you at higher risk

of burns. Also, the use of wood stoves and exposure to heating


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Signs and Symptoms of First

Degree Burns Injuries are superficial / mild

Swelling& redness of the injured area

Pain develops No blisters seen

Burned area becomes white on touch

Takes 3-6 days to heal


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Immediate Emergency Medical

Intervention Remove patient from heat source

Remove the burnt clothing

Run cool water over burnt area

Gently clean the injured area

Gently dry Apply anti biotic such asSilver Sulphadiazine

Use a sterile bandage to cover burns Take tetanus vaccination, if required


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Signs and Symptoms of second

Degree Burns Burns extends to middle skin layer, dermis

Swelling, redness and pain observed

Burnt area may turn white on touch

Blisters develop, that ooze a clear fluid

Scars may develop

Restricts movement, if injury occurs at joint

Dehydration may occur Healing time varies, depends on extent of

injury


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Intervention Clean the affected area thoroughly

Gently dry

Apply antibiotic cream over affected area

Make the patient lie down

Keep burnt body part at a raised level

Skin graft may be required

Physical therapy may be essential to aidmobility

Splints may be used to rest affected joints Hospitalization is essential


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Signs and Symptoms of Third

Degree Burns Damage occurs to all 3 skin layers

Destroys adjacent hair follicles, sweat glands,nerve endings

Lack of pain due to destroyed nerves

Injured area does not turn white on touch

No blisters observed

Swelling occurs

Skin develops leathery texture

Discoloration of skin observed Scars develop


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Crusty surfaces (Eschars) develop-impairs circulation

Dehydration occurs resulting in shock

Symptoms may worsen with time

Disfigurement may result

Healing depends on extent of injury

90% body surface injury results indeath

60% injury in elderly, fatal


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Intervention Requires immediate hospital care

Dehydration treated through intravenousfluid supply

Oxygen is administered Eschars are surgically opened

Periodically run clean cool water overburns

Nutritious diet helps to heal quickly Regular monitoring essential

Mental Depression treated by anti-depressants


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Diagnostic Test

Biopsy

Biopsy refers to removing and studying

sample tissue. In the case of burn

patients, biopsy is a diagnostic test that

is useful because it examines the extent

of collagen damage to the skin, vascular

damage to the tissue, and damage tocell proteins in the skin.


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Thermography

Other tests used for burn victims are lessfamiliar than a standard biopsy.Thermography is the term for studies ofburn temperature. When attempting todetermine the exact depth of a burnwound, doctors can use thermography as adiagnostic tool because deeper woundsare cooler than more superficial wounds.There is reduced vascular perfusion, orblood circulation, to the deeper wounds,leading to a lower temperature.


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Video Angiography

Another diagnostic test for burnevaluation is a process known as laser

fluorescence videography. Thissophisticated technique measureschanges in the perfusion of tissues byinjecting a substance called

indiocyanine green intravenously.Damaged tissues have poor circulation,which is visualized by the videography.


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Documents

ABC - Extensive Injury and Burns