Assessment and types of burn PBL 02 – Skin Deep Peter Byrnes, 27 Jan 2011 Rehabilitation starts at...
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Assessment and types of burn PBL 02 – Skin Deep Peter Byrnes, 27 Jan 2011 Rehabilitation starts at the time of injury Every person who touches a burn survivor
Assessment and types of burn PBL 02 Skin Deep Peter Byrnes, 27
Jan 2011 Rehabilitation starts at the time of injury Every person
who touches a burn survivor can positively impact their outcome. -
ANZBA guidelines, Introduction.
Slide 2
Resources ANZBA Guidelines The epidemiology of burn injuries in
an Australian setting, 20002006 The epidemiology of burn injuries
in an Australian setting, 20002006 Psychological and social aspects
of burns Lectures Burns and wound healing P Pakkiri Issues facing
the burns patient M Rudd
Slide 3
Summary Classification Cause of injury Depth and TBSA (Area)
Accidental and non-accidental Special types Assessment History of
injury Depth and Area Complicating factors Psychosocial
factors
Slide 4
Classification by cause
Slide 5
Special types of burn
Slide 6
Chemical burns Toxicity? eg Hydrogen Flouride Electrical burns
deep tissue injury Need to record voltage, current, and time of
exposure
Slide 7
History Need information to predict the severity of tissue
damage How hot? How long? How fast did temp rise and fall? What
first aid was applied? Concomitant injuries Other trauma fall, MVC,
explosion trauma Smoke inhalation
Classification by Area TBSA = Total Body Surface Area Area (and
depth) dictates the severity of the inflammatory and hypermetabolic
response A burn of > 20 25% TBSA creates a global inflammatory
reaction and indicates a significant risk for the respiratory
system (ANZBA guide, p28)
Special areas Burns involving: Hands Face Perineum Joints
Should be transferred to a burn centre. complexity of post burn
reconstruction functional impact of inappropriate management ANZBA
Guide, p 33
Slide 13
Classification by depth ANZBA Guide p32 Partial thickness
Epidermal necrosis Dermis spared Separation of epidermis from
dermis Clinically recognized as a blister
Slide 14
Classification by depth Deeper burn more tissue destruction
More likely to need surgery More likely to form scar tissue Tissue
destruction should be monitored for at least 48 hours post burn
injury Usually multiple depths involved
Slide 15
ANZBA Guide p32 Classification by depth An intermediate partial
thickness burn is the most difficult to assess and is most likely
to change depending on the early management e.g. appropriate first
aid and other patient factors. (Guide p29)
Slide 16
ANZBA Guide p32 Classification by depth Full thickness
Epidermis and dermis damaged Cell structures completely lost Three
zones can be identified Zone of coagulation maximum damage,
irreversible damage Zone of stasis area around zone of coagulation,
tissue perfusion decreased, potentially salvageable Zone of
hyperaemia outermost tissue where perfusion is increased
Slide 17
Slide 18
Assessment of depth ANZBA Guide p31
Slide 19
Assessment of depth ANZBA Guide p31
Slide 20
Assessment of depth Bedside evaluation Biopsy and histology
Perfusion measurement techniques thermography angiography (ICG
video) Modalities for the Assessment of Burn Wound Depth Devgan et
al, J Burns Wounds 2006
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1687143/