Assessment and types of burn

PBL 02 – Skin DeepPeter 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.

Resources

• ANZBA Guidelines• The epidemiology of burn injuries in an Austra

lian setting, 2000–2006

• Psychological and social aspects of burns• Lectures– Burns and wound healing – P Pakkiri– Issues facing the burns patient – M Rudd

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

Classification by cause

Special types of burn

Special types of burn

• Chemical burns– Toxicity? eg Hydrogen Flouride

• Electrical burns – deep tissue injury– Need to record voltage, current, and time of

exposure

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

Psychosocial assessment

• Scars and disfigurement – adjustment• Stress disorders• Non-accidental injury?– Abuse• Cigarette burns• Immersion burns – sock, glove, or donut patterns

– Self harm?

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)

Assessment of TBSA

Assessment of TBSA

http://www.tg.org.au/etg_demo/etg-lund-and -browder.pdf

Special areas

Burns involving:– Hands – Face – Perineum – Joints

Should be transferred to a burn centre.• complexity of post burn reconstruction• functional impact of inappropriate managementANZBA Guide, p 33

Classification by depth

ANZBA Guide p32

Partial thickness• Epidermal necrosis• Dermis spared• Separation of epidermis from dermis• Clinically recognized as a blister

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

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)

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

Assessment of depth

ANZBA Guide p31

Assessment of depth

ANZBA Guide p31

Assessment of depth

• Bedside evaluation• Biopsy and histology• Perfusion measurement techniques– thermography– angiography (ICG video)

Modalities for the Assessment of Burn Wound DepthDevgan et al, J Burns Wounds 2006http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1687143/