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BURNS MANAGEMENTDr. Mansoor Khan, MBBS, FCPS-I, PGY2
Khyber Teaching Hospital, Peshawar
“Coagulative necrosis of tissue due to extremes of temperature,
chemicals or irradiation”
Carelessness(40%), Accidents(35%), Fit or faint(5%),Alcohol(5%), Psychiatric(5%)
Scalds account for 60% of burns in childrenFlame accounts for 50% of burns in adultsContact(10%),Electrical(5%),Chemical(3%)
SCALDS
FLAME
CONTACT
ELECTRIC
CHEMICAL
RADIATION
RADIATION
Jackson’s burn wound model
Jackson’s burn wound model
S
K
I
N
FIRST DEGREE BURNS
Epidermal layer, Pink, painful, and edematousHeals 3-5 days w/o scarring
Causes: Flame, Sun, Flash from explosion
SUPERFICIAL SECOND DEGREE
Epidermis and papillary region of dermis, Blisters, bullae, serous fluidCherry red moist appearing, Painful, sensation intact, Edematous
Heals in 7-28 days with minimal scarringCause: flame, flash, scald, contact
Epidermis and reticular region of dermisBlisters, bullae, serous fluid, Pale ivory moist appearing
Painful, sensation intact, Edematous, Heals in 7-28 days with variable scarringCause: flame, flash, scald, contact
DEEP SECOND DEGREE
THIRD DEGREE FULL THICKNESS
Extends into subcutaneous tissue, White, yellow, brown leatheryAppearance, Thrombosed vessels, loss of elasticity, marked edema
Possible escharotomy, Painless to touch, Requires graftingCauses: flame, electricity, chemicals, prolonged exposure
May take 2-3 days to fully present true depth
FOURTH DEGREE
Extends to muscle, Loss of function, Black, charred appearanceMay require amputation, May require escharotomy and fasciotomy
Causes: very prolonged exposure to flame, chemicals, and high voltage
Total body surface area burned
Palmar Surface of Patient’s Hand =1% Wallace’s “Rule of Nines”Lund and Browder Charts
Lund-Browder chart
Management of the Burns Patient
PreventionFirst Aid Measures
Emergency treatment/triageAcute/on-going phases
Reconstruction/rehabilitation
First Aid Measures for Burns
Remove patient from cause.Put out flames “stop, drop and roll”.
Blanket or douse with waterRemove clothing in scalds
Airway, protect c/spine, give oxygenCalm and reassure patient
COOL THE BURN SURFACE
Cold running water or packs between 8 and 25 deg C for 30 mins.
15 deg C is ideal tempTemperatures below 5 deg may deepen burn
Watch for HYPOTHERMIA! Wrap patient in clean sheet or towel and keep
warm
Emergency treatment/triage
ABCDESecondary Survey
Triage Area,depth Minor vs MajorAnalgesia
?Resuscitate ?Monitoring?Admit
Dressing
Burns are extremely painfulMorphine 0,05-0,1 mg/kg as
starting doseAvoid oral or im routes
EntonoxKetamine
Tetanus ProphylaxisAntibiotics
Parkland formula
4 mL/kg body weight per percentage burn TBSA
half the volume is given in the first 8 hours postburn,
with the remaining volume delivered over 16 hours
Burns Surgery
EscharotomyTangential Excision
ExcisionExcision to deep fascia
Repair-direct, graft or flapReconstruction
Escharotomy
Circumferential deep burns to limbs, chest and abdomenIncisionsDepth of incisionNo anaesthetic except for kids
Excision/direct closure
Skin grafting:
Skin grafting:
Reconstruction
THANKS