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    Jemal Yimam Jibril Berhanu Kalkidan Zenebe: Presented by

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    Vincent Ser
    This document discusses burn injuries, including: 1. It defines burns and their causes, classifying them as thermal, radiation, electrical, or chemical. Burns are further classified based on depth and severity. 2. The pathophysiology of burns is described, including local changes like zones of coagulation and systemic effects like increased susceptibility to infection, hypothermia, and hypovolemia. 3. Complications of burns are outlined, particularly the impact on respiratory function from inhalation injuries, as well as intestinal, renal, immune, and circulatory system changes.

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    Jemal Yimam Jibril Berhanu Kalkidan Zenebe: Presented by

    Uploaded by

    Vincent Ser
    65 views57 pages
    This document discusses burn injuries, including: 1. It defines burns and their causes, classifying them as thermal, radiation, electrical, or chemical. Burns are further classified based on depth and severity. 2. The pathophysiology of burns is described, including local changes like zones of coagulation and systemic effects like increased susceptibility to infection, hypothermia, and hypovolemia. 3. Complications of burns are outlined, particularly the impact on respiratory function from inhalation injuries, as well as intestinal, renal, immune, and circulatory system changes.

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    Lecture ppt on burn

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    Burn

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    This document discusses burn injuries, including: 1. It defines burns and their causes, classifying them as thermal, radiation, electrical, or chemical. Burns are further classified based on depth and severity. 2. The pathophysiology of burns is described, including local changes like zones of coagulation and systemic effects like increased susceptibility to infection, hypothermia, and hypovolemia. 3. Complications of burns are outlined, particularly the impact on respiratory function from inhalation injuries, as well as intestinal, renal, immune, and circulatory system changes.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    65 views57 pages

    Jemal Yimam Jibril Berhanu Kalkidan Zenebe: Presented by

    Uploaded by

    Vincent Ser
    This document discusses burn injuries, including: 1. It defines burns and their causes, classifying them as thermal, radiation, electrical, or chemical. Burns are further classified based on depth and severity. 2. The pathophysiology of burns is described, including local changes like zones of coagulation and systemic effects like increased susceptibility to infection, hypothermia, and hypovolemia. 3. Complications of burns are outlined, particularly the impact on respiratory function from inhalation injuries, as well as intestinal, renal, immune, and circulatory system changes.

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    of 57

    BURN

    PRESENTED BY- Jemal yimam


    Jibril Berhanu
    Kalkidan zenebe
    Objectives
    To understand burn , the risk factors and its etiologic agent

    To know Classifications of burn and importance of it

    To know how to asses the area and depth of burn

    To understand the path physiology of burn

    To know complications of burn

    To be able to know how to manage burn and also the indications for
    surgery

    To be able to know how to take history and investigate patients with


    burn
    DEFINITION:
    Burn: is coagulative necrosis of the epidermis and underlying
    tissue that most commonly results from the transfer of
    heat energy.
    Death from burn occur in bimodal distribution
    immediately after injury
    weeks later as a result of multiorgan failure
    two-thirds of burn occur at home
    75% of all burn related death occur in house due to house fire
    young adults flammable liquids
    toddlers-hot liquid
    Significant % in children is due to child abuse
    Risk factors
    low socio-economic status
    unsafe environment
    Criteria for referral to burn center
    partial thickness burn >10% of TBSA
    burns involving face , hands , feet , genitalia ,
    perinium or major joints
    Any full thickness burn
    electrical burns
    chemical burns
    inhalation burns
    Burns in patients with pre-exiting medical
    disorders

    Any patient with concomitant burn and trauma(


    fracture)

    burned children in hospitals without qualified


    personnel or equipment
    Burns requiring special social, emotional or long
    term rehabilitation
    BASED ON CAUSES
    To be able to address proper treatment

    THERMAL
    Scald
    Flame
    Flash
    Contact
    Inhalation injury
    RADIATON
    ELECTRICAL
    CHEMICAL
    Thermal burns : induce cellular damage
    primarily by transfer of energy and coagulative
    necrosis
    A. SCALD BURNS
    contact from hot water are the most common
    cause of burn
    Depth is proportional to temperature, duration of
    contact & thickness of skin
    B. FLAME BURNS
    Next most common
    House fires, smoking related fires, improper use of
    flammable liquids, automobile accidents, ignition of
    clothing from stoves or space heaters, fall into open
    fire or space heater
    C.FLASH BURNS
    Explosion of natural gas, propane, gasoline
    & other flammable liquids
    Depth depends on the amount and type of fuel
    May be associated with thermal damage to the upper
    airway
    D. CONTACT BURNS
    Result from contact with hot metals, plastic, glass or hot coals
    Limited in extent & very deep
    Chemical burns
    Could be - accidentally, occupational, assault
    The degree of tissue damage, as well as the level of toxicity , is
    determined by:
    -chemical nature of the agent
    - concentration of the agent
    - duration of skin contact Causative agents
    Alkali, burns are more dangerous than acidic burns-
    -lime,KOH,NaOH, bleach ,cement(calcium oxide)
    -may penetrate deep
    - mechanisms
    Acids-may be more superficial,eschar formation
    -induce thermal injury
    -formic acid, hydrofluoric acid , Hcl
    Other organic and inorganic chemicals
    -hydrocarbons
    Electrical burns
    current: Alternating(AC)
    Direct(DC)
    Tissues:- high resistance -tendon, fat, bone
    Intermediate resistant- skin
    lowest resistance mucous membrane,
    nerves, blood vessels, and muscles
    sources of injury
    1. low-voltage < 1000 volt of current
    no transmission to deeper tissues
    household current (110-220 V)
    mouth (oral commissure)
    2. high-voltage>1000 volt of current
    cutaneous burn at the entry and exit sites, combined with hidden
    destruction of deep tissue
    3. Lightning strike
    RADIATION BURNS - burns associated with
    nuclear blasts, uv-light, x-rays, cancer radiotherapy
    CLASSIFICAION
    BASED ON DEPTH OF INJURY

    1. 1st Degree (superficial)


    2. 2nd Degree(partial thickness)
    2.1,Superficial 2.2,Deep
    3. 3rd degree (Full thickness)
    4. 4th Degree
    Based on depth
    1st degree burn ( superficial )
    confined to the dermis
    painful , erythematous , blanchable to
    touch
    heal within a weak
    self limited
    e.g;-sun burn &minor scald

    2nd degree burn (partial thickness)


    involves dermis
    -superficial 2nd degree burn
    epidermis and superficial portion of dermis
    painful , erythematous , blanch to touch , blister
    formation
    heal in seven fourteen days
    may result in slight skin discoloration
    e.g;-scald injury & flash flame burns
    Deep 2nd degree burn
    epidermis and most of dermis involves
    doesnt blanch touch
    less sensitive to light touch but
    remain painful to pinprick
    re-epitheliaze in 14-35 days or progress to 3rd degree
    burn
    forms severe scar
    3rd degree burn ( full thickness )
    involves all epidermis and dermis with
    subcutaneous tissue
    no dermal & epidermal appendages remain
    characterized by hard leathery eschar that is
    painless and black , white or cherry red
    requires skin grafting to timely
    heal by re-epithelialization from wound edges
    4th degree burn
    involves full-thickness of dermis and epiderms to
    extend into muscle , bone & brain tissue
    e.g -high voltage electric injury
    -severe thermal burns
    Based on severity of the burn:
    depth of burn
    burned body surface area
    associated conditions
    medical problems
    trauma
    Critical burn creteria
    3rd degree burn > 10% of BSA
    2nd degree burn > 30% of BSA
    >20% in pediatrics
    respiratory injury
    hands , feet , face or genitalia
    electrical and chemical burns
    complicated burn by trauma
    underlying health problems
    Moderate burn criteria
    3rd degree 2-10% BSA
    2nd degree 15-30% BSA
    10-20% in pediatrics
    without complicating factors
    excluding hands , face ,feet or genitalia
    Minor burn criteria
    3rd degree <2% BSA
    2nd degree <15% BSA
    1st degree <20% BSA
    <10% in pediatrics
    PATHOPHYSIOLOGY OF BURNS
    Can be
    Local change
    -zone of coagulation
    - zone of stasis
    -zone of hyperemia

    Systemic change
    -cardiovascular change
    -respiratory change
    -gastrointestinal changes
    -renal changes
    - metabolic change
    -immunological change
    -hematological changes
    Areas of cutaneous injuries are classified as
    zone of coagulation
    -occur at the point of maximum injury
    -irreversible tissue loss

    zone of stasis
    -characterized by decreased tissue perfusion
    -high risk of progression to coagulative necrosis

    zone of hyperemi
    -the outer most zone
    -characterized by tissue perfusion increased b/c of VD
    -
    SUSCEPTIBILITY TO
    SEPTICEMIA INFECTIONS

    HYPOVOLEMIA HYPOTHERMIA
    Affects mostly skin. However, burns can also
    damage the airways & lungs, with life threatening
    consequence. Airway injuries when the face &
    neck are burned.in burning vehicle..inhaling
    hot & poisonous gases.
    Warning signs of burns to the respiratory system
    are- burns around the face & neck, a history of
    being trapped in a burning room, change in voice
    & stridor.
    Physical burn Injury to the airway above the
    larynx
    Inhaled hot gases can cause supraglottic
    airway burns & laryngeal edema.
    Inhaled steam can cause supraglottic burns &
    loss of respiratory epithelium.
    Inhaled smoke particles can cause chemical
    alveolitis & respiratory failure.
    Inhaled poisons, such as carbonmonoxide,
    can cause metabolic poisoning.
    Full-thickness burns to the chest can cause
    mechanical blockage to rib movement.
    Physical burn Injury to the airway below the
    larynx
    Rare, however, Steam has a large latent heat of
    evaporation & can cause thermal damage to the
    lower airway.
    Metabolic Poisoning
    COformed in the fire has 240 times more
    affinity than Oxygen for hemoglobin.
    Carboxyhemoglobin.>10% needs pure
    treatment with pure oxygen for more than 24
    hours. Death occurs with concentration 60%.
    Hydrogen Cyanide..interfers with mitochondrial
    respiration causing metabolic acidosis.
    Inhalational Injury
    ..Can cause alveolitis, bacterial pneumonitis,
    presence or absence has significant impact on
    mortality of patients.
    Mechanical block on rib movement-Burned skin is
    very stiff & thick.
    Inflammation & Circulatory changes
    Burns produce an inflammatory reaction (Mast
    cell & Neutrophils degranulate.TNF
    produce).The activation of Hagman Factor
    initiates a number of protease-driven cascades,
    a,l,tering the arachidonic acid, thrombin &
    kalirikien pathways.
    LOSS OF IV FLUID
    This leads to vastly increased vascular
    permeability.
    Water, solutes & proteins moves from the
    intra to the extravascular space.
    The volume of fluid lost is directly
    proportional to the area of the burn.
    Above 15% of surface area, the loss of fluid
    produces shock.
    Other life threatening events with major burns
    Cell Mediated Immunity is significantly reduced in large
    burns, leaving them more susceptible to bacterial &
    fungal infections.
    Sites are lung, burn wound, tracheostomy & urethral
    catheterization.
    Changes to the Intestine
    The inflammatory stimulus & shock can cause
    microvascular damage ischemia to the gut mucosa.
    This reduces gut motility & can prevent the absorption
    of food. Failure of enteral in a patient with burn is a life
    threatening complication.
    Gut bacterial translocation Gastric
    stasis, peritoneal edema
    Abdominal compartment syndrome
    Splint of diaphram Increase in
    airway pressure for respiration.
    Circumferential burns may compromise
    blood supply.
    Major determinants of the outcome of a burn
    1.Percentage of surface area involved.
    2.Depth of burn.
    3.Presence of an Inhalational Injury.
    Assessment of a burn wound
    Assessing size
    Burn size needs to be formally assessed in a
    controlled environment. This allows the area
    to be exposed & any soot or debris washed
    off. Care should be taken not to cause
    hypothermia during this stage.
    Burn size
    estimates the extent of injury.
    Rule of nines
    In adults
    Body parts TBSA
    Each upper extremity 9%

    head and neck 9%


    Each lower extremities 18%
    anterior trunk 18%
    posterior trunk 18%
    perineum and genitalia 1%

    Infants -21% of TBSA - -> head and neck


    -13% of TBSA - -> each leg
    o which incrementally approaches the
    adult proportions with increasing
    The patients whole hand is 1% TBSA, & is a
    useful guide in small burns, which maps out
    the percentage of TBSA of sections of our
    anatomy.
    The Lund & Browder chart is useful in large
    burns which maps out the percentage of TBSA
    of sections of our anatomy.
    Assessing the depth from history
    It takes hot water at 650 c, exposure for 45
    sec will produce a full thickness burn, for 15
    sec a deep partial thickness burn & for 7 sec a
    superficial partial thickness burn.
    INVESTIGATIONS
    BLOOD COMPLETE PICTURE
    CROSS MATCH
    X-RAYS
    URINE ANALYSIS
    ECG
    RFTs
    ELECTROLYTES
    Management
    Management
    IMMEDIATE CARE OF THE BURNED PATIENT
    Pre hospital care
    Hospital care
    TREATING THE BURNED WOUND
    Conservative management
    surgical treatment
    Pre-hospital care
    Stop the burning process
    Check for other injuries
    Cool the burn wound
    Give oxygen
    Elevate
    The criteria for acute admission to a burns unit
    Suspected airway or inhalational injury
    Any burn likely to require fluid resuscitation
    Any burn likely to require surgery
    Patients with burns of any significance to the hands, face,feet or
    perineum
    Patients whose psychiatric or social background makes it
    inadvisable to send them home
    Any suspicion of non-accidental injury
    Any burn in a patient at the extremes of age
    Any burn with associated potentially serious sequelae
    including high-tension electrical burns and concentrated
    hydrofluoric acid burns
    Major determinants of the outcome of a burn
    Percentage surface area involved
    Depth of burns
    Presence of an inhalational injury
    Hospital care
    Airway and Breathing
    Assess for potential airway involvement
    o burn occur in an enclosed structure or explosion
    o hoarseness, stridor, facial burns, singed facial hair
    o expectoration of carbonaceous sputum
    Endotracheal intubation Initial management
    Cricothyroidectomy Delay
    Cont
    increase in respiratory effort and rate
    rising pulse, anxiety and confusion
    Decreasing oxygen saturation
    Circulatory Status
    o Burns do not cause rapid onset of hypovolemic
    shock
    o If shock is present, look for other injuries
    o Circumferential burns may cause decreased
    perfusion to extremity
    FLUID RESUSCITATION
    The principle of fluid resuscitation is two maintain intravascular fluid
    following burn
    In children with burns over 10% TBSA and adults with
    burns over 15% TBSA, consider the need for intravenous fluid

    If oral fluids are to be used, salt must be added


    Fluids needed can be calculated from a standard formula

    Parkland formula %BSA weight (kg) 4 = volume

    Half this volume is given in the first 8 hours, and


    the second half is given in the subsequent 16 h
    ours
    here are three types of fluid used.
    Ringers lactate or Hartmanns solution
    albumin solution or fresh-frozen plasma,
    Hypertonic
    . saline
    .
    Monitoring of resuscitation
    The key is to monitor urine output
    hematocrit measurement
    acidbase balance
    Wound care
    Each wound is dressed with an appropriate covering
    that serves several function
    protects the damaged epithelium
    provide splinting action
    reduce evaporative heat loss
    minimize cold stress
    provide comfort over the painfull wound
    Wound dressing
    1 Antimicrobial dressing ;-
    Use Topical antibiotic
    - silver sulfadiazine cream
    - mafenide cream
    - Silver nitrate solution

    2 Synthetic and Biologic Dressings


    These coverings include allograft (cadaver ), xenograft (pig
    skin),Transcyte, Integra Biobrane
    Excision and Grafting

    Excision
    In deep dermal burns, the top layer of dead dermis is shaved
    off until punctate bleeding is observed and the dermis can be
    seen
    to be free of any small thrombosed vessels also
    Full-thickness burns require full-thickness excision of
    the skin then
    Zimmer instrument Watson blade, and Weck blade
    Timing of excision :
    2 types
    1. Facial excision :include the burn , sc fat to
    the level of investing fascia
    2. Tangential (sequential) excision :by
    sequentially removing thin slices of burned
    tissue until a viable bed remains
    Grafting
    Deep second- and third-degree burns do not heal in timely fashion without auto
    grafting

    Grafting
    split-thickness skin graft

    Full-thickness skin grafts


    meshed
    Flap
    ADDITIONAL ASPECTS OF TREATING THE
    BURNED PATIENT

    Analgesia & Tetanus prophylaxis


    Energy balance and nutrition
    Burns patients need extra feeding
    A nasogastric tube should be used in all patients
    with burns over 15% of TBSA
    Removing the burn and achieving healing stops the
    catabolic drive
    Physiotherapy
    REFERENCE
    Bailey &loves short practice of surgery ,25th
    ed.
    Sabiston textbook of surgery,18th ed.
    Schewartz manual surgery, 8th ed
    uptodate

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