Burn Management - PowerPoint PPT Presentation

Loading...

PPT – Burn Management PowerPoint presentation | free to view - id: 5da71-YzA2N



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Burn Management

Description:

BURNS ... Chemical burns: necrotizing substances (acids, alkali) ... Brooke formula. BURNS. Assessment of adequacy of fluid replacement ... – PowerPoint PPT presentation

Number of Views:13706
Avg rating:5.0/5.0
Slides: 38
Provided by: drmohameda
Category:
Tags: burn | management

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Burn Management


1
Burn Management
  • Mohamed Ahmed Sayed
  • Assistant Lecturer of Plastic and Reconstructive
    Surgery
  • Ain Shams University Faculty of Medicine
  • dr_mohamed_a_at_yahoo.com
  • http//www.geocities.com/dr_mohamed_a

2
  • Burn wounds occur when there is contact between
    tissue and an energy source, such as heat,
    chemicals, electrical current, or radiation.
  • The effects of the burn are influenced by the
  • intensity of the energy
  • duration of exposure
  • type of tissue injured

3
Where do most burns occur?
  • 0 - 4 years, from kitchen, bathroom.
  • 5-74 years, outdoors, kitchen.
  • Teenagers, suicide (females).
  • gt 75 years, kitchen, outdoors.

When do most burns occur?
  • Winter more than summer

4
Major cause of fires in the home
  • Carelessness with cigarettes!!
  • Hot water from water heaters set at high levels
    above 60 C
  • Cooking accidents
  • Space heaters
  • Gasoline, lighter fluids, etc.
  • Chemicals

5
Types of Burn Injury
  • Thermal burns flame, flash, contact with hot
    objects.
  • Scald burns hot fluids.
  • Chemical burns necrotizing substances (acids,
    alkali).
  • Electrical burns intense heat from an electrical
    current
  • Smoke inhalation injury inhaling hot air or
    noxious chemicals
  • Cold thermal injury frostbite.

6
Thermal Burns
7
Scald Burns
8
Chemical Burn
  • examples cleaning agents...

Remember.
  • Tissue destruction may continue for up to 72
    hours.
  • It is important to remove the person from the
    burning agent or vice versa.
  • The latter is accomplished by lavaging the
    affected area with copious amounts of water.

9
Smoke and Inhalation Injury
  • Can damage the tissues of the respiratory tract
  • Although damage to the respiratory mucosa can
    occur, it seldom happens because the vocal cords
    and glottis closes as a protective mechanisms.

10
Electrical Burns
11
Electrical Burns
  • Injury from electrical burns results from
    coagulation necrosis that is caused by intense
    heat generated from an electric current.
  • The severity depends on
  • amount of voltage
  • tissue resistance
  • current pathways
  • surface area in contact with the current
  • length of time the current flow.

12
Electrical injury can cause
  • Fractures of long bones and vertebra
  • Cardiac arrest or arrhythmias--can be delayed
    24-48 hours after injury
  • Severe metabolic acidosis--can develop in minutes
  • Myoglobinuria--acute renal tubular necrosis.

13
Treatment of electrical burns
  • Fluids--Ringers lactate or other fluids-flushes
    out kidneys--you want 75-100 cc/hr until urine
    sample clear
  • an osmotic diuretic (Mannitol) may be given to
    maintain urine output

14
Cold Thermal Injury (Frostbite)
15
Classification of Burn Injury
  • Severity is determined by
  • depth of burn
  • extend of burn calculated in percent of total
    body surface (TBSA)
  • location of burn
  • patient risk factors

16
Depth of Burns
Medicolegal classification clinical
classification
17
Extend of Burns
Lund-Browder Chart Rule of Nines
18
Location of Burns
  • Vital organs of burn
  • Face, neck
  • Chest
  • Perineum
  • Hand
  • Joint regions
  • Other areas

19
Patient risk factors
  • Associated trauma
  • Inhalation injuries
  • Circumferential burns
  • Electricity
  • Age (young or old)
  • Pre-existing disease
  • Abuse

20
3 Phases of Burn Management
  • emergent (resuscitative)
  • acute
  • rehabilitative

21
Pre-hospital Care
  • Remove from area! Stop the burn!
  • If thermal burn is large--FOCUS on the ABCs
  • Aairway-check for patency, soot around nares, or
    signed nasal hair
  • Bbreathing- check for adequacy of ventilation
  • Ccirculation-check for presence and regularity
    of pulses

22
Other precautions...
  • Burn too large--dont immerse in water due to
    extensive heat loss
  • Never pack in ice
  • Pt. should be wrapped in dry clean material to
    decrease contamination of wound and increase
    warmth

23
Emergent Phase (Resuscitative Phase)
  • Lasts from onset to 5 or more days but usually
    lasts 24-48 hours
  • begins with fluid loss and edema formation and
    continues until fluid motorization and diuresis
    begins
  • Greatest initial threat is hypovolemic shock to a
    major burn patient!

24
Management in the emergent phase is...
  • Airway management-early nasotracheal or
    endotracheal intubation before airway is actually
    compromised (usually 1-2 hours after burn)
  • ventilator? ABGs? Escharotomies?
  • 6-12 hours later Bronchoscopy to assess lower
    respiratory tact
  • chest physiotherapy, suction

25
Complications during emergent phase of burn
injury are 3 major organ systems...
  • Cardiovascular
  • Respiratory
  • Renal systems

26
Fluid Therapy
  • 1 or 2 large bore IV lines
  • Fluid replacement based on
  • size/depth of burn
  • age of pt.
  • individualized considerations.
  • options- RL, D5NS, dextam, albumin, etc.
  • there are formulas for replacement
  • Parkland formula
  • Brooke formula

27
Assessment of adequacy of fluid replacement
  • Urine output is most commonly used parameter
  • Urine osmolarity is the most accurate parameter
  • UOP 30-50 ml/hr in an adult

28
Wound care
  • Escharotomy / Fasciotomy
  • Escharectomy homograft
  • Dressing / hydrotherapy
  • Debridement
  • Application of autograft
  • Splinting
  • PB contractures management

29
Wound Care continued...
  • Staff should wear disposable hats, gowns, gloves,
    masks when wounds are exposed
  • appropriate use of sterile vs. nonsterile
    techniques
  • keep room warm
  • careful handwashing
  • any bathing areas disinfected before and after
    bathing

30
(No Transcript)
31
Other care measures include
  • Face
  • eye
  • ear
  • Hands arms
  • Perineum
  • Physiotherapy

32
Drug Therapy
  • Analgesics and Sedatives
  • Tetanus immunization
  • Antimicrobial agents Silver sulfadiazine

Nutritional Therapy
  • Burn patients need more calories failure to
    provide will lead to delayed wound healing and
    malnutrition.

33
Clinical Manifestations
  • Burn wound either heals by primary intention or
    by grafting.
  • Scars may form contractures.
  • Mature healing is reached in 6 months to 2 years
  • Avoid direct sunlight for 1 year on burn
  • new skin sensitive to trauma

34
Care of B U R N S
  • B - breathing
  • U - urine output
  • R - rule of nines
  • resuscitation of fluid
  • N - nutrition
  • S - shock
  • silvadene

35
Referral Criteria
  • 2nd or 3rd Degree Burns
  • gt10 TBSA
  • Burns to vital organs of burn
  • circumfrential burns
  • Electrical Burns
  • Chemical Burns
  • Inhalation Injury

36
Referral Criteria
  • Concomitant trauma (If Major Trauma, The Trauma
    Center , Not the Burn Center should be the
    initial stabilizing unit)
  • When in doubt , consult with a burn center

37
Questions?
About PowerShow.com