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Thread: Burns

  1. #1
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    Exclamation Burns

    Burns

    Pathophysiology

    * Burn = Coagulative destruction of the skin or mucous membrane
    * Caused by heat, chemical or irradiation
    * Thermal damage occurs above 48 C
    * Extent of necrosis is related to temperature and duration of contact
    * Burns can result in:
    o Increased capillary permeability and fluid loss
    o Hypovolaemia and shock
    o Increased plasma viscosity and microthrombosis formation
    o Haemoglobinuria and renal damage
    o Increased metabolic rate and energy metabolism

    Assessment

    * Initial assessment should be by ATLS principles
    * Good early management is required to prevent morbidity or mortality

    Airway

    * Look for signs of inhalation injury
    * Facial burns, soot in nostrils or sputum

    Breathing

    * Be aware of carbon monoxide poisoning
    * Patient may appear 'pink' with a normal pulse oximeter reading

    Circulation

    * The fluid loss from a burn is significant
    * It can result in hypovolaemic shock and acute renal failure

    Assessment of extent

    Body surface area (BSA) involved can be estimated from

    * Lund & Browder chart
    * Wallace rule of nine

    Area % BSA
    Head 9
    Each upper limb 9
    Each lower limb 18
    Front of trunk 18
    Back of trunk 18
    Perineum 1

    * Palm of hand approximates to 1% BSA

    Burn depth

    * Ability of skin to repair depends on depth of burn
    * Burns can be classified as:
    o Superficial burns
    o Partial thickness burns
    o Full-thickness burns

    Superficial burns

    * Needs to be differentiated from erythema
    * Epidermis and papillae only are involved
    * Results in red serum0filled blisters
    * Skin blanches on pressure
    * Burn is painful and sensitive
    * Healing occurs in 10 days with no scarring

    Partial-thickness burns

    * Epidermis is lost with varying degrees of dermis
    * Burn is usually coloured pink and white
    * May or may not blanche on pressure
    * Variable degrees of reduced sensation may be present
    * Epithelial cells are present in hair follicles and sweat glands
    * Results in regeneration and spread
    * Healing occurs in 14 days
    * Some depigmentation of scar may occur
    * May require skin grafting

    Full-thickness burns

    * Both epidermis and dermis are destroyed
    * Burn appears white and does not blanche
    * Sensation is absent
    * Without grafting healing occurs from edge of wound

    Fluid replacement

    To assess fluid requirement need to identify

    * Time of injury
    * Patient weight
    * Percent BSA involved

    Intravenous fluid replacement needed for burns

    * >10% BSA in child
    * >15% BSA in adult

    Fluid replacement formulae

    Muir & Barclay formula

    * = weight (Kg) x BSA / 2 per period
    * Provide volume requirement in colloid to be given in first 4 hours
    * This volume should be repeated
    o Every 4 hours for the first 12 hours
    o Every 6 hours between 12 and 24 hours
    o Every 12 hours between 24 and 36 hours

    ATLS formula

    * = weight (kg) x %BSA x (2-4)
    * Gives total volume (in ml) to be infused in first 24 hours

    Criteria for referral to burns unit


    * > 10% BSA in child
    * > 15% BSA in adult
    * Inhalation injuries
    * Burns involving the airway
    * Electrical burns
    * Chemical burns
    * Special areas - eyes, face, hands

    Escharotomy

    * Deep circumferential burns of torso can impair respiration
    * In a limb can reduce distal vasculature
    * In both situations escharotomies should be considered
    * No anaesthetic is required
    * Burn should be incised into subcutaneous fat
    * Release of underlying soft tissue should be ensured
    * On chest should be performed bilaterally in anterior axillary line
    * Bleeding may be significant and transfusion may be required

    Special situations
    Respiratory burns

    * Smoke inhalations should be suspected if:
    o Explosion in enclosed environment
    o Flame burns to the face
    o Soot in mouth or nostrils
    o Hoarseness or stridor
    * Intubation may be required
    * Blood carboxyhaemoglobin levels can give indication of extent of lung injury

    Electrical burns

    * Most electrical burns are flash burns and are superficial
    * Do not occur by electrical conduction
    * Flash from an electrical burn can reach 4000 C
    * Low-tension burns are usually small but full thickness
    * High-tension burns usually have an entry and exit wound
    * Current passes along path of least resistance (e.g. blood vessels, fascia, muscle)
    * Extent of tissue destruction can often be underestimated
    * High-tension burns can be associated with cardiac arrhythmias
    * Myonecrosis and myoglobinuria can also occur

    Chemical burns

    * Commonest acids involved are hydrochloric, hydrofluoric and sulphuric
    * Acid burns may penetrate deeply down to bone
    * First aid treatment involves liberal irrigation with running water
    * Calcium gluconate may be useful in hydrofluoric acid burns
    * Commonest alkalis are sodium hydroxide and cement
    * Again can cause deep-dermal or full-thickness burns

  2. #2
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    It's nicely given in LB.
    But much lengthy.
    anyone have better notes?


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  3. #3
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    good post man simple n eay

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