BURNS :(( 1 ))

## Causes of Burns include :1- Scald or Sunburn :- are superficial .

2- Fat burns :- deep dermal (( deep paritial-thickness )) .
3- Flame burns :- mixed deep dermal and full-thickness .
4- Alkali burns :- often deep dermal or full-thickness .
5- Acid burns :- weak concentration cause superficial .
strong concentration cause deep dermal .
6- Electrical contact burns :- full-thickness .
## Depth of the Burn :1- Superficial paritial-thickness burns :- just the epidermis and
the uderlyind dermis is moist , heal without scarring in 2 weeks .
2- Deep paritial-thickness burns (( deep dermal )) :- the epidermis
is lost and involve damage deeper in the dermis , exposed dermis is
not moist , take 3 or more weeks to heal and leave hypertrophic
scarring .
3- Full-thickness burns :- all the dermis is lost , there is no
capillary return , there is no sensation of pain because the nerve
ending are destroyed .
## Degree of Burns :* First Degree Burns :- (( like sunburn )) , only the superficial
layer of the skin , healing 3-5days .
* Second Degree Burns :- Paritial-thickness and Full-thickness
burns .
* Third Degree Burns :- all layers of skin destroyed and extend
into the subcutaneous tissue (( no pain )) .
* Fourth Degree Burns :- Full thickness that extend into muscle
and bones .
## Assessing Area of Burn :- methods include
1- The pt. whole hand is 1% TBSA , and useful in case of small
burns .
(( TBSA = Total Body Surface Area )) .
2- The Lund and Browder chart is useful in larger burns .
3- The rule of Nines is adequate for a first approximation only
which is as follow :- each Upper Limb is 9% TBSA .
- each Lower Limb is 18% TBSA .
- Torso is 18% each side (( anterior and posterior )) .
- Head and Neck is 9% TBSA .

## Assessing the Depth of a Burn :(( 2 ))

1- History Taking : temperature , time and burning material .
2- Superficial burns has capillary filling .
3- Deep paritial-thickness burns donot blanch , but have some
sensation .(donot blanch=donot turn pale with finger pressing).
4- Full-thickness burns feel leathery and have no sensation .
## Hospital Care for a Burn patient :-its important to do ABCDEF which are :1) A airway.
2) B breathing.
3) C circulation.
4) D disability (( neurological status )).
5) E exposure with environmental control.
6) F fluid resuscitation : we give I.V fluids ((Ringer Lactate)) by
the following formulla
(( % of burn * 4 * body weight ))
e.g. 30% burn , body wt = 70kg
so
30*4*70 = 8400ml
-half of this (( 4200ml )) in 8hours from burn.
-other half (( 4200ml )) in other 16hours.
7) Anti-Microbial :- topical Silver Sulphadiazine( Flumazine ).
-there is no role for systemic antibiotics ??
1- we don't know which micro-organism
2- systemic antibotic will not reach the dead skin(eschcar).
3- in the first few hours or few days of burn the patient is
sterile (( no any infection )) .
4- it will increase the resistance in the community .

'

## Principle of dressings for Burns :1) Full-thickness and deep dermal need antibacterial dressing to
delay colonisation prior to surgery .
2) Superficial burns will heal and need simple dressing .
3) An optimal healing enviroment can make a difference to outcome
in borderline burns .
## Criteria for Admission to Hospital in case if Burns ??
1- Extreme age (( elderly and children )) with 10% 2nd degree.
2- Other age group 20% 2nd degree .
3- All age group 5% 3rd degree burns .
4- Present of comorbidty that affect healing or prolong it .
5- Electrical burns ( if there is hx of loss of conscious ) should
be admitted , but if there is sinus rhythem no need , if there is
pain even if 1% burn should be admitted .
6- Chemical burns with acid or alkali (Alkali are worst).
7- Circumfrencial burns like neck (it may compromise vessels).
8- burns affect form and function (knee , face , wrist).
9- Medicolegal cases ( father burn the child ...... etc. ).
10- Pt. lives alone , or have no house or live in a camp .

Notes of Dr Kurdo

(( 3 ))

- Congenital Auricular Atresia :- first stage we bring the costal

cartilage , and we carve into auricle and insert it into the area
for six months , then we elavte it and apply skin graft on .
- Skin Graft :- is transferring of skin from one part of the body
to another part without preservation of blood supply and also
called ( Autograft ) . and we have two type :1- Paritial-thickness skin graft :- is the most common , is
harvesting the epidermis and portion of the dermis , the remaining
dermis will heal without leaving a scar ideally .
2- Full-thickness skin graft :- harvesting all layers of the skin
and directly closing the area of the donor , and there is only few
areas to harvest the skin like the inguinal region .
## we take graft from the thigh or the back because it has a large
surface area .
## there is a device called (( Mesher )) , it makes multiple small
holes in the skin , the benifit of this holes is :1- when applying the graft , those holes allowe our skin to
expand .
2- any clotted tissue , extra granulation tissues between wound
and skin graft pass through this holes .
BUT cosmetically its very ugly .
## what are the indication of skin graft ??
1- Row area of skin in case of burns .
2- Row area of mucus membrane , for example removing a tumor
mouth or vagina and applying a skin graft .
* excision of Leukoplakia and covering by skin graft .
* excision of a tongue tumor and applying skin garft .
## what are contraindication of applying skin graft ??
1- Infection .
2- Bleeding ( or bleeding disorders ) .
**so at this time we apply Flap , contraindication of skin
graft are indications for Flap .
- Flap :- is transferring of tissue ( not necessary to be skin )
from one part to another part with preservation of blood supply .

(( 4 ))
- Many Patients with Systemic disease are at risk of decreased
immunity and so they're more liable for developing cancer .
for example pt. with renal failure and chronic dialysis are at
increased risk of developing malignancy .
- why Burn pt. die ??
1- one of the main causes is hypovolemic shock , and end up with
renal failure (( rapid rehydration is necessary )) .
2- Another main cause is Infection (( septic shock )) .
3- Neurogenic shock .
4- Bleeding if left without dressing .
5- Iatrogenic .
-Drugs inducing liver damage ??
1- Paracetamol
2- antibitics (( erythromycine , clarithromycine , anti-TB drugs ,
rifampicine , tetracycline )).
3- Hormones (( testesterone)) .
- Drugs inducing Renal failure ??
1- NSAID's (( voltarin , aspirin )) .
2- antibiotics (( aminoglycosides , Penicillins , Cephalosporins )) .
3- Digoxin .
- What are the causes of Diabetic foot ??
1- Neuropathy ( 80% ) .
2- Angiopathy : abnormal wall of blood vessels (( small , middle
and large )) , but mainly middle sized vessels , thickness of the
wall , loss of elasticity , atherosclerotic , occlussion ,
obstruction .
3- Infection (( Hyperglysemia is good media for infection )).
4- Immunocompromised .