Burns

Lecture- Medical Lincenciate Dr Robert Zulu

Introduction
Burn injury may be defined as damaged to an epithelial surface caused by heat. Scald refers to burns caused by hot water. Morbidity and mortality depends on the Body surface area involved, depth of the injury and age of the patient

Pathophysiology
Local effects Thermal injury causes coagulative necrosis to the epidermis and the underlying tissues. These constitute local effects. The zone of coagulation is surrounded by a zone of stasis which is surrounded by a zone of hyperaemia.

Pathophysiology
Burn depth the specific material involved in the burn injury will determine the severity of the burn injury May be classified as first degree, second degree, third degree, and fourth degree May also be classified as superficial and deep burns

Pathophysiology
First degree burns are localised to the epidermis Second degree burns involve the superficial dermis, and may go as far as deep into the dermis Third degree burns also called full thickness burns involve the epidermis, dermis and into the subcutaneous fat Fourth degree burns may extend into the underlying muscle

Pathophysiology
Burns size Determination of the burn size estimates the extent of injury Rule of nines Rule of sevens Rule of the palm

Pathophysiology
Systemic Effects Significant burns associated with release of massive inflammatory mediators These produce vasoconstriction and vaso dilatation, increased capillary permeability and oedema locally and distant organs

Pathophysiology

Systemic effects Hypermetabolic state Vascular permeability and oedema Immunosuppression Increased GUT mucosal permeability Decreased renal blood flow Alter haemodynamics

Aetiology
Flame:- superheated, oxidised air Scald:- Hot liquids Friction:Chemical:Electrical:-

Management

Resuscitation A-Inhalation burns B-Breathing C-Fluid management D-specific type of burns

Management
Pre-hospital Remove patient from hazard Inhalation burns- 100% oxygen Caregiver should wear protective clothing Burning clothes should be removed, cover victim with dry blanket Remove all rings, belts, watches and jewelry

Management
Wound care outside the hospital involves applying clean dry dressing on the wounds Do not apply any creams or lotions or herbs Cover the patient in a warm dry blanket Morphine may be given after initial assessment

Manaement

Wound care Daily cleaning, +/- silver sulphadiazin Wet soaks Pus swabs Antibiotics Blood transfusion Sloughectomy Escharotomy

Management
Fluid management Muir and Barclay -% Burns X Weight X 0.5= x mls -1st 24hrs= x(4hrs) x(4hrs) x(4hrs), x(6hrs) x(6hrs) -2nd 24hrs= x(12hrs), x(12) -Remember to add maintenance fluid

Management
Monitoring a. Fluid replacement:.Urine output, Pulse, Mental status, oedema b. Wound healing . Colour, pus, slough, features of the wound c. Nutritional status .Weight, skin fold thickness, oedema

Complications
Early complications Airway obstruction, Hypothermia Fluid and electrolyte inbalance Anaemia Myoglobinuria Hyponatraemia Hypernatraemia

Complications
Late complications Wound infection SIRS MODS Skin Contractures Curlings ulcer

Skin Grafting
Autograft ( own skin) Xeno graft (pig skin) Provides wound cover and some immunological benefit. Must be removed completely or allowed to slough. Allograft ( Homograft, Cadaver skin) Provides all the normal skin functions. Epithelium can be allowed to slough.

Skin grafting
Deep burns do not heal in timely fashion. Superficial burns heal by re-epitheliasing within 10-14days as long as the wounds the conditions for healing are present Excision and grafting of deep burns on the 3rd or 4th post burn day. Or assess after two weeks and skin graft unhealed areas

Skin Grafting
Early excision and grafting is the current practice Some wounds may need serial excision of slough Leaving these dead tissues only serves as a niddus of infection

Skin grafting
Split thickness skin graft Full thickness skin graft Flaps( rotational, advancement)

Skin Grafting
Avoid Infected wound Anaemic patients Wound with slough Absence of granulation tissue Malnourished patients

Exercise
One year child with burns of both lower limbs. Is seen at the hospital 6 hours latter. The child weigh 10kg. Describe your management plan the next 24hrsfrom the time you see the patient