Burns: Epidemiology, Types, Indications for Admission, and Management, Lecture notes of Chemistry

Download Burns: Epidemiology, Types, Indications for Admission, and Management and more Lecture notes Chemistry in PDF only on Docsity!

BURNS

Dr. Eyad Baqain Plastic and Reconstructive Surgery

Epidemiology

• (^) 0.5-1% of UK population suffer burn /year.
• (^) 10% of these require admission
• (^) Of these admissions, 10% are life threatening
• (^) 75,000 Burn victims admitted to hospital every year in USA
• (^) 45% of US admissions for the scald burn are in the children < 5years of age
• (^) Flame burn are the largest group of patients admitted to a burn unit

TYPES OF BURNS

• (^) Flame burns; fires
• (^) Scold burns; hot liquids
• (^) Electrical burns; lightening injuries
• (^) Chemical burns; acids & alkali

Burn wound?

• (^) Cell damage starts at 41 Deg Celsius
• (^) Coagulation of Protein > 50 Deg Celsius
• (^) Depth of wound: Temperature, Duration
• (^) Chemicals: ph, strength
• (^) Electricity: voltage, entry-exit points

Indications for admission to BU

• (^) Burns in patients with medical disorders
• (^) Burns in patients with concomitant trauma
• (^) Circumferential burns
• (^) Suspected abuse
• (^) Extremes of age

Organization of Burn Care

First Aid Scene

• (^) Cool burn wound:
  • reduce direct thermal trauma & stabilize mast cells, reducing release of histamine and other inflammatory mediators
• pain relief
• running water (15 degree C.)
• worth considering for up to 2 hours

Treatment in the A&E

1. A B C, Like all other trauma patients, should be evaluated systematically
2. Intubation ??
3. Look for other injuries
4. Assess burn wound

Inhalational injury

• (^) Fires
• (^) Closed space
• (^) Singed nasal hair
• (^) Carbonaceous material in nose & mouth

Inhalational injury

• (^) Direct thermal injury (upper airway)
• (^) Chemical injury ; products of combustion (lower airway)
• (^) CO poisoning ; systemic effect

Assessment of burn wound

• (^) Remove all clothes/ maintain warm temp.
• (^) Remove all jewellery
• (^) Check the back
• (^) Estimate % BSA burn
• (^) Estimate depth
• (^) Recognize need for escharotomy

Large Burns (20 - 30%)

• (^) Quantity of mediators is large : whole body oedema
• (^) Hypovolaemic shock
• (^) Fall in plasma volume
• (^) Fall in cardiac output

Intravenous fluids

Parkland formula :

• (^) 4 ml R.L. × %TBSA × Wt (kg) half over 8 hrs half over 16 hrs
• (^) 0.5 ml /kg /%TBSA of 5% albumin in RL 24 hrs after injury , over 8 hrs ( for > 30% burn)
• (^) Children : 3ml R.L.× %TBSA × Wt
  • maintainance (G/S 0.45%)

Formula is a guideline

U.O.P. of 0.5 ml/kg/hr in adults U.O.P. of 1 ml/kg/hr in children