BURNS Prof LM Ntlhe SBAH UP Definition Thermal

BURNS Prof LM Ntlhe SBAH- UP

Definition: Thermal injury to tissues/organs

MACHANISMS : 1) HEAT Sunburn Scalding Open Flame Contact Flash. . . explosive heat 2) ELECTRICAL 3) CHEMICAL 4) RADIATION 5) COLD

SKIN

Depth • 1 st Degree: Sunburn – Erythema , pain no blisters. • 2 nd Degree: Partial-thickness ( Superficial or Deep). Blisters , weeping , wet & painful. • 3 rd Degree: full thickness- dark, leathery, waxy white, painless, charred & swollen. NB: Combinations

CLASSIFICATION • Superficial • Deep Partial • Full Thickness NB: COMBINATIONS

Superficial

Deep partial

Deep Full Thickness

PATHOPHYSIOLOGY • Local. . . Coagulative Necrosis Note JACKSONS Zones (C /S /H) • Systemic. . . ≥ 30% burn. . . ALL SYSTEMS affected SHOCK Multisystem failure and mortality may ensue

CVS BURN SHOCK : ↑Capillary Permeability →Fluid & Protein loss Vasodilatation. . . . Histamine , Serotonin & PGs Myocardial depressants. . TNF alpha ↓HSP

R/S INHALATION burn MECHANICAL RESTRICTION. . . Eschar CO Poisoning BLAST INJURY. . . Pneumothorax, ARDS

Renal Failure HYPOVOLAEMIA MYOGLOBINURIA GASTRO- INTESTINAL TRACT Splanchnic Vasoconstriction → Mucosal ischaemia bacterial → Translocation→ septisaemia Curling ulcer. . . stomach/duodenum METABOLIC. . BMR. . 3×norm IMMUNOLOGICAL. . ↓CMI/ HI

Mx of Acute Burns(Multidiscipl) • First aid & Scene management • ABCDE / Secondary Survey

Airway with C spine: O 2 for all Inhalation injury-intubate O 2 early DIAGNOSIS : • Enclosed space. • Facial burns. • Singed nasal hair. • Carbonaceous sputum. • Stridor/Hoarse voice. • Bronchoscopy

Circulation Venous access & bloods for biochem/FBC/x. Match IVF – R/Lactate……. colloid Amount of fluid. . . Rule of NINE for BSA burned. (Wallace) PARKLAND formular Monitors/foley catheter/NGT/Tet Toxoid/Analgesia.

Wallace. . . Rule of nine

Formulas to begin Rescuscytatn 1. Parkland : R/L 4 ml/kg /% BSA over 24 hrs. 1/2 of the volume in 8 hrs (from the time of burn) 1/2 over the next 16 hrs. 2. EVANS. 3. Slater. 4. Brooke. 5. Modified Brook. 6. etc. NB : GUIDELINES ONLY

Complications • • Contractures Curling ulcer Infection Keloids

Burn Wound Care Dressing – many commercial ones - Simple linen Cleaning – warm H 2 O/shower Surgery – Escharotomy for limbs & chest - Early Echarectomy and SSG/Skin substitutes - Release of contractures Nutritional suport Rehabilitation

Tropical agents. • • • Silver salfadianzine. Acriflavin. Povidine iodine. Muporocin Growth factors.

Skin subtitudes • Allograft • Xenografts. • Biobrane. • Trancyte. Permanent skin subtitudes. Epicel. Alloderm Integra.

Nutrition • • - ↑CHO ↑Protein Enteral Parenteral

Electrical Burns • Body acts as a conductor of electricity- generates heat(i. e. electrical energy→heat→-tissue injury) • ARF……. rhabdomyolysis • Different rates of heat loss i. e. skin & deeper tissue muscle. Px-ABC, ECG, Urinary catheter/debride +- SSG • Dark urine=haemochromogens • IVF >>>. . . u/o 100 mls/hr • 25 g manitol & 12. 5 g – subsequently • Na. Ho 3. . . if fluid resistant acidosis.

Chemical Burns Acids Alkali Petroleum Concentration, duration of contact & amount Rx-flush with lots of H 2 O(shower/hose) • Powder – brush away before flushing • •

Cold Injury • Frostnip -mildest, pain, pale, numbness, reversible (unless chronic exposure… • Frostbite-freezing due to Intracellular ice crystals & microvascular occlusion…. anoxia Classified: 1 st degree – hyperaemia, oedema 2 nd degree- vesicles, hyperaemia, oedema 3 rd degree- full thickness, subcutaneous fat 4 th degree- necrosis of skin, muscle & bone

Frostbite • Warm clothes & fluids. • Circulating H 2 O at 40 c until pink (20 -30 mins), maybe painful – Analgesia -Cardiac monitor • Goal – preserve (damaged/injured) tissue • Tet Toxoid • A/B if infection present • Sterile dressing • No smoking • Adjuvants – Heparin – Thombolytic Px – Hyperbaric O 2 Px – Dextran 40 % • Weeks/months to demarcate

Hypothermia Definition: Core body Temperature <35⁰c • Mild 35⁰ – 32⁰c • Moderate 32⁰c – 30⁰c • Severe <30⁰c Dropping maybe rapid or slow Elderly & kids prone, PVDx Polytrauma=<36⁰c

• Mx : ABCD / CPR warm pt. . . External. . . Core : Pleural /Peritoneal Cardio. Pulmonary Bypass WARM TO ≥ 35⁰ NOT dead until WARM and dead !!!!