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 Burns Katy Talbot. What is a Burn Injury?  A disruption of the normal tissue architecture of the skin/other organic structure. The most damaging feature.

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Presentation on theme: " Burns Katy Talbot. What is a Burn Injury?  A disruption of the normal tissue architecture of the skin/other organic structure. The most damaging feature."— Presentation transcript:

1  Burns Katy Talbot

2 What is a Burn Injury?  A disruption of the normal tissue architecture of the skin/other organic structure. The most damaging feature is the interruption of blood supply to the skin.  A burn has multiple aetiologies:  Thermal (hot or cold)  Electrical  Chemical (acids)  Radiation (sunburn)  Friction

3 Pathophysiology of a Burn Coagulation -Irreversible tissue necrosis. Stasis -Ischaemia which may be reversible, depending on managemen t Hyperaemia -Reversible erythema

4 Emergency Management of Burns 1. Stop the burn process & Cool the burn. 2. ATLS & Assessment of burn wound. 3. Resuscitation. 4. Reassess burn. 5. Definitive Treatment.

5 First Aid to a Burns Patient  STOP THE BURN PROCESS  Remove the source of the burn e.g fire, radiation etc.  Remove all burnt clothing unless adhered to the skin.  Acid burns can be irrigated with a sodium bicarbonate solution (baking powder & water)

6 First Aid to a Burns Patient  COOL THE BURN WITH WATER  Irrigate the wound with running water.  It reduces pain and slows the necrotic process – reduces burn depth and improves outcome.

7 Warm the Patient, Cool The Burn.  Those at the extremes of age, and those with extensive burns are at particularly at risk of hypothermia after a burn injury.  Try and keep the patient covered up and warm while cooling the burn.  It is recommended to limit the cooling time to 20 minutes due to the risk of hypothermia.

8 First Aid to a Burns Patient  COVER THE BURN  If you have no dressings available cover the wound with cling film while being transferred to hospital.  Important not to wrap circumferentially – can exert pressure and have a tourniquet effect if oedema starts to develop.

9 ATLS For Burns Patients  AIRWAY WITH C-SPINE PROTECTION  The airway can become obstructed due to swelling of neck tissues secondary to a burn, or due to a primary inhalation injury.  Indications for Intubation:  Stridor  Prophylactic  GCS <9  Agitation

10 Inhalation Injury  Inhalation injury is a burn of the respiratory tract due to breathing in toxic gases.  Causes airway obstruction due to swelling of the soft tissue structures.  Suspect inhalation injury when:  Burn in a confined space  Facial burn/singed facial hair  Soot/Charring  Mucosal inflammation in mouth or nose  Carbonaceous sputum  Stridor/Hoarse Voice.

11 ATLS For Burns Patients  BREATHING WITH VENTILATION  Give high flow 100% humidified oxygen.  Assess the chest for ventilation and movement defects  Deep circumferential burns to the chest can restrict chest wall movements, reducing compliance leading to breathing difficulty.  May need to release skin with escharotomies.

12 Chest Escharotomy

13 ATLS for Burns Patients  CIRCULATION WITH HAEMORRHAGE CONTROL  Assess Circulation – non-burnt skin colour, temp, cap refill, pulse, BP, JVP.  Insert 2 large bore cannulas, preferable in non- burnt skin.  Fluid resuscitation o Adults with >15% TBSA o Children with >10% TBSA

14 Resuscitation for Burns Patients  Burns patients have a large risk of hypovolaemic shock  In a burn wound there are microvasculature changes which increase capillary permeability and damage the lymphatic system. The oncotic pressure of the plasma is reduced and of the tissue is increased.  Therefore widespread burns can lead to a systemic loss of volume from the vasculature.

15 Parklands Formula  3-4mls/kg/TBSA% = mls in 24hours post injury.  ½ in the first 8 hours.  ½ in the next 16 hours.  Ringers Lactate/Hartmann’s are the preferred fluids.  Also essential to monitor urine output (>0.5ml/kg/hr)

16 ATLS for Burns Patients  DISABILITY  Assess neurological status  Reduced GCS could be due to inhalation of toxic products of combustion (CO) causing hypoxia.

17 ATLS for Burns Patients  EXPOSURE  Expose and assess the extent of injury  Remove any clothing or jewellery which may become constrictive with swelling.

18 Assessing the Size of a Burn  Uses Total Body Surface Area (TBSA)  Wallace Rule of 9s for adults.  Lund-Browder Chart for paediatric cases – the head of a child typically takes up more of their TBSA.  A handprint is about 1% TBSA. This can be useful for estimating very small or large burn size.

19 Lund-Browder Chart

20 Assessing Burn Depth  Superficial Burn  Involves the epidermis only  Appearance: Dry and red, blanches to pressure, moderately painful, no blisters at the time of injury.  Will heal within 7 days with no scarring.  Not included in TBSA assessment.

21 Assessing Burn Depth  Superficial Dermal Partial Thickness  Involves the epidermis and the papillary (superficial dermis)  It is extremely painful due to the exposure of sensory nerves.  Appearance – pale pink, fine blisters are characteristic. Blanches to pressure, with a rapid cap refill.  Will heal in 14 days, and may have a pigment defect scar.

22 Assessing Burn Dept  Mid Dermal Partial Thickness  Involves epidermis and part of the dermis. Skin adnexal organs are also affected.  Less painful than superficial dermal burns as some of the pain nerve endings will be damaged.  Appearance – Dark pink/red, large blisters, sluggish cap refill.  Heals in days, and may cause hypertrophic scarring

23 Assessing Burn Depth  Deep Dermal Partial Thickness  Involves epidermis, and most of the dermis. Only the very deep adnexal organs intact.  Decreased sensation  Appearance – Red and White blotches, extensive blisters which rupture soon after injury, no cap refill, no blanching.  Takes >21 days to heal and most often needs surgery. 81% chance of scarring.

24 Assessing Burn Depth  Full Thickness Burn  All epidermis, dermis, and adnexal structures destroyed. No blood supply = infarction of the skin.  NO SENSATION TO PINPRICK  Appearance – White, charred leathery skin, no blisters, no cap refill, no blanching.  Will not heal without surgery, and will scar.

25 Escharotomy  Full thickness burns may require escharotomy surgery.  This is a full thickness incision of the burned skin down to SC fat.  It is done to relieve the constricting effect of the leathery tight skin. This can restrict ventilation in the chest or cause limb ischaemia.

26 Early Management  Nasogastric Tube – Early feeding is essential in burns patients as they go into a state of hypermetabolism. Indicated in adults >20% TBSA and children >15% TBSA.  Tetanus Prophylaxis  Hypothermia Prevention – Insulate the patient, warm room, warm IV fluids.  Infection control

27 Definitive Burn Surgery  Debride devitalised skin and blisters  Skin grafts – Autograft is preferred. In patients with extensive injury skin substitutes can be used until they grow some more skin to graft.  Meshed grafts are good for extensive injuries as can cover a larger area, and allows the damaged skin to drain.  Sheet grafts have a better cosmetic and functional outcome.  Use compression to reduce hypertrophic scarring, and splints to prevent contractures.


29 References   violence/first-aid-information/ violence/first-aid-information/  treatment#a1135 treatment#a1135    ndex.html ndex.html

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