Transcript Burns
Evaluation and Management of Burns Geoffrey Lee Plastics Intern Physiology Anatomy Types • • • • • • Thermal Cold exposure Chemical Electrical current Inhalation Radiation Severity • Size • Depth • Site Size • Percentage of body surface area estimates – Palm method = 1% – Rules of Nines • • • • Each leg represents 9 x 2 = 18% Each arm 9% Anterior and posterior trunk each 9 x 2 = 18% Head 9% – Lund-Browder chart Depth • • • • • Colour Moist vs dry Blanching Blisters Pain Superficial • • • • • • • • Only epidermal layer Painful Dry Red Blanch with pressure Do not blister Heal 5-7 days No scarring Superficial Partial Thickness • Epidermis and superficial part of dermis • Painful • Red • Weeping • Blanches with pressure • Heal in 7-21 days • Unlikely scarring, pigment changes may occur Deep Partial Thickness • Epidermis and deeper dermis • Painful to pressure only • Blister • Wet or waxy dry • Mottled colorisation • Do not blanch with pressure • Heal in 3-9 weeks • Hypertrophic scarring likely Full Thickness • Extend through all layers of dermis • Anaesthetic or reduced sensation • Appearance varies • Dry • Do not blanch with pressure • No vesicles • Severe scarring with contractures • Usually require grafting Forth Degree • Deep and extend through skin into underlying tissues such as fascia, muscle and/or bone Dangerous Sites • • • • • • • • Face Ears Eyes Hands Feet Genitalia Perineum Major joints Management • Major vs moderate/minor • Major burns should be transferred to specialized burns centres • Victoria: – Victorian Adult Burns Service (VABS) at the Alfred – Burns Unit at RCH Victorian State Burns Service Referral Criteria • • • • • • • • • • • • • • Burns with associated inhalation injury Burns greater than 10% total body surface area Burns to special areas – face, hands, major joints, feet and genitals Full thickness burns greater than 5% total body surface area Electrical burns Chemical burns Circumferential burns of limbs or chest Burns with associated trauma Burns in the very young or elderly people Burn injury in patients with pre-existing illness or disability that could adversely affect patient care and outcomes Suspected non-accidental injury in children or the elderly Burns in children under the age of 12 months Small area burns - in patients with social problems, including children at risk Burns occurring in pregnant women Major burns • • • • • • • • Primary survey Assess extent of burns Beware of circumferential full thickness burns Analgesia NGT insertion Tetanus Prevent hypothermia Fluid resus Fluid Resus • Parkland formula • Amount required in 24hrs = 4 x wt(kg) x BSA(%) • Half in first 8hrs • Half in next 16hrs • Maintenance fluids in addition for children weighing less than 30kg • Guided clinically and by urine output Minor Burns • • • • • • • • First aid Cleaning burns Blister management Dressings Analgesia Tetanus Follow up Post burn skin care Electrical Burns • Low voltage (<1000V) • High voltage (>1000V) • First aid – Turn power off – Ensure own safety • Dysrhythmias • Compartment syndrome • Fluid resus Full thickness exit wound to armpit post high voltage electrical burn injury Chemical Burns • History – – – – – Type of agent Strength and concentration Site of contact, swallowed or inhaled Manner and duration of contact Mechanism of action of chemical • First aid – – – – Full thickness burns to the legs caused by kneeling in cement Prolonged irrigation of water Remove contaminated clothing Brush off metals and powders Do not attempt neutralising without specialist advice Questions?