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B U R N S . Dept of General Surgery(SBAH-UP) Prof L.M. Ntlhe

B U R N S . Dept of General Surgery(SBAH-UP) Prof L.M. Ntlhe. Definition: Thermal injury, open flame, hot water, hot contact, chemical & electrical. Classification: Skin Histology. Depth. First Degree: sunburn – Erythema , pain no blisters.

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B U R N S . Dept of General Surgery(SBAH-UP) Prof L.M. Ntlhe

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  1. B U R N S .Dept of General Surgery(SBAH-UP)Prof L.M. Ntlhe

  2. Definition: Thermal injury, open flame, hot water, hot contact, chemical & electrical

  3. Classification: Skin Histology

  4. Depth First Degree: sunburn – Erythema, pain no blisters. 2nd Degree: partial-thickness-blisters,weeping wet & painful.Blanches 3rd Degree: full thickness-dark,leathery, wary white, painless charrel & swollen. Combinations

  5. Body surface area- Rule of ninePalm & fingers(1%)

  6. Inhalation Burns Special Areas Thumbs Perineum Joints Face Circumferential Limbs

  7. Chemical Burns • Acids • Alkali • Petroleum • Concentration, duration of contact & amount Rx-flush with lots of H2O(shower/hose) • Powder – brush away before flushing

  8. 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. Rx-ABC, ECG, Urinary catheter Dark urine=haemochromogens • IVF-u/o 100mls/hr • 25g manitol & 12.5g – subsequently • +- NaHo3 if fluid resistant acidosis.

  9. Resuscitation of acute burn: ABCD • Airway: confined spaces burn – ETT Cfs: earlysubtle & delonged. • Breathing: Oedema – obstruction -Toxic fumes Chemical tracheo- bronchiolitis

  10. Co poisoning-Diagnosis.. history - <20 % asymptomatic - >20-30% - headache/nausea - >30-40% - confusion - 40-60% - coma - >60% - death Cherry red skin (rare) -Co 240x affinity for Hb cf 02(T1/2=4hrs cf 40min on 100% 02

  11. Circulation • Foley in place, BP maybe impossible • Aim @ 1ml/kg /1hour for kids <30kg, 30ml/kg /1 hour adults • R/L: 2-4 mls/kg/2 or 3rd degree BSA burn – 24 hours. • Parklands Calculated Volume – ½ - 8hours -1/2- 16hours – 24hrs based on the time of injury not on admission. 2.Muir Burclay 3.Galveston regime (pediatric) 4.Modified Brooke 5.Evans Associated injuries Rx as per necessity. Flow sheet(input/output Antibiotics – not immediately

  12. Circumferential burns • Jewelry • Check pulses & circulation – dopplers • Escharotomy • Fasciotomy…..rarely(high voltage electrical burn NGT Analgesia-IVI morphine Wound care- cover burns

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

  14. Non-freezing injury • Due to microvascular endothelial damage & stasis • Trernch foot / Fishermen • 1.6 to10 C

  15. Frostbite • Warm clothes & fluids. • CirculatING H2O at 40c 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 O2 Px – Dextran 40 % • Weeks/months to demarcate

  16. Hypothermia Definition: Temperature <35c • Mild 35 – 32c • Moderate 32 – 30c • Severe <30c Dropping maybe rapid or slow Elderly & kids prone, PVDx • Polytrauma=<36c

  17. CFs • Temperature low • LOC • Cold to touch, gray, cyanotic • Vitals….. cardiac arrest

  18. ABCD • CPR • Prevent heat loss • O2 • ICU • U&E – K+ 10mml/L • Passive external warming • Active core warming – Peritoneal/pleural • - Cardiopulmunary Bypass Cardiac drugs fibrillation..<28c • Bretillium Tosilate…..good • Dopamine……..good • Lignocain…….not effective

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