BURNS

1. BURNS

2. Outlines * Skin anatomy and function * Terminology about the burns * Epidemiology * Burn wound depth * Types of burn according to the causes * Indications for admission * Estimation of % TBSA burn * Inhalational burn injury * Circumferential burns * Steps for assessment of burn wound

3. Skin anatomy  The skin is the largest organ of the body range from 0.25 meter square in newborn to 1.8 in adult and wt 4kg. It consist from 2 layers upper epidermis and lower dermis. Epidermis consists from 4 layers Basal layer, Spinous layer, Grandular layer, and Horny layer. The dermis consist mainly from fibrous connective tissue blood vessels, nerves, and epithelial appendages.

4. Skin function -protection (chemical, infx, ��) -prevent fluid loss and preservation of internal environment -regulate the temperature -initial immune response -sensation (tough, pressure, pain, heat &cold) -VitD synthesis

5. Terminology Flame burn: from exposure to fire Scald burn: from hot liquid Circumferential burn: burn involving the circumference of the limb, digit, or the trunk resulting in edema Escharotomy: full thickness incision through burned skin to release the construction.

6. Cont, Full thickness burn: burn involving both whole epidermis and whole dermis Partial thickness: burn involving the whole epidermis and part of the dermis Superficial burn: w/o thickness ,,,only the epidermis

7. 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

8. High Risk Groups *The very young. *The very old . *The very unlucky (21% are bystanders). *The very careless ( �th from there own action).

9. Depth of the burn wound *Superficial (first degree) *Partial thickness (second degree) superficial partial deep partial *Full thickness (third degree) Burn injury to bone and muscles

10. Cont, *First degree burns -Also called superficial burn -Involve only the epidermis layer -Characterized by: erythema pain is the chief symp dry mild edema skin function contact w/o loss of fluid and systemic effects are rare healing spontaneously w/o scar in 5 to 10 days Sun burn is the most common cause (need analgesia)

13. *Partial Thickness burns(2nd degree burn) *Superficial partial burn -Involve the epidermis and part of the dermis -Characterized by blisters formation redness mosit painfull edema healing w/o or with minimal scarring in 7 to 14 days

15. *Deep partial thickness burn More deep >less redness and pain Grey to white in color Dry Very mild pain Healing with severe hypertrophy scar in 25 to 35 days Conversion to full thickness by bacterial infx is common

16. *Full thickness burn (third degree) White waxy charred appearance May involve the fat and under lying tissues Lack of sensation Leathery dry texture skin No spontaneous healing need debridement and healed by scar

19. Types of burn according to the causes Flame burns; fires Scold burns; hot liquids Electrical burns; lightening injuries Chemical burns; acids & alkali

20. FLAME BURN

21. SCOLD BURN-most common in children-depend on the deg of hotness and the duration of exposure

22. CHEMICAL BURN-caused by contact with acid or alkali -the closer the ph to the extremes, the more severity-alkaline burns worse than acid one.-irrigation must begin as soon as possible

23. Electrical BURN-the more the voltage the more the injury-local damage to the nerves and muscles-and deep damage >metabolic derangement, compartment syndrome, thrombosis and visceral damage-cardiac arrhythmia and arrest

24. Indications for admission > 5% FT at any age > 10% PT in <10 yrs >50yrs > 20% PT in adults ,between 10 and 50 yrs Special areas: face, perineum, hands, feet Electrical ( including lightening) >>death (arrhythmias) Chemical Inhalational injury

25. Cont, Burns in patients with medical disorders Burns in patients with concomitant trauma Circumferential burns Suspected abuse Extremes of age

26. Estimation of % TBSA Rules of Ninesfor adults This scale very imp To determine the Severity of the Burn If>20-30%of TBSA involved We call it major burn

27. Role of 9 in children

28. inhalational burn injury occur due to: -Fires -Closed space Result in: -Singed nasal hair -Edematous mucosa of the nasal cavity -The pt become black Carbonaceous material in nose & mouth

29. Cont, Direct thermal injury (upper airway) Chemical injury ; products of combustion (lower airway) CO poisoning ; systemic effect

30. CO poisoning Toxic symptoms > 20%, death at 60% CO-Hb > 5% is indicative of inhalational injury but not severity. 200 � 250 � greater affinity for Hb than oxygen. Treatment ; 100% O2, hyperbaric oxygen.

31. Circumferential burns It involve the whole circumference of the affected organ Lead to severe edema >>>ischemia Very imp to dx it early to prevent its complication On limbs >>>ischemia On chest>>>impaired the respiration Treated by escharotomy

32. Escharotomy

33. Steps for assessment of burn wound Remove all clothes and metallic material Check the back Estimate the %BSA burn Estimate the depth Recognize the need for escharotomy

34. First Aid scene Extinguish flame, switch off power source, remove chemical soaked clothes, etc� Cool burn wound under tap water immediately in first 20 min Dilute acid- alkali (repeating irrigation)

35. 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

36. Treatment in the A&Eat ER 1) A B C, Like all other trauma patients, should be evaluated systematically 2) Intubation ?? 3) Look for other injuries 4) Assess burn wound

37. Intubation : Suspicion of inhalational injury Severe facial & neck burn � easy early intubation will become difficult and impossible later on�