Burn Management :: علاج الحروق
-
Upload
dr-mohamed-a-el-rouby -
Category
Documents
-
view
6.356 -
download
4
description
Transcript of Burn Management :: علاج الحروق
![Page 1: Burn Management :: علاج الحروق](https://reader033.fdocuments.in/reader033/viewer/2022061115/54649febb4af9fda3f8b46fc/html5/thumbnails/1.jpg)
Burn Management
Mohamed Ahmed SayedAssistant Lecturer of Plastic and Reconstructive Surgery
Ain Shams University – Faculty of Medicine
[email protected]://www.geocities.com/dr_mohamed_a
![Page 2: Burn Management :: علاج الحروق](https://reader033.fdocuments.in/reader033/viewer/2022061115/54649febb4af9fda3f8b46fc/html5/thumbnails/2.jpg)
• Burn wounds occur when there is contact between tissue and an energy source, such as heat, chemicals, electrical current, or radiation.
• The effects of the burn are influenced by the:intensity of the energyduration of exposuretype of tissue injured
![Page 3: Burn Management :: علاج الحروق](https://reader033.fdocuments.in/reader033/viewer/2022061115/54649febb4af9fda3f8b46fc/html5/thumbnails/3.jpg)
Where do most burns occur?
• 0 - 4 years, from kitchen, bathroom.
• 5-74 years, outdoors, kitchen.
• Teenagers, suicide (females).
• > 75 years, kitchen, outdoors.
When do most burns occur?• Winter more than summer
![Page 4: Burn Management :: علاج الحروق](https://reader033.fdocuments.in/reader033/viewer/2022061115/54649febb4af9fda3f8b46fc/html5/thumbnails/4.jpg)
Major cause of fires in the home
• Carelessness with cigarettes!!
• Hot water from water heaters set at high levels above 60° C
• Cooking accidents
• Space heaters
• Gasoline, lighter fluids, etc.
• Chemicals
![Page 5: Burn Management :: علاج الحروق](https://reader033.fdocuments.in/reader033/viewer/2022061115/54649febb4af9fda3f8b46fc/html5/thumbnails/5.jpg)
Types of Burn Injury• Thermal burns: flame, flash, contact with hot objects.
• Scald burns: hot fluids.
• Chemical burns: necrotizing substances (acids, alkali).
• Electrical burns: intense heat from an electrical current
• Smoke & inhalation injury: inhaling hot air or noxious chemicals
• Cold thermal injury: frostbite.
![Page 6: Burn Management :: علاج الحروق](https://reader033.fdocuments.in/reader033/viewer/2022061115/54649febb4af9fda3f8b46fc/html5/thumbnails/6.jpg)
Thermal Burns
![Page 7: Burn Management :: علاج الحروق](https://reader033.fdocuments.in/reader033/viewer/2022061115/54649febb4af9fda3f8b46fc/html5/thumbnails/7.jpg)
Scald Burns
![Page 8: Burn Management :: علاج الحروق](https://reader033.fdocuments.in/reader033/viewer/2022061115/54649febb4af9fda3f8b46fc/html5/thumbnails/8.jpg)
Chemical Burn
examples: cleaning agents...
Remember….
• Tissue destruction may continue for up to 72 hours.• It is important to remove the person from the burning
agent or vice versa.• The latter is accomplished by lavaging the affected area
with copious amounts of water.
![Page 9: Burn Management :: علاج الحروق](https://reader033.fdocuments.in/reader033/viewer/2022061115/54649febb4af9fda3f8b46fc/html5/thumbnails/9.jpg)
Smoke and Inhalation Injury• Can damage the tissues of the
respiratory tract
• Although damage to the respiratory mucosa can occur, it seldom happens because the vocal cords and glottis closes as a protective mechanisms.
![Page 10: Burn Management :: علاج الحروق](https://reader033.fdocuments.in/reader033/viewer/2022061115/54649febb4af9fda3f8b46fc/html5/thumbnails/10.jpg)
Electrical Burns
![Page 11: Burn Management :: علاج الحروق](https://reader033.fdocuments.in/reader033/viewer/2022061115/54649febb4af9fda3f8b46fc/html5/thumbnails/11.jpg)
Electrical Burns• Injury from electrical burns results from coagulation
necrosis that is caused by intense heat generated from an electric current.
• The severity depends on:amount of voltagetissue resistancecurrent pathwayssurface area in contact with the currentlength of time the current flow.
![Page 12: Burn Management :: علاج الحروق](https://reader033.fdocuments.in/reader033/viewer/2022061115/54649febb4af9fda3f8b46fc/html5/thumbnails/12.jpg)
Electrical injury can cause:• Fractures of long bones and vertebra
• Cardiac arrest or arrhythmias--can be delayed 24-48 hours after injury
• Severe metabolic acidosis--can develop in minutes
• Myoglobinuria--acute renal tubular necrosis.
![Page 13: Burn Management :: علاج الحروق](https://reader033.fdocuments.in/reader033/viewer/2022061115/54649febb4af9fda3f8b46fc/html5/thumbnails/13.jpg)
Treatment of electrical burns…
• Fluids--Ringers lactate or other fluids-flushes out kidneys--you want 75-100 cc/hr until urine sample clear
• an osmotic diuretic (Mannitol) may be given to maintain urine output
![Page 14: Burn Management :: علاج الحروق](https://reader033.fdocuments.in/reader033/viewer/2022061115/54649febb4af9fda3f8b46fc/html5/thumbnails/14.jpg)
Cold Thermal Injury (Frostbite)
![Page 15: Burn Management :: علاج الحروق](https://reader033.fdocuments.in/reader033/viewer/2022061115/54649febb4af9fda3f8b46fc/html5/thumbnails/15.jpg)
Classification of Burn Injury
Severity is determined by:– depth of burn– extend of burn calculated in percent of total body
surface (TBSA)– location of burn– patient risk factors
![Page 16: Burn Management :: علاج الحروق](https://reader033.fdocuments.in/reader033/viewer/2022061115/54649febb4af9fda3f8b46fc/html5/thumbnails/16.jpg)
Depth of BurnsMedicolegal classification clinical classification
Erythema
Super.
Dermal
Deep
Dermal
Full
Thickness
1st
2nd
3rd
![Page 17: Burn Management :: علاج الحروق](https://reader033.fdocuments.in/reader033/viewer/2022061115/54649febb4af9fda3f8b46fc/html5/thumbnails/17.jpg)
Extend of BurnsLund-Browder Chart Rule of Nines
Age in years 0 1 5 10 15 Adult
A-head (back or front) 9½ 8½ 6½ 5½ 4½ 3½
B-1 thigh (back or front) 2¾ 3¼ 4 4¼ 4½ 4¾
C-1 leg (back or front) 2½ 2½ 2¾ 3 3¼ 3½
![Page 18: Burn Management :: علاج الحروق](https://reader033.fdocuments.in/reader033/viewer/2022061115/54649febb4af9fda3f8b46fc/html5/thumbnails/18.jpg)
Location of Burns
• Vital organs of burn:• Face, neck • Chest • Perineum• Hand• Joint regions• Other areas
![Page 19: Burn Management :: علاج الحروق](https://reader033.fdocuments.in/reader033/viewer/2022061115/54649febb4af9fda3f8b46fc/html5/thumbnails/19.jpg)
Patient risk factors
• Associated trauma
• Inhalation injuries
• Circumferential burns
• Electricity
• Age (young or old)
• Pre-existing disease
• Abuse
![Page 20: Burn Management :: علاج الحروق](https://reader033.fdocuments.in/reader033/viewer/2022061115/54649febb4af9fda3f8b46fc/html5/thumbnails/20.jpg)
3 Phases of Burn Management
–emergent (resuscitative)
–acute
–rehabilitative
![Page 21: Burn Management :: علاج الحروق](https://reader033.fdocuments.in/reader033/viewer/2022061115/54649febb4af9fda3f8b46fc/html5/thumbnails/21.jpg)
Pre-hospital Care• Remove from area! Stop the burn!
• If thermal burn is large--FOCUS on the ABC’sA=airway-check for patency, soot around
nares, or signed nasal hair
B=breathing- check for adequacy of ventilation
C=circulation-check for presence and regularity of pulses
![Page 22: Burn Management :: علاج الحروق](https://reader033.fdocuments.in/reader033/viewer/2022061115/54649febb4af9fda3f8b46fc/html5/thumbnails/22.jpg)
Other precautions...
• Burn too large--don’t immerse in water due to extensive heat loss
• Never pack in ice
• Pt. should be wrapped in dry clean material to decrease contamination of wound and increase warmth
![Page 23: Burn Management :: علاج الحروق](https://reader033.fdocuments.in/reader033/viewer/2022061115/54649febb4af9fda3f8b46fc/html5/thumbnails/23.jpg)
Emergent Phase (Resuscitative Phase)
• Lasts from onset to 5 or more days but usually lasts 24-48 hours
• begins with fluid loss and edema formation and continues until fluid motorization and diuresis begins
• Greatest initial threat is hypovolemic shock to a major burn patient!
![Page 24: Burn Management :: علاج الحروق](https://reader033.fdocuments.in/reader033/viewer/2022061115/54649febb4af9fda3f8b46fc/html5/thumbnails/24.jpg)
Management in the emergent phase is...
• Airway management-early nasotracheal or endotracheal intubation before airway is actually compromised (usually 1-2 hours after burn)
• ventilator? ABGs? Escharotomies?• 6-12 hours later: Bronchoscopy to assess lower respiratory
tact• chest physiotherapy, suction
![Page 25: Burn Management :: علاج الحروق](https://reader033.fdocuments.in/reader033/viewer/2022061115/54649febb4af9fda3f8b46fc/html5/thumbnails/25.jpg)
Complications during emergent phase of burn injury are 3 major organ systems...
–Cardiovascular
–Respiratory
–Renal systems
![Page 26: Burn Management :: علاج الحروق](https://reader033.fdocuments.in/reader033/viewer/2022061115/54649febb4af9fda3f8b46fc/html5/thumbnails/26.jpg)
Fluid Therapy• 1 or 2 large bore IV lines• Fluid replacement based on:
– size/depth of burn– age of pt.– individualized considerations.
• options- RL, D5NS, dextam, albumin, etc.• there are formula’s for replacement:
– Parkland formula – Brooke formula
![Page 27: Burn Management :: علاج الحروق](https://reader033.fdocuments.in/reader033/viewer/2022061115/54649febb4af9fda3f8b46fc/html5/thumbnails/27.jpg)
Assessment of adequacy of fluid replacement• Urine output is most commonly used
parameter
• Urine osmolarity is the most accurate parameter
• UOP= 30-50 ml/hr in an adult
![Page 28: Burn Management :: علاج الحروق](https://reader033.fdocuments.in/reader033/viewer/2022061115/54649febb4af9fda3f8b46fc/html5/thumbnails/28.jpg)
Wound care• Escharotomy / Fasciotomy• Escharectomy + homograft• Dressing / hydrotherapy• Debridement
• Application of autograft• Splinting
• PB contractures management
![Page 29: Burn Management :: علاج الحروق](https://reader033.fdocuments.in/reader033/viewer/2022061115/54649febb4af9fda3f8b46fc/html5/thumbnails/29.jpg)
Wound Care continued...• Staff should wear disposable hats, gowns,
gloves, masks when wounds are exposed• appropriate use of sterile vs. nonsterile
techniques• keep room warm• careful handwashing• any bathing areas disinfected before and after
bathing
![Page 30: Burn Management :: علاج الحروق](https://reader033.fdocuments.in/reader033/viewer/2022061115/54649febb4af9fda3f8b46fc/html5/thumbnails/30.jpg)
![Page 31: Burn Management :: علاج الحروق](https://reader033.fdocuments.in/reader033/viewer/2022061115/54649febb4af9fda3f8b46fc/html5/thumbnails/31.jpg)
Other care measures include
• Face– eye – ear
• Hands & arms
• Perineum
• Physiotherapy
![Page 32: Burn Management :: علاج الحروق](https://reader033.fdocuments.in/reader033/viewer/2022061115/54649febb4af9fda3f8b46fc/html5/thumbnails/32.jpg)
Drug Therapy
• Analgesics and Sedatives
• Tetanus immunization• Antimicrobial agents: Silver sulfadiazine
Nutritional Therapy• Burn patients need more calories & failure
to provide will lead to delayed wound healing and malnutrition.
![Page 33: Burn Management :: علاج الحروق](https://reader033.fdocuments.in/reader033/viewer/2022061115/54649febb4af9fda3f8b46fc/html5/thumbnails/33.jpg)
Clinical Manifestations• Burn wound either heals by primary
intention or by grafting.• Scars may form & contractures.• Mature healing is reached in 6
months to 2 years • Avoid direct sunlight for 1 year on
burn • new skin sensitive to trauma
![Page 34: Burn Management :: علاج الحروق](https://reader033.fdocuments.in/reader033/viewer/2022061115/54649febb4af9fda3f8b46fc/html5/thumbnails/34.jpg)
Care of B U R N SB -B - breathing
UU - urine output
RR - rule of nines
resuscitation of fluid
N -N - nutrition
S S - shock
silvadene
![Page 35: Burn Management :: علاج الحروق](https://reader033.fdocuments.in/reader033/viewer/2022061115/54649febb4af9fda3f8b46fc/html5/thumbnails/35.jpg)
Referral Criteria
• 2nd or 3rd Degree Burns
• >10% TBSA
• Burns to vital organs of burn
• circumfrential burns
• Electrical Burns
• Chemical Burns
• Inhalation Injury
![Page 36: Burn Management :: علاج الحروق](https://reader033.fdocuments.in/reader033/viewer/2022061115/54649febb4af9fda3f8b46fc/html5/thumbnails/36.jpg)
Referral Criteria
• Concomitant trauma (If Major Trauma, The Trauma Center , Not the Burn Center should be the initial stabilizing unit)
• When in doubt , consult with a burn center
![Page 37: Burn Management :: علاج الحروق](https://reader033.fdocuments.in/reader033/viewer/2022061115/54649febb4af9fda3f8b46fc/html5/thumbnails/37.jpg)
Questions?