Evaluation and Management of Burns

Geoffrey LeePlastics 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– Prolonged irrigation of water– Remove contaminated clothing– Brush off metals and powders– Do not attempt neutralising without specialist advice

Full thickness burns to the legs caused by kneeling in cement

Questions?