Pitfalls in burn management by Dr. Sunil Keswani, National Burns Centre, Airoli
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Transcript of Pitfalls in burn management by Dr. Sunil Keswani, National Burns Centre, Airoli
PITFALLS IN BURN MANAGEMENT
Dr Sunil KeswaniCosmetic Surgeon and Burns Surgeon
NATIONAL BURNS CENTRENavi Mumbai
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
Aim of burn care
• Rescue• Resuscitate• Refer• Resurface
• Rehabilitate• Reconstruct• Review
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
Principles of BURN MANAGEMENT
• Airway management-quick and appropriate• Prompt and accurate fluid resuscitation• Removal of dead burnt skin and replacement
with homograft(cadaveric skin from SKIN BANK) or biologic skin substitutes
• Appropriate adequate nutrition• Good chest PT• Replacement of homograft with autograft or
cultured skin(cultured keratinocytes)
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
Which burn patients need HOSPITALISATION?
• We go by the AMERICAN BURN ASSOCIATION GUIDELINES
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
Does a child with only head face burns require hospitalisation?
• YES.
• The head face in a child constitues about 18% BSA while in an adult it is 9 %!!
• Anything above 10% BSA in a child needs hospitalisation
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
How do we reduce INFECTION IN BURNS?
• Hand washing• Infection control measures like Isolation,Use
of disposables,Separate bedpan,stethoscope and BP apparatus for each burn patient and a 1:1 nurse patient ratio.
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
Philipp Ignaz Semmelweis• Hungarian Physician
reduced the incidence of Puerperal Fever in a Vienna Hospital by introducing the practice of HAND WASHING with chlorinated water
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
Louis Pasteur• French microbiologist
and chemist• Germ theory of disease• Founder of
Microbiology along with Robert Koch
• Pasteurisation of milk• Popularised the concept
of HAND WASHINGDr. Sunil Keswani, National Burns Centre,
www.burns-india.com, [email protected]
LEVELS OF ICU CARE • Level - I – provides
monitoring, observation and short term ventilation.
• Level - II – Provides Observation, Monitoring & Long Term Ventilation With Resident Doctors.
• Level - III – provides all aspects of intensive care including invasive haemo dynamic monitoring & dialysis.
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
BED STRENGTH
• IDEALLY 8 TO 12 BEDS.
• LARGER AREAS – DIFFICULT TO ADMINISTER AND SMALLER AREAS NOT BEING COST EFFECTIVE.
• 5 TO 8 BEDS PER 50 HOSPITAL BEDS FOR A LEVEL III ICU / 10-16% OF THE TOTAL NUMBER OF HOSPITAL BEDS.
Dr. Sunil Keswani, National Burns Centre,
www.burns-india.com, [email protected]
BED SPACE & BEDS• ALL SEPARATE CUBICLES
• 225 – 250 SQUARE FEET PER BEDS
• BEDS - ADJUSTABLE, NO HEAD BOARD, SIDE RAILS AND WITH WHEELS,REMOTE CONTROLLED WITH FACILITY FOR ALL POSITIONING FOR NURSING CARE AND PHYSIOTHERAPY AND EMERGENCY SITUATIONSDr. Sunil Keswani, National Burns Centre,
www.burns-india.com, [email protected]
Fluid Management• Fluids per hour=Wt(kg) x % of Burns divided by 4• Start with RL in adults and Isolyte P in children• After 24 hrs start DNS• If not adequate urine output in 12 hrs start colloids
FFP• CVP above 10 cms water and inadequate uo Inj
Lasix • More fluids required in Electric Burns and
Inhalation Injury • Always central line (sometimes even thro burnt
tissue) for initial resuscitation Dr. Sunil Keswani, National Burns Centre,
www.burns-india.com, [email protected]
Fluid resuscitation
• Need to replace losses to maintain homeostasis.• Formulas are ONLY GUIDELINES.• Monitor physiologic parameters.• Maintain adequate tissue perfusion to prevent
increase in depth of burn.• Too little fluid Hypotension renal failure, etc.► ►• Too much fluid Edema Tissue hypoxia► ►
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
Electrical injury resuscitation
• Fluid needs greater
• 9 mL x TBSA burn (%) x body weight (kg) in first 24 hrs
• If myoglobinuria, may require bicarbonate infusion to alkalinize urine to pH > 8
• End point: urine output of 1.5-2 mL/kg/hrDr. Sunil Keswani, National Burns Centre,
www.burns-india.com, [email protected]
Electrolyte Abnormalities
• HYPOKALEMIA- seen more often than Hyperkalemia
• Commonest cause of non infective paralytic ileus
• Serum K <3mEq/l KCl at 10mEq/hr• Serum K <2mEq/l KCl at 40mEq/hr• Daily Ser Electrolytes in first 3 days
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
Electrolyte Abnormalities• HYPOCALCEMIA-most commonly due to
Hypoalbuminemia• Lowering of Ser Albumin by 1g/ml lowers Ser
Calcium by 1g/ml• Alkalosis also lowers Ser Ca by increasing
protein binding• Correction required only if symptomatic • Associated Hypomagnesemia needs
simultaneous correction to prevent tetany and arrhythmias
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
Reducing the HYPERMETABOLIC RESPONSE
• Temperature regulation• Nutrition• Pharamacological manipulation-Propranolol
40 mg BD and Oxandrolone 5mg BD• Early excision and homografting
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
Role of LMWH
• Incidence of Deep Vein Thrombosis is significant enough to warrant routine use of LMWH
• Incidence of Pulmonary embolism is reduced significantly
• Daltaparin or Enoxiparin• Fragmin or Clexane• This is stopped once patient is mobile
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
Role of Intermittent Compression Device
• Intermittent compression pump along with LMWH decreases the incidence of DVT by as much as 50%
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
Nutrition
• Aggressive nutritional support to counterbalance the effect of Hypermetabolism and Protein catabolism following Burns
• ENTERAL feeding is preferred over PARENTERAL feeding
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
Nutritional support
• Burns patient is hypercatabolic – up to 150- 200% above baseline.
• Nutrition needed for burns >20% TBSA.• Curreri formula
– Adult: 25kcal/kg/day + 40kcal/ % TBSA burn– Child: 60kcal/kg/day + 35kcal/ % TBSA burn
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
BUTTERMILK DIET(BMD)
• Eggs- 4 /Protein powders(Whey protein or Soya protein)
• Bananas- 4• Sugar- 4 Tbsf• Curds (Yoghurt) -1000cc• Mixed with water to
1600cc
Tracheostomy
• Head face neck burns IMMEDIATE TRACHEOSTOMY to facilitate airway and nursing
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
Chest Physiotherapy
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
Limb Physiotherapy
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
Fasciotomy• Pain • Pallor-look at capillary refill
time-if less than 2 secs-VENOUS OBSTRUCTION and if more than 5 secs –ARTERIAL OBSTRUCTION
• Pressure• Pulselessnes• Paresthesia• Paralysis• Poikilothermia• Progression
• Compartmental pressures above 25mm Hg warrant a FASCIOTOMY
• There are devices to measure this pressure
• We use DOPPLER to decide
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
Fasciotomy-LINES OF INCISION
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
Fasciotomy-methodology
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
Fasciotomy-methodology
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
Leg-FASCIAL COMPARTMENTS
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
Esharotomy
• Thick circumferential non-yielding eschar warrants an ESHCAROTOMY
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
Esharotomy-LINES OF INCISION
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
Esharotomy
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
INTRAABDOMINAL HYPERTENSIONand
INTRAABDOMINAL COMPARTMENT SYDROME
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
Abd compartment syndrome-LAPAROTOMY
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
Early excision Vs Delayed excision
• Always early excision if patient comes early enough and facilities exist
• Early enough is upto 72 hrs postburn• Early excision decreases the chances of Sepsis
and facilitates early moblisation and better and more predictable functional recovery.
• Delayed excision is generally at 3 weeks or later
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
Early Excision
• Within the first 3-5days• After 5 days chances of Sepsis higher and
bleeding more• 15% of BSA is excised at a time• Coverage of excised area by Meshed
Homograft is mandatory
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
Order of excision
• Areas easy and quick to excise: trunk and legs
• Joints and throats• Hands and face
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
Early Excision
• Blood Loss– Clear pre-operative plan– Excision prior to wound hyperemia– Elevation of extremities– Tourniquet control– Dilute Epinephrine tumescent fluid– Epinephrine soaked sponges
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
Early Excision
• Procedure (En Bloc)– For deeper burns– Skin and fat excised in one session– Less time consuming– Excision down to the natural cleavage plane– Down to fat or Fascia
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
AllograftClassic benefits of allograft as a physiologic and
mechanical barrier:
• Reduction in water, electrolyte and protein loss
• Reduction in energy requirements secondary to the attainment of a closed wound
• Reduction in wound infection rates• Reduction in pain• Conservation of autografts• Improved general welfare and psychological
outlook of the patientDr. Sunil Keswani, National Burns Centre,
www.burns-india.com, [email protected]
Allograft
• Reduction in the number of bacteria under a biological dressing
• Phagocytes within a wound use the fibrin network established between the allograft and the wound to trap and phagocytose bacteria without the production of opsonins or antibody
• The effects of allografts in reducing bacteria and promoting healing have proven beneficial
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
Porcine Skin
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
Porcine skin being meshed
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
Differences Between Skin Substitutes
• Materials that are applied for short periods then removed, to stimulate autologous healing
• Cell free material that encourage colonization by autologous cells, to stimulate new skin formation
• Cell containing skin substitutes: to provide immediate functional replacement
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
Integra
• Most widely accepted synthetic skin substitute• Bilaminar structure• The median ‘take’ is 85%• Two-stage procedure, with a minimum interval
of 3 weeks between the application of the Integra and the split-skin grafting
• Relatively expensive
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
Integra
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
Acticoat
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
Fascial Excision
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
Integra applied
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
Covered with Acticoat
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
Cultured autologous keratinocytes
• Grown in vitro and then applied to wounds • Take of cultured epithelial autografts depends
on the wound bed• Expensive • Skilled labour and quality control, • 3–5 weeks to produce 1.8m2 confluent sheets
of cells from a 2 cm2 biopsy• Fragile sheets• Blistering, infection, and contractures.
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
Wound Closure
• Suggested Clinical Indications for CAE– burn injuries >90% broad– 70-90% more limited– <70% no clear indication
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
Meshed graft Vs Meek Micrografting Vs Sheet Graft
• Acute burns always meshed or meek micrografting for better takes
• Reconstructive procedures like overgrafting and release of contractures always sheet grafting for better cosmesis
• Meek micrografting gives wider coverage and more predictable takes than mesh grafting but more expensive
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
MATERIALS & METHODSSurplus cutting
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
MATERIALS & METHODSPositioning on plate.
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
MATERIALS & METHODSDermatome cut through
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
MATERIALS & METHODSAdhesive Spraying
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
MATERIALS & METHODSAdhesive Spraying
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
MATERIALS & METHODSCork removing.
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
MATERIALS & METHODSGauze expansion
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
MATERIALS & METHODSGauze expanded.
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
MATERIALS & METHODSMicrograft positioning
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
MATERIALS & METHODSAfter gauze removal. 7th day.
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
MATERIALS & METHODS10th day wound care.
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
MATERIALS & METHODSLong term control.
POST-PHYSICAL REHABILITATION OUTCOME
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
DISCUSSION• Reliable alternative.
• Easy technique.
• Larger expansions.
• High integration.
• Fast epithelization.
• Better infection response versus mesh graft.
• Easy to handle because of its pliability.
• Comparative with mesh tecniques and functional results studies are required in the future.
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
NEED FOR PAIN RELIEF
• PAIN IS A FORM OF STRESS AND PRODUCES ELEVATION IN STRESS HORMONES AND CATECHOLAMINES.
• PAIN RELIEF ADVANTAGES:-• SHORTER HOSPITAL STAY.• IMPROVED MORTALITY RATES• LESS CATABOLISM AND ENDOCRINE DERANGEMENTS.• FEWER THROMBOEMBOLIC COMPLICATIONS• PAIN FREE DRESSINGS MAKE PATIENTS MORE COMFORTABLE AND
DECREASES THE MORBIDITY AND MORTALITY.
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
NEED FOR PAIN RELIEF
• Circumferential chest burns-pain restricts full respiratory excursions ,atelectasis and pneumonias
• Pain prevents patients from eating well-nutrition affected.
• Pain depresses the patient-psychosomatic problems• Pain contributory to Post burn psychosis• Pain-poor compliance during physiotherapy-poor
rehabilitation-poor functional outcome
Mentosternal Contracture
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
Mentosternal Contracture
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
Homogrft and Autograft
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
Penoscrotal burns
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
PRE-OP POST-OP
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
PRE-OP POST-OP
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
PRE-OP POST-OP
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
PRE-OP POST-OP
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
PRE-OP POST-OP
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
PRE-OP POST-OP
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
PRE-OP POST-OP
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
PRE-OP POST-OP
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
PRE-OP POST-OP
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
PRE-OP POST-OP
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
PRE-OP POST-OP
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
CLINICAL USE OF HOMOGRAFT
AT NBC
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
Skin Bank and Skin DonationDONATE SKIN AND SAVE A LIFE
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
Patient Name- Neeta Parekh Age- 48Gender- FemaleTBSA Of Burns- 35%Degree Of Burns-2nd Degree Areas Of Burns-chest, Both Upper ExtremitiesCause Of Burns-During Lighting Diya
PATIENT DETAILS
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
ADMISSION FORM
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
PHOTOS ON DAY OF ADMISSION
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
PHOTOS ON DAY OF ADMISSION
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
EARLY BURN EXCISION
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
APPLICATION OF HOMOGRAFT
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
1ST DRESSING CHANGE OF HOMOGRAFT
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
2ND DRESSING CHANGE OF HOMOGRAFT (4TH DAY)
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
3RD DRESSING CHANGE OF HOMOGRAFT (6TH DAY)
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
FOLLOW UP
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
FOLLOW UP
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
APPLICATION OF HOMOGRAFT
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
1ST DRESSING CHANGE OF HOMOGRAFT
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
2ND DRESSING CHANGE OF HOMOGRAFT (4TH DAY)
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
3RD DRESSING CHANGE OF HOMOGRAFT (6TH DAY)
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
FOLLOW UP
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
FOLLOW UP
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
END RESULT
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
Patient Name- Ramsingh Age- 52 Gender- MaleTBSA Of Burns- 55%Degree Of Burns-2nd DegreeAreas Of Burns- Face ,Chest, Both Upper Extremities,, Lower Extremities.Cause Of Burns- Explosion
PATIENT DETAILS
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
ADMISSION FORM
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
PHOTOS ON DAY OF ADMISSION
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
PHOTOS ON DAY OF ADMISSION
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
EARLY BURN EXCISION
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
APPLICATION OF HOMOGRAFT
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
1ST DRESSING CHANGE OF HOMOGRAFT
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
2NDDRESSING CHANGE OF HOMOGRAFT
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
5TH DRESSING CHANGE OF HOMOGRAFT
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
FOLLOW UP
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
EARLY BURN EXCISION
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
APPLICATION OF HOMOGRAFT
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
1ST DRESSING CHANGE OF HOMOGRAFT
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
2ND DRESSING CHANGE OF HOMOGRAFT
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
FOLLOW UP
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2ND STAGE TANGENTIAL EXCISION
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
APPLICATION OF HOMOGRAFT
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
2ND DRESSING CHANGE OF HOMOGRAFT (4TH DAY)
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
TREATMENT GOING ON
BEFORE TREATMENT
AFTER TREATMENT
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
Patient Name- Yojana D. GhaseAge- 24 Gender- FemaleTBSA Of Burns- 20%Degree Of Burns-2nd Degree Deep Areas Of Burns- Chest, Abdomen, Right Upper Extremity, Lower Face .Cause Of Burns-flame Burn.
PATIENT DETAILS
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
ADMISSION FORM
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
PHOTOS ON DAY OF ADMISSION
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
EARLY BURN EXCISION
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
APPLICATION OF HOMOGRAFT
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
1ST DRESSING CHANGE OF HOMOGRAFT
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
2ND DRESSING CHANGE OF HOMOGRAFT
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
4TH DRESSING CHANGE OF HOMOGRAFT
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
BEFORE AUTOGRAFTING AFTER AUTOGRAFTING
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
END RESULT
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
PITFALLS IN BURN MANAGEMENT
• Early tracheostomy• Prompt adequate resuscitation• Colloids after 12 hrs• Infection control practices• Pain relief• Early enteral nutrition• Early mobilisation and Intensive chest PT• DVT prophylaxis
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
PITFALLS IN BURN MANAGEMENT
• Escharotomy• Fasciotomy• Early excision and use of banked skin• Fascial excison and use of banked skin or
autografts• Early rehabilitation-
physical,social,psychological
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
TEAM APPROACH TO BURNS
• Plastic Surgeon• General Surgeon• Ophthalomologist• ENT surgeon• Intensivist• Nephrologist• Anesthesiologist• Cardiologist• Psychiatrist
NursesMicrobiologistPhysiotherapistOccupational therapistPsychological CounsellorSocial WorkerDietitianPrevention team
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
Screening of patients
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
Surgeries being performed in the previous camps
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
Post- Operative care of the patients
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
Skin Donation Helpline:
022 2779 3333
www.skindonation.inwww.burns-india.com