Professional Documents
Culture Documents
Management of Burn Injuries: Dr. Lawal G.D Registrar, Dept. of Surgery, NHA
Management of Burn Injuries: Dr. Lawal G.D Registrar, Dept. of Surgery, NHA
Management of Burn Injuries: Dr. Lawal G.D Registrar, Dept. of Surgery, NHA
• In the United Kingdom about 250 000 people are burnt each year.
Of these, 175 000 attend accident and emergency departments,
and 13 000 of these are admitted to hospital.
PREDISPOSING FACTORS:
• Extremes of age (<3yrs, >60yrs)
• Male sex/adolescence
• Compromising factors such as alcoholism, epilepsy,
chronic psychiatric or medical illness/disability
AETIOPATHGENESIS
The common burns are :
• scald- hot water, hot soup, hot oil, hot tar/asphalt etc.
• Fluid loss is fastest in the first 8 hours and tapers off within 24 -48
hours
• Without infection the reabsorption of oedema fluid is complete in 5-7
days
B. Renal dysfunction
• This is secondary to hypovolaemia- reduction in renal
perfusion → ↓GFR →acute tubular necrosis
• In deep burns haemoglobinuria and myoglobinuria may occur
leading to damage of the distal convoluted tubules
C. Gastrointestinal
• Mucosal damage – due to hypoperfusion →Loss of mucosal
integrity (Curling’s ulceration, GI bleeding), Ileus, Gastric
dilatation
• Translocation of gut bacteria via the portal system and
lymphatics- risk of sepsis
D. Anaemia
• Early anaemia is usually due to direct destruction
of red blood cells by heat
• PARTIAL THICKNESS-
1.superficial partial thickness-blisters, pink, moist, good capillary
refill and blanches,
2.deep dermal partial thickness-dry, poor/absent capillary refill,
impaired sensation
ESCHAROTOMY
INITIAL ASSESSMENT AND RESUSCITATION (contd)
• half the calculated volume given in first 8 hours post burn, with the
remaining delivered over 16 hours
NB: daily maintenance fluild in the form of 4.3% D/S is added in children-
they have a large surface area to body mass ratio and low glycogen store
Patients in need of higher fluid calculated from Parkland formula:
• electrical burns
• inhalational injury
• those on home diuretics
• presence of escharotomy or fasciotomy
E. Monitoring
-Hourly urinary output- aim for output of 1-2ml/kg/hr[n children and
0.5-1ml/kg/hr (or ≈30-50mls/hr) for adult
-vital signs temperature, pulse rate, blood pressure
-pulse oximeter
-continuous ECG monitoring in major burns
-serial determination of haematocrit, Serum electrolytes, glucose and
albumin
-doppler monitoring for compartment syndrome
MANAGEMENT OF INHALATIONAL INJURIES
Best managed in an ICU under the care of the anaesthesiologist,
burn surgeon and the chest physician
RELATIVE:
- Hoarseness
- Facial burn
- Sooty sputum
MANAGEMENT OF INHALATIONAL INJURIES (contd)
• Escharotomy
• Bronchoscopy ± intubation
• Monitor arterial blood gases
• 100% Oxygen
• Nebulized adrenalin(5mg) and salbutamol (2.5-5mg)
• Positive pressure ventilation
• Repeated bronchoscopic lavage
• Incentive spirometry and Chest physiotherapy
WOUND CARE:
• Determination of depth of burns is critical
• Dressing could be by exposure or occlusive .
• Superficial partial thickness burn usually heals in 14-21 days
• Deep partial thickness burns heals in 2-6 weeks with some
scarring
• Full thickness burns takes longer to heal- complications
• Initial wound care aims to reduce bacterial load, remove dead
tissue, and prevent wound infection
• Psychiatric disturbances
• Hypertrophic scarring
• Keloids
• Dyschromic scars
• Contractures/Deformities
• Marjolin’s ulcers
NEW AND EVOLVING MEANS OF MANAGEMENT
• Skin culture (Cultured Epidermal Autograft [CEA]) i.e growing
sheets of epithelium and applying it to the burn wound.
• Orcel temporary dressing- a marterial made up of layers of human
skin cells (from someone other than the donor0 and collagen from
cows. Use to dress burn wound and graft donor site for 2-3 weeks
then removed
• Tissue expanders made up of specialized balloon and inflated with
normal saline – use to cover areas burns injury
• Polychromatic light emiitting diodes use to stimulate healing of
burn wound in diabetics
PROGNOSIS
• age <3yrs, >60yrs
• TBSA >60%
• Inhalational injury