DEFINITION, AETIOLOGY

AND MANAGEMENT OF
BURNS
By
Dr Opara K. O.
(Consultant Burn, Plastic, Hand and
reconstructive Surgeon )
 OUTLINE
• INTRODUCTION
• CLASSIFICATION
• AETIOLOGICAL FACTORS
• MANAGEMENT
Pre-Hospital Care
Hospital Care
Complications
Reconstruction
Rehabilitation
Prognosis
Introduction
• Definition – Coagulate necrosis of a
tissue usually following
thermal injury.
• The most traumatic form of injury a person
can sustain and still survive.
• Affects the very young, the very old, the
very careless, and the very unlucky.
• >90% PREVENTABLE.
Team approach.
Classification

• Based on burn wound depth.

1) Partial thickness 2) Full
thickness burn
Major burns
* > 10% TBSA in a child < 10yrs or adult
> 50 yrs

* > 20% TBSA in others.

* Involvement of special areas – face, hands, perineum, feet, genitalia, major

joints.

* > 5% TBSA full thickness burn.

* Associated inhalational injury

* Significant electric injury

* Significant chemical injury

Causes of Burns

• Thermal

• Chemical

• Electrical

• Radiation burn
Thermal

• Naked flame.- kerosene lamp

explosion
pipeline explosions.
House fires

• Hot liquids– hot oils, hot water

• Hot objects
Chemical burns

• Acids
• Alkali.
• Phosphorous
• Phenol
• Hydrofloric acid
• hydrocarbon
Electrical

• High voltage and Low voltage injuries

* heat generation by conduction of current
* Arc burns
* ignition of clothing
* high incidence of concomitant injury

Note – associated injuries, deeper tissue

involvement, progressive tissue loss.
Pre-hospital care
• Remove from danger.
• Stop/limit further injury.
water water water water water
water water
• A - airway
B - breathing
C - circulation
• Cover with a clean clothe
• Evacuate to hospital
Brief History and
Examination
- patient biodata
- time of injury
- agent of injury
- circumstances of injury
- treatment before presentation,
including
amount of fluid.
- co-morbid condition
Early Resuscitation

A – Airway

B - Breathing
Early Resusc. Cont.

C – Circulation

D – Diagn. and treatm. of other

life/ limb threatening injuries.

E – Evaluation of burn wound

E - Evaluation of extent of
Injury.
- general examination.

- areas involved.

- extent and depth of injury.

- patient weight.
Extent of burn wound

• Wallace’s rule of nine.

• Lund and Browder chart.

Admit or not to Admit

• Admit - Major burns.

Fluid resuscitation and
monitoring
• Fluid requirement.
parkland formula – wt. in kg x
TBSA x 4

• Monitoring – Hourly urine output.

$$$ -- TUBE IN, TUBE OUT

• IV analgesics in early
resuscitative phase.
• Anti tetanus immunization
• Anti acids
• Antibiotics. To give or not to
give.
WOUND CARE

• Initial cleaning and

debridement.
• Escharotomies.
• Serial debridement for elec. Inj
• Topical antimicrobial agents
• Wound dressing
• Early wound cover
Nutrition
• High protein/High calorie diet.
• CURRERI FORMULA:
ADULT REQ. = 25kcal/kg +40kcal/%burn
CHILDREN = 60kcal/kg + 35kcal/%burn

• Early commencement of enteral feeding.

• Nutritional monitoring
Carbohydrate
requirement
• Should constitute 55 to 60% of
calorie intake
• Maximum - 7g/kg/day
• Strict glycaemic control
beneficial but with risks.
( maintain at 6-8mmol/L)
• LIPIDS:

• - Small quantities required to prevent

essential fatty acid deficiency.

• Should constitute only about 15% of the

calorie requirement

• - large quantities up to 35% is detrimental.

• Non nutritional lipid intake should be

monitored
 PROTEIN REQUIREMENT

• Needed to restore amino acid pool

for
- substrate synthesis
- synthesis of acute phase
proteins
- synthesis of immune
proteins
- Gluconeogenesis

• 1.5 to 2g/kg/day
Physiotherapy

• Proper positioning.

• Judicious use of splints.

• Active and passive exercises.

Complications

• Can affect every system.

• Better prevented.
Fluid and electrolyte
imbalance.

# Fluid and electrolyte imbalance.

under resuscitation
over resuscitation
Hypothermia

• Loss of skin barrier

• Massive infusion of cold fluids.
Urinary system

• Renal insufficiency.

* pre-renal renal failure

* acute tubular necrosis

Infection

• Loss of skin barrier

• Immune suppression.

• Translocation of gut bacteria

Types of infections

• Burn wound infection

• Chest infection

• Systemic infection.
Nutritional deficiency

• Protein energy malnutrition

• Micronutrient deficiency

causes
• Loss of protein rich wound exudate
• Inadequate intake
• Hypercatabolic state
Cardiovascular system

• Ischaemic injury
• Anaemia
* direct heat damage.
* increased red cell fragility.
* blood loss with dressing
* bone marrow depression
Gastrointestinal
complications
• GI bleedeing
• Acute Gastric Dilatation
• Gut necrosis
• Liver failure
Respiratory system

• Chest infection
• ARDS
• RESPIRATORY FAILURE
MUSCULOSKELETAL
SYSTEM
• Gangrene and loss of body
parts.
* direct injury * ischaemic
complication
• Deformities
• Heterotopic calcification
Scar complications

• Hypertrophic scars and keloids

• Contractures
• Dyschromic scars
• Unstable scars
• Scar cancer
Neurological
complications
• More with electr. Injuries
• Peripheral nerve injury
• Seizure disorder
Psychological
complications

• Post burn Neurosis

• Post burn Psychosis

CONCLUSION

• Early institution of adequate

management is the most
important determinant of
outcome
• Proactive and knowledge based
• Economics not self sustaining
• May do well to refer
• Do Not scoop and run
Thank you.

Thank you.