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Burns

BURNS
• Airway injuries
• % of area of burns
• Depth of burn
• M/c burns- scalds (hot liquid) children
• M/c burns in hospital (thermal or flame)
• Electrical burns-1000V
• Low tension- interfere with SA node rhythm
• High tension- Direct myocardial damage
• AIRWAY
• Assess damage- inhalational injury
• EARLY recognition of airway burn
• Thermal burns
• HYPOXIA
• Swelling of airway (upper airway-flame, lower airway- steam)
• Inhalation- chemical alveolitis
• Toxin (C0, HCN)- Met acidosis
• Eschar (deep burn) over chest wall- impaired respiration
• ET tube
• Tarcheostomy
• Needle cric(12 G)
• Crico thyroidotomy
Breathing
• Humidified air
• Ventilator support

• CIRCULATION
• First 36 hr
Wallace rule
Lund browder
• Head and neck in infant- 18% (<1yr)
reduce 1% every year till it reaches 9%
• One LL in infants- 14% (<1yr)
increased 0.5% every year till it reaches 18%
• Depth of burns- temperature, duration
• Parkland 4 x BSA burnt x wt in kg (1st 24hr only crystalloids)
½ in 1st 8hours, ½ in next 16hours
• 1st degree burns not included in calculating volume of area burns
• Fluid preferred RL- Hartmann solution

• Muir and Barkley- after 24 hours

• Galveston (children)- additional fluid –dextrose saline


Pathology
Features 2nd degree 3rd/4th degree
1st degree

Epidermis Papillary & reticular dermis Subcutaneous tissue- 3


Superficial(pain) deep(painless) Muscle +bone- 4

Capillary + - -

Sensation + + -

Blister - + -

Colour- red pink White or black


Leathery appearence

Healing- 2 weeks 3 weeks Requires surgery

No scar Hypertrophic scar Depends on surgical technology


Management of burns
• Stop, drop ?, cool H20 at room temperature
• Burning side up- effective upto 1 hr, max effect <10min
• Avoid hypothermia
Admission in burns
• 10% partial thickness burns- <10years
• 20%partial thickness burns- adult
• Full thickness burns- always admit
• Electrical burns and chemical burns (alkali)- always admit
• Hypovolemia- most critical –first 36 hours
• Immunity decreased( skin breached)
• M/c source of infection (burn woundIV
lineFoleysTracheostomy)
• M/c organism- Pseudomonas, Strep Pyogens
• M/c viral HSV
• M/c cause of immediate death- suffocation
• Early death- hypovolemia,
• late death- sepsis
Hormones released in burn patients:

• Catecholamines,
• Steroids,
• Glucagon,
• GH,
• TSH
Entry point