A burn is an injury to the skin or tissue caused by heat, radiation, electricity, friction or chemicals. Thermal burns are caused by hot liquids, flames, or objects. First aid involves removing the person from the heat source, cooling the burn with water, and keeping them warm. Burn types include thermal, chemical, smoke inhalation, electrical and radiation burns. Proper management includes wound care, fluid resuscitation to prevent shock, preventing infection and complications, and reconstructive surgery for scarring and contractures.
2. Definition
A burn is an injury to the skin or other
organic tissue primarily caused by heat
or due to radiation, radioactivity,
electricity, friction or contact with
chemicals. Thermal (heat) burns occur
when some or all of the cells in the skin or
other tissues are destroyed by: hot liquids
(scalds)
3. First aid for burns
Remove from burn source
Cool the burn with cool or lukewarm running
water for 20 minutes as soon as possible after
the injury.
Never use ice, iced water, or any creams or
greasy substances like butter.
Keep yourself or the person warm.
Use a blanket or layers of clothing, but avoid
putting them on the injured area.
4. Types of burns injury
Thermal burn Chemical burn
Smoke and inhalation injury
Electrical burns Radiation burns
Caused by flame
5. Thermal burn
Flash
Scald Contact with hot object.
Chemical burn
Caused by tissue contact with strong acids,
alkali or organic compounds.
The concentration, volume and type of chemical, as well as
the duration of contact determine severity of a chemical
injury
6. Smoke and inhalation injury
It result from inhalation
of hot air or noxious chemical and can cause damage to
the tissue of respiratory tract and mucosa.
Three main types of inhalation injury are
1. Carbon monoxide poisoning
2. Inhalation injury above glottis
3. Inhalation injury below the glottis
7. ELECTRICAL BURNS
Electrical burn injuries are caused by
heat that is generated by the electrical energy as it passes
through the body.
RADIATION BURNS
Radiation bums are the least
common type of burn injury and are caused by exposure to
a radioactive source.
These type of injuries have been associated with nuclear
radiation in industry and therapeutic radiation.
8. First aid management for burns
PUT ON FLAMES
If the casualty's clothing is on fire, cover
the casualty with a large piece of non synthetic material
(such as a wool or cotton blanket) and roll the casualty
on the ground until the flames are smothered.
If non synthetic material cannot be obtained quickly,
get the casualty to the ground and have him roll on the
flame until it goes out.
9. Do not use synthetic materials such as nylon and rayon
because they may melt and cause additional injury.
In case of third-degree burns, emergency medical assistance
should be called immediately, and while they arrive, the
following steps can be carried out:
Burnt clothing should not be removed, however, you can
make sure that the victim is not in contact with burning
materials or exposed to heat or smoke.
10. Severe, large burns should not be immersed in cold
water , because this can result in the victim going into
shock.
Check whether there are signs of movement, coughing,
or breathing.
In case these signs are not there, CPR, or
cardiopulmonary resuscitation can be started.
The burned parts of the body should be elevated above
the heart level, if possible.
The burned area can be covered by using a moist , cool,
sterilized bandage, or cloth, or towels.
11. SERIOUS BURN REQUIRING HOSPITALIZATION
ARE
Greater than 15% burns in an adult .
Greater than 10% burns in a child.
Any burn in the very young, the elderly or the infirm.
Any full thickness burn Burns of special regions: face,
hands, feet, perineum.
12. Management of burns
CARE OF BURNS
B- Breathing
U- Urine output
R- Rule of nines Resuscitation of fluid
N-Nutrition
S-Shock Silvadene
13. EMERGENCY TREATMENT
The management of major burn injury is
A - Airway.
B- Breathing and ventilation.
C-Circulation.
D Disability-neurological status
E- Environmental control-keep warm
F- Fluid resuscitation.
14. PHASE OF BURNS MANAGEMENT
1.Emergent or immediate resuscitative phase.
2.Acute phase.
3.Rehabilitation phase
15. Emergent or Immediate phase
Starts from onset of injury
to completion of fluid resuscitation.
First aid
Prevention of shock
Prevention of respiratory distress
Detection and treatment of concomitant
injuries
Wound assessment and immediate care
Tetanus immunization
16. BIOLOGIC DRESSING (Skin Graft)
Allograft Autograft Heterograft
Skin taken from other same person Different
person [cadaver speciesNenograft
segment of skin from animal such as pig
]
18. PARKLAND/BANTER FORMULA:
RL: 4ml x kg body wt x TBSA burned.
Day 1: Half to be given in first 8hrs: half to be given over
next 16 hrs.
Day 2: colloid is added
Example. For a 70 kg patient with 50% TBSA burn
4ml x70KgX50% burn 14,000ml (141 in 24 hrs.)
1/2of total in first 8 hrs-7000ml
1/4of total in second 8 hr -3500 ml
1/4of total in third 8 hr -3500ml
19. CONSENSUS FORMULA:
RL-4ml x kg body wt x % TBSA burned
Half to be given in first 8 hrs: remaining half to be given
over next 16 hrs
BROOkE ARMY FORMULA
1.Collods;0.5mlXgbodt wt X 5TBSA
2. RL. 15ml x kg body wt x 5 TBSA burned
3. Glucose(5in water): 2000ml for insensible loss
Day 1: Half to be given in first 8hrsremaining half over next
16hrs
Day 2: Half of colloids; half of electrolytes
20. EVANS FORMULA:
1. Colloid: I ml x kg body wt x TBSA burned
2. Saline: 1ml x kg body wt x % TBSA burned
3. Glucose(5% in water):2000ml for insensible
loss
Day1: Half to be given in first 8hrs; remaining half'
over next 16hrs
Day2: Half of previous day's colloid & electrolytes
maximum of 10,000ml over 24hrs
21. ACUTE PHASE
a. Wound care and closure
b. Prevention or treatment of complication, including
infection
c. Nutritional support
d. Prevention of scars and contractures
e. Physical, occupational and vocational rehabilitation
f. Functional and cosmetic reconstruction
g. Psychosocial counseling
22. METHODS OF TREATING BURNS
Open method or Exposure method
Face, neck, perineum, trunk
Allowing exudate to dry in 3 days
Occlusive
Less pain, absorption of secretion, comfort,
transportability, accelerated debridement
Aesthetic considerations
Semi-open method
Covering of wound w/ topical antimicrobials:
Silver sulfadiazine 1% (Flamazine).
Silver nitrate 0.5% sol'n .
Mafenide acetate (sulfamylon acetate)
23. Don'ts .
Do NOT apply ointment, butter, ice, medications, cream, oil
spray, or any household remedy to a severe burn because this
may hamper proper healing.
Do NOT breathe, blow, or cough on the burn.
Do NOT disturb blistered or dead skin as they can become
susceptible to infection.
.Do NOT remove clothing that is stuck to the skin.
Do not apply ice on the burned skin, because this can lead to
frostbite, thus damaging the skin even further.
Do NOT immerse a severe burn in cold water. This can cause
shock.
24. TYPES OF RECONSTRUCTIVE ANDCOSMETIC
SURGERY; FOR BURNS,CONGENITAL
DEFORMITIES, INJURIES AND COSMETICS
PURPOSE
Reconstructive
surgery following burn injury involves almost all aspects of
plastic surgery. The patient population include children and
adults. All areas of the body can be involved. Deep structures
can be injured either acutely or secondarily. Satisfactory
outcomes require correction of both functional and aesthetic
deformities. Yet, at the same time, the reconstruction of burn
deformities requires a unique perspective and an emphasis on
certain fundamentals and techniques that make it a specialized
area of reconstructive surgery.
25. Need for burns reconstructive surgery
Contractures (permenant tightening of muscle)Burns
cause tissue loss, wounds heal with contraction, and
contractures result. Contractures can be either intrinsic
or extrinsic.
Intrinsic contractures result from injury or loss of tissue
in the affected area, causing subsequent distortion and
deformity of the part.
Extrinsic contractures occur when tissue loss at a
distance from an affected area creates tension that
distorts the structure.
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34. COSMETIC SURGERY FOR CONGENITAL DEFECT
AND COSMETIC PURPOSE
Abdominoplasty: It is reshaping and firming of the
abdomen
Blepharoplasty: It is reshaping of the eyelids or the
application of permanent eyeliner
Mammoplasty: Breast augumentaion: Augumentation of
the breast by means of fat grafting, saline or silicone gel
prosthetics, which was initially performed to women with
micro mastia.
35. Reduction mammoplasty: It is removal of
skin and glandular tissue which is done to
reduce back and shoulder pain in women
with gigantomastia and or for psychological
benefit men withgynecomastia.
Mastopexy: It is Lifting or reshaping of
breast to make them less saggy, often after
weight loss,
