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The thermal injury

  1. 1. Done BY : Dr. Sara Al-Ghanem | Medical intern from KFU 1
  2. 2. I-definition & incidence II- types ( etiology ) 4-management of burn 5-complicatios III- classifications According 2
  3. 3. A burn is defined as a traumatic injury to the skin or other organic tissue primarily caused by thermal or other acute exposures. Burns occur when some or all of the cells in the skin or other tissues are destroyed by heat, cold, electricity, radiation, or caustic chemicals. 3
  4. 4. Burns are the fourth most common type of trauma worldwide, following traffic accidents, falls, and interpersonal violence. Approximately 90 percent of burns occur in low to middle income countries. Most burn injuries occur in a domestic setting, with cooking as the most common activity. Pediatric burns occur more commonly in the home (84% ) and while children are unsupervised (80%) . Adults are equally likely to sustain a burn in the home, outdoors or at work. Burns to adult females occur mostly at home, while burns to adult males occur mostly in outdoor or work locations. The elderly are most likely to sustain a burn in the bathroom, 4 followed by the kitchen .
  5. 5. Thermal Cold exposure (frostbite) Chemical burns Electrical current Inhalation Radiation burns 5
  6. 6. IV- classifications According to: Burn depth & clinical presentation of each type Size or extent Severity grading 6
  7. 7. Burn depth 7
  8. 8. involve only the epidermal layer of skin No blister, painful dry, red, and blanch with pressure. healed in six days without scarring. commonly seen with sunburns. 8
  9. 9. Partial-thickness I- superficial: Superficial – blisters painful, red, and weeping, and blanch with pressure. heal in 7 to 21 days.  scarring is unusual.  pigment changes may occur. 9
  10. 10. I- deep: extend into the deeper dermis damage hair follicles and glandular tissue. painful to pressure only almost always blister (easily unroofed), are wet or waxy dry, and have variable mottled colorization from patchy cheesy white to red . They do not blanch with pressure. Healing in three to nine weeks. invariably cause hypertrophic scarring. If they involve a joint, joint dysfunction is expected even with aggressive physical therapy.  A deep partial-thickness burn that fails to heal in three weeks is functionally and cosmetically equivalent to a full thickness burn 10
  11. 11. I- deep: 11
  12. 12. extend through and destroy all layers of the dermis and often injure the underlying subcutaneous tissue. Burn eschar, the dead and denatured dermis, is usually intact.. 12
  13. 13. eschar can compromise the viability of a limb or torso if circumferential.  Full thickness burns are usually anesthetic or hypoesthetic. Skin appearance can vary from waxy white to leathery gray to charred and black. skin is dry and inelastic and does not blanch with pressure  Hairs can easily be pulled from hair follicles. Vesicles and blisters do not develop. Without surgery, these wounds heal by wound contracture with epithelialization around the wound edges.  Scarring is severe with contractures  complete spontaneous healing is not possible. 13
  14. 14. extend through the skin into underlying tissues such as fascia, muscle, and/or bone potentially life-threatening injuries Never heal , unless surgically treated 14
  15. 15. • The two commonly used methods of assessing TBSA in adults are the Lund-Browder chart and "Rule of Nines,” • whereas in children, the Lund-Browder chart is the recommended method because it takes into account the relative percentage of body surface area affected by growth. • When the burn is irregular and/or patchy, the palm method may be useful 15
  16. 16. Role of 9  Adult head & neck = 9% TBSA upper limb = 9 % TBSA trunk = 18% TBSA back = 18% TBSA genitalia = 1% TBSA lower limb= 18 % TBSA 16
  17. 17. Lund-Browder chart SARA AL-GHANEM 17
  18. 18. SARA AL-GHANEM 18
  19. 19. Small or patchy burns can be approximated by using the surface area of the patient's palm. The palm of the patient's hand, excluding the fingers, is approximately 0.5 percent of total body surface area and the entire palmar surface including fingers is 1 percent in children and adults
  20. 20. The major determinants of severity of any burn injury are : -Burn factors: - Type of the burn - the percentage of total body surface area - the presence of an inhalational injury, - depth & site of the burn - presence of infection - associated injuries -complications -Patient's factors : age , sex , mentality , socio-economic status, concomitant diseases
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  24. 24. SARA AL-GHANEM 24
  25. 25. The principles of managing an acute burn injury are the same as in any acute trauma case: A Airway control. B Breathing and ventilation. C Circulation. D Disability – neurological status. E Exposure with environmental control. F Fluid resuscitation SARA AL-GHANEM 25
  26. 26. Initial management of the burned airway (A) • Early elective intubation is safest • Delay can make intubation very difficult because of 
swelling • Be ready to perform an emergency cricothyroidotomy if intubation is delayed • Recognition of the potentially burned airway • A history of being trapped in the presence of smoke or hot gases • Burns on the palate or nasal mucosa, or loss of all the hairs in the nose • Deep burns around the mouth and neck SARA AL-GHANEM 26
  27. 27. Breathing : management of inhalational injury (B) : • The clinical features are : a progressive increase in respiratory effort and rate, rising pulse, anxiety and confusion and decreasing oxygen saturation. • Treatment starts as soon as this injury is suspected and the airway is secure. Physiotherapy, nebulisers and warm humidified oxygen are given . 27
  28. 28. In children with burns over 10% TBSA and adults with burns over 15% TBSA, consider the need for intravenous fluid resuscitation The key is to monitor urine output Fluids needed can be calculated from a standard formula 28
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  31. 31. Full-thickness and deep dermal burns need antibacterial dressings to delay colonization prior to surgery Superficial burns will heal and need simple dressings An optimal healing environment can make a difference to outcome in borderline depth burns 31
  32. 32. • The four most common dressings for fullthickness and contaminated wounds are : • 1% silver sulphadiazine cream • 0.5% silver nitrate solution • Mafenide acetate cream • Serum nitrate, silver sulphadiazine and cerium nitrate 32
  33. 33. 1-Analgesia 2-Energy balance and nutrition 3-Monitoring and control of infection 33
  34. 34. Infection control in burns patients: • Burns patients are immunocompromised • They are susceptible to infection from many routes • Sterile precautions must be rigorous • Swabs should be taken regularly • A rise in white blood cell count, thrombocytosis and increased catabolism are warnings of infection • If there are signs of infection, then further cultures need to be taken and antibiotics started 34
  35. 35. 6-Psychological 4-Nursing care 5-Physiotherapy 35
  36. 36. 7-Surgical treatment • Deep dermal burns need tangential shaving and split-skin grafting • All full-thickness burns need surgery • The anaesthetist needs to be ready for significant blood loss • Topical adrenaline reduces bleeding • All burnt tissue needs to be excised • Stable cover, permanent or temporary, should be applied 
at once to reduce burn load 36
  37. 37. Escharotomy incising the whole length of full-thickness burns 37
  38. 38. graft SARA AL-GHANEM 38
  39. 39. general complications of burns 1-inhalation injury & airway damage 2-CO poisoning 3-all types of shocks 4-renal failure (acute tubular necrosis) 5-supra-renal failure
6-GI ulcers ( curling ulcers ) 7-multi-organ failure 39
  40. 40. -Wound infections .
-Wound escher( is a very tough layer in the 3rd degree burn covering the row area & necrotic tissue) >> causing deformities & movement restriction -Malignant ulcers -Loss of functions -Dupuytren contracture (wrist joint movement restriction) -Hypertrophic scar (keloid) 40
  41. 41. -disfigurement -Family breaking & divorce -Low self-esteem -Long absence from the work -unemployment
-pressure 41
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  43. 43. SARA AL-GHANEM 44
  44. 44. SARA AL-GHANEM 45