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Burns management
1. Management of the
burn patient
NATHAN STEWART
ADAPTED FROM PRESENTATION BY DR ALAN PHIPPS
2.
In 1997-2005 the rate of total Burn Injury related
deaths for Australia was 0.5 per 100,000 persons.
In 2003-04 the age-adjusted hospitalisation rate of
fire, burn and scald related injury in Australia was
31.9 cases per 100,000 population per year.
During the period of 2001-02, throughout Australia,
burns and scalds were responsible for 6,248
hospitalisations in public hospitals with the
average length of stay being 7.1 days incurring an
estimated cost of $132 million.
3. Progress in Burn Care
Fluid resuscitation
Dedicated burns units
Antimicrobials
Intensive care
Nutrition
Early excision
Skin cover
Specialisation
3
10. Everybody
Every intervention influences the scar worn for life,
therefore, everyone who assists in the management
of that patient becomes a member of the burn care
team
11. First Aid for burns
Remove from burn source
Cold water - except when in contact with electricity
This has the most effect on the final outcome!
Still some effectiveness up to 4 hours post burn.
At least 20 minutes of cold running water.
Remove clothes. Need to avoid Hypothermia though!
Gels e.g. Burnshield
Cling film & dry clean sheet
No ointments, creams, powders, butter, etc. etc.
11
13. Minor burns
Defined by exclusion of
area more than 5% of body surface
deep
infected
problem area - face, hands, perineum, feet
inhalation injury
other injury or underlying medical problem
suspected non-accidental injury
13
21. Burn Resuscitation:
Airway
HISTORY
EXAMINATION
Confusion / Altered
Consciousness
Fire in an ENCLOSED SPACE
e.g. House fire
Burns to Face / Oropharynx
Car fire
Toxic fumes (Industrial)
Hoarseness / Stridor / Exp
rhonchi
Soot in nostrils or Sputum
Dysphagia / Drooling
26. Burn Shock
Likely if burned area more than
15% body surface in adults
10% body surface in children (and elderly)
26
27. Burn Resuscitation:
Shock
Definition
(Dietzman & Lillehei (1968))
The inability of the circulatory system to meet the
needs of tissues for oxygen & nutrients and the
removal of their metabolites.
28. Parkland formula
for fluid resuscitation
4ml Hartmann’s solution per 1% burn per
kg body weight
half in first 8hrs post-burn
half in the following 16hrs
= 0.25ml/%burn/kg/hr in first 8 hrs from
time of burn
colloid in second 24hrs
28
31. Management of the
burned patient
Full “primary and secondary” surveys
Check for other injuries
31
32. Managing the burn wound
- considerations
Surgery vs. spontaneous healing
Mechanisms of healing
Pathological zones in the burn
Determination of burn depth
Influence of dressings
32
34. Assessment of burn depth
Clinical examination: 50-75% accurate
Pinprick test
Repeated examination
34
35. Assessment of burn depth
35
Easy when very superficial
or full-thickness
Harder when intermediate
or mixed
36. Why excise the burn?
Burn wound is a focus for sepsis
Burn stimulates inflammatory mediators
Deep burns cannot heal without grafts
Possible effect on future scar quality
but
Non full-thickness burns may heal spontaneously
Superficial burns heal with acceptable scars
Excised burn wound must be closed
Major burn surgery is hazardous
36
43. Early burn surgery
Superior outcomes where suitably equipped
mortality
length of hospital stay
morbidity during acute burn
scar quality
43
44. Desirable surgical
management
Excision of all non-shallow burns as soon as
practicable in as few stages as possible
Closure of excised wounds with autograft, allograft
or artificial material
Definitive wound closure
44
45. Large area burns - the
problem
Area / mass of necrotic tissue
Shortage of donor sites
Infection
Systemic effects (SIRS, ARDS)
Associated problems of inhalation
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