Burn Injuries and Their Types

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Questions and Answers

What is the primary purpose of positioning in burn treatment?

To promote muscle atrophy

To decrease edema and maintain soft tissue in an elongated state (correct)

To immobilize the patient completely

To increase pain sensation during recovery

When calculating daily caloric needs for fluid administration in children, how is the requirement determined for a child weighing 25 kg?

100 ml/kg for the first 10 kg, then 50 ml/kg for the next 10 kg, and 20 ml/kg for the remaining 5 kg (correct)

50 ml/kg for the entire weight of 25 kg

100 ml/kg for all 25 kg

20 ml/kg for only the first 20 kg

What positioning technique should be used for patients with facial burns to reduce edema?

Supine position with limbs extended

Lying flat with a pillow under the head

Semi-sitting position to improve facial edema (correct)

Prone position with hands elevated

What is the recommended method for applying topical treatments in burn care?

Occlusive method with a non-adherent layer and absorbent layer Signup and view all the answers

What is the significance of using silver sulphadiazine in burn treatment?

It is effective for infection control and wound healing Signup and view all the answers

What percentage of the Egyptian population is affected by major burns?

0.1% Signup and view all the answers

Which type of burn is primarily responsible for injuries in children and housewives?

Thermal burns Signup and view all the answers

What is a common complication caused by skin injuries resulting from burns?

Infection Signup and view all the answers

Which layer of the skin is responsible for producing the stratum corneum?

Basal layers of the epidermis Signup and view all the answers

What is the primary purpose of the outer cells of the epidermis?

Acting as a protective barrier Signup and view all the answers

What type of burn involves damage to only the epidermis?

Superficial burn Signup and view all the answers

Which method is NOT recommended as a part of the first aid for burns?

Apply ice directly to the burn Signup and view all the answers

What is the primary purpose of using resuscitative fluid therapy in burn management?

To restore fluid balance and prevent shock Signup and view all the answers

According to the Rule of Nines, which percentage of the body is considered for each arm in adults?

9% Signup and view all the answers

What is true about full thickness burns?

They extend through the epidermis and all of the dermis. Signup and view all the answers

What is the initial action to take when treating a flame burn?

Extinguish the flame and move the patient away from danger Signup and view all the answers

In the context of burn assessment, what does the Lund and Browder chart specifically help with?

Calculating the total body surface area affected by burns Signup and view all the answers

Which of the following is an indication for using an endotracheal tube in burn management?

In the presence of airway obstruction Signup and view all the answers

Study Notes

Introduction

Burns are common, with about 0.1% of the population in Egypt affected by major burns
The death rate from burns is approximately 30%
Reconstructive surgery is often needed after burns, affecting around 30-40% of burn patients
Domestic causes are responsible for a large proportion of burn injuries (75%), particularly affecting children and housewives
Burns represent significant costs for healthcare and management

Types of Burns

Burns are classified by the type of agent that caused the injury
Thermal Burns: Caused by heat sources such as flames, hot liquids, and direct contact with hot objects
Electrical Burns: Result from exposure to electricity, including high-voltage sources like lightning and low-voltage appliances
**Chemical Burns:**Caused by contact with acids, alkalis, and other corrosive substances
Radiation Burns: Occur as a result of exposure to ionizing radiation, such as from nuclear accidents or medical procedures

Effects of Burns

Burns cause destruction of tissue, affecting the skin and potentially other organs

Skin

The skin serves as a protective barrier for the body, regulating temperature and preventing fluid loss
Damage to the skin can lead to infection, impaired fluid balance, and temperature regulation
The skin has two primary layers:
- Epidermis: The outer layer, consisting of dead cells that act as a protective barrier and contain pigment for UV protection
- Dermis: The inner layer, made of tough connective tissue containing specialized structures

Burn Classification

Burns are categorized by the depth of damage to the skin
- Superficial Burns: Confined to the epidermis, causing redness and pain
- Superficial Partial-Thickness Burns: Involve the epidermis and part of the dermis, characterized by blisters and pain
- Deep Partial-Thickness Burns: Affect the epidermis and most of the dermis, resulting in pain and potential scarring
- Full-Thickness Burns: Destroy all layers of the skin, leading to insensitivity to pain and requiring skin grafts for healing

Burn Extent

The extent of a burn is assessed to determine the severity and treatment plan:
- Rule of Nines: A method for estimating the total body surface area (TBSA) affected by burns in adults, dividing the body into regions representing 9% of the total surface area
- Rule of Five: A similar method adapted for infants and children, assigning percentages based on body weight and age to account for their smaller bodies
- Lund and Browder Chart: A more precise method for estimating TBSA burn, used in hospitals, considering the patient's age and body proportions

Burn Management

Burn management involves various strategies to address pain, infection, and tissue damage:
- First Aid: Prioritizes safety and reducing the severity of the burn injury
  - Extinguishing Flames: Remove the patient from the source of the fire
  - Airway Management: Ensure a clear airway, potentially using an endotracheal tube
  - Cooling: Apply cool saline or tap water for 15 minutes to minimize pain, reduce fluid loss, and limit burn depth (be aware of the risks of contamination)
  - Wound Coverage: Cover the burn area with sterile towels or an ironed sheet to prevent infection
  - Chemical Burns: Remove contaminated clothing and flush the affected area with copious amounts of water. If applicable, use neutralizing agents.
  - Electrical Burns: Administer CPR if necessary
- Definitive Treatment: Hospitalization is required for comprehensive burn management
  - General Treatment:
    - Airway: Secure airway with intubation if needed
    - Fluid Management: Insert a large bore intravenous catheter or central line to administer fluids
    - Catheterization: Insert a Foley catheter for urine output monitoring
    - Burn Center Transfer: Refer to a burn unit or admit to the Intensive Care Unit (ICU)
    - Pain Management: Administer strong analgesics such as pethidine
    - Antibiotics: Prescribe antibiotics to prevent infection and administer tetanus prophylaxis
    - Stress Ulcer Prevention: Use H2 blockers to prevent stress ulcers
  - Local Treatment:
    - Clothing Removal: Carefully remove adherent clothing from the burn area
    - Wound Dressing: Apply sterile cotton dressings to the open wounds (either open or closed methods)
    - Surgical Intervention: Perform escharotomy (incisions to relieve pressure from circumferential burns), tangential excision (removal of damaged skin), and skin grafts (transplantation of healthy skin) to promote healing and prevent contractures
    - Contracture Prevention: Utilize splints, braces, and positioning to prevent joint contractures and deformities
    - Positioning: Maintain body positions that promote optimal healing and minimize scar contractures

Resuscitative Fluid Therapy

Fluid resuscitation is critical for burn patients to restore lost volume and maintain cardiovascular function:
- Parkland's Formula: A standard formula used to calculate the amount of fluids required, based on the patient's weight and TBSA burned, utilizing lactated Ringer's solution
  - Administration: 50% of the calculated fluid is administered in the first 8 hours, the remaining 50% over the next 16 hours
  - Second Day: Half of the original fluid volume is given on the second day
- Caloric Needs: Ensure adequate caloric intake through intravenous glucose solutions:
  - Adults: 2000 ml glucose 5%
  - Children: 100ml/kg for the first 10kg, 50 ml/kg for the next 10kg, and 20 ml/kg for each kg above 20kg
- Monitoring: Closely monitor the patient's vital signs (Pulse, B.P, temperature, CVP in critical cases), urine output per hour, and fluid balance
- Oral Fluids: Avoid oral fluid intake during the resuscitative phase

Positioning

Proper positioning is crucial for burn patients to reduce edema, maintain soft tissue elongation, and prevent contractures:
- Head and Neck:
  - Position: Lying position with a towel roll behind the neck and/or a pillow under the shoulders to maintain extension
  - Facial Burns: Semi-sitting position to minimize facial edema
- Upper Limbs:
  - Elevation: Elevate on pillows with the shoulder abducted and slightly flexed, elbow and wrist extended, and hand positioned for optimal function (MCP joints flexed, IP joints extended, thumb in palmer abduction)
- Lower Limbs:
  - Elevation: Raise the end of the bed
  - Positioning: Hip in extension, knee extended, ankle in dorsiflexion using a foot drop splint

Dressing

Wound care involves cleaning, debridement of dead tissue or blisters, and applying topical agents:
- Cleaning and Debridement: Thoroughly clean and remove dead tissue
- Topical Agents: Apply silver sulfadiazine cream, silver nitrate solution, or betadine cream 2-3 times daily
- Open Method: Used for burns on the face, perineum, or one side of the trunk or limb, not recommended for hands
- Closed Method: Utilizes a multi-layered dressing (non-adherent, absorbent, and pressure bandage) for optimal wound protection and changed every 2-3 days

Surgery

Surgical interventions may be necessary for full-thickness burns, especially circumferential burns:
- Escharotomy: Incisions made through the eschar (the thick, leathery dead tissue) to release pressure and improve blood flow, reducing the risk of compartment syndrome. These incisions are usually made along the length of the limb.
- Other Surgical Procedures: Include tangential excision (removal of damaged skin) and skin grafting (tranplantation of healthy skin) for definitive wound closure and healing.

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Description

Explore the various types of burns, including thermal, electrical, chemical, and radiation burns. This quiz highlights the causes, implications, and statistics surrounding burn injuries, focusing particularly on their impact within the population of Egypt. Dive into the significant healthcare aspects associated with treating burn patients.