Burn Management 2022 PDF

BURN INJURIES By Reham Elkalla Lecturer of physical therapy for surgery, BUC By the end of this lecture the student will be able to Recognize the anatomy of integumentary system List the functions of integumentary system Identify the incidence...

BURN INJURIES By Reham Elkalla Lecturer of physical therapy for surgery, BUC By the end of this lecture the student will be able to Recognize the anatomy of integumentary system List the functions of integumentary system Identify the incidence of burn injury Identify The different types of burn injuries Conduct the proper first aids for burn injuries Classify the degree of burn injuries Apply the proper evaluation for burned patient Conduct The proper rehabilitation program  ANATOMY AND FUNCTION OF INTEGUMENTARY SYSTEM Skin is the Largest organ of the body and the first line of defense. In the average person, the skin weighs more than 4–5 kg. Receives roughly one-third of resting cardiac output. The thinnest skin is located on the eyelids and eardrums, while the thickest skin is located on the palms of the hands and the soles of the feet.  Worldwide : an estimated 6 million people seek medical treatment for burns annually, but most are treated in outpatient clinics. In developing low- and middle-income countries, burn injuries are an indomitable problem than in the USA and Europe or other high income. INCIDENCE OF One-third of burn victims are children. BURN INJURIES In fact, fire and burn injuries are the second leading cause of death in children between 1 -4 yrs, and the third leading cause death in children under 19 yrs. Most burn injuries occur in the home, primarily in the kitchen and bathroom. In Egypt, Burn injuries represent a major problem However, the exact number of burns is difficult to determine.  SKIN ANATOMY 1- Epidermis Outer layer of the skin. Avascular (has no blood vessels and receives nourishment from dermis. Thickness from 0.06 to 0.6 mm, with the thickest portions located on the palms of the hands and the soles of the feet. Consists of 5 stratums The deepest layer, the stratum basale, is attached to the dermis below by a thin, acellular basement membrane. Has three appendages located within the dermis: hair, glands, and nails.  2- Dermis Inner layer of skin. Highly vascular (has blood vessels) The dermis is 2–4 mm thick Consisting of two layers, papillary dermis (thin and superficial ) and The deeper, Reticular dermis makes up 80% of the dermal thickness. The papillary layer of the skin is responsible for fingerprints Contains blood vessels , Oil glands, Sweat glands, Hair follicles, Fat tissue, Nerves, Connective tissue. Superficial lymphatics are also located within the dermis. 3- Subcutaneous tissue (Hypodermis). Supports the skin and consists of adipose tissue and fascia. Adipose tissue is highly vascular, loose connective tissue that stores fat, which provides energy, cushioning, and insulation. Fascia is highly fibrous connective tissue and separates and surrounds structures and facilitates movement between adjacent structures, including muscle, tendon, and bone. Deeper lymphatic vessels are located within the subcutaneous tissue  Protection Functions of the Skin Sensations Synthesis of vit. D Excretion of wastes Temperature regulation Determines characteristics FUNCTION OF THE SKIN Functions of the Epidermis Functions of the Dermis Provides a physical and chemical barrier Supports and nourishes epidermis Regulates fluid Houses epidermal appendages Provides light touch sensation Assists with infection control Assists with thermoregulation Assists with excretion Assists with thermoregulation Critical to endogenous vitamin D production Provides sensation Contributes to cosmesis/appearance Functions of the Subcutaneous tissue (Hypodermis). Gives smoothness and contour to the body, contains fat for use as energy production and provides insulation for body. Mechanical shock absorber Fat-soluble vitamins, A, D, E, and K are stored in adipose tissue of this layer. It provides cushioning over bony prominences, such as the greater trochanter of the femur, thus decreasing the risk of pressure ulcers. Deeper lymphatic vessels are located within the subcutaneous tissue Age-related changes in skin Sweat glands diminish in number. Atrophy of epithelial and fatty layers of tissue and become thin. Diminishing of the thickness of subcutaneous fat on the legs or forearms, even if abdominal or hip fat remains abundant. Fat loss from the subcutaneous tissue is causing the relative prominence of the bony protuberances of the thorax, scapula, trochanters, and knees. The loss of this valuable padding contributes to the development of pressure ulcers. Collagen and elastin shrink and degenerate. Collagen content of the skin decreases by approximately 1% per year throughout adult life. The net effect of all these changes is thin, dry, and inelastic skin that is increasingly susceptible to separation of dermis and epidermis as minor friction or shearing forces cause an injury known as skin tear elated Changes BURN INJURY It is a coagulation destruction of the skin or other body parts due to thermal, chemical, electrical, irradiation or atomic causes. Etiology of burn injuries ETIOLOGY OF BURN INJURIES Table 1: Types of burn injures  2-CHEMICAL BURN Acidic burn Alkaline burn Occur if acidic chemicals come in contact Occur when the alkaline chemicals denature with the integument, skin proteins neutralize the proteins within the skin causing liquefaction the acid, causing coagulation necrosis and necrosis and deeper penetration of tissue damage. limiting the extent of tissue injury. Therefore, burns resulting from alkaline chemicals tend to be more severe than burns due to acids. N.B. In addition to direct cutaneous damage from chemicals, inhalation of the fumes created by chemical spills can lead to pulmonary dysfunction. 3-ELECTRICAL BURN Recall that resistance is the impedance to the flow of electricity. Dry skin has a high resistance, whereas wet or moist skin has less resistance. Blood vessels and nerves have low resistance and are good conductors of electricity. Bone and muscle have higher resistances. Resistance to electrical flow results in heat production. The skin, because of its large external surface area, can dissipate this heat better than deeper tissues. Electrical injuries commonly present with a depressed or charred entrance wound and a larger, explosive appearing exit wound. Early and late neurological injuries, such as carpal tunnel syndrome and other mono- and polyneuropathies, are common. The flow of electricity through the body may also induce cardiac dysrhythmias, cardiac arrest, and pulmonary arrest. 4- RADIATION BURNS High-energy radiation is used to shrink or kill cancerous cells, and when it passes through the body, skin cells may be damaged, skin cells may not have enough time to regenerate, and sores or ulcers may develop.  Chemical burn Scald burn Thermal burn Radiation burn Electrical Burns Electrical Burns FIRST AIDS FOR THERMAL BURN 1. Remove victim away from source of heat 2. Burning Clothes, A. If victim’s clothing is on fire, their airway will be at risk. B. Try to get the victim on the ground (stop, drop and roll) to put out the flames. C. If available, use a fire blanket to extinguish flames. Start at the victim’s head and work towards their feet. 3. Cool burned areas with cool running water (not ice). Cover burned area when cooled. 4. Call for medical assistance. FIRST AID FOR CHEMICAL BURN 1 2 3 4 1. Flush the 2. Make sure 3. Remove 4. Call for affected area chemical does contaminated medical with cool not reach cloths away assistance and running water unaffected from the skin. tell them what for 20 minutes, areas. type of repeat if chemical burn. necessary. No ice. First aids for electrical burn Don't touch the injured person if he is still in contact with the electrical current. Turn off the source of electricity if possible. If not, move the source away from both you and the injured person using a dry, non conducting object made of cardboard, plastic or wood. Call local emergency if the source of the burn is a high-voltage wire or lightning. Stay at least 20 feet (about 6 meters) away if wires are jumping and sparking. Don't move Don't move a person with an electrical injury unless he is in immediate danger and cover the affected area. Begin CPR if the person shows no signs of circulation (breathing, coughing or movement).  Outpatient Management For 1st and 2nd degree burns less than 10% TBSA. Blisters should be left intact and dressed with silver sulfadiazine cream. Dressings should be changed daily washing to remove any cream left.  Initial emergency(hospital) Procedures Fluid infusion must be started immediately NGT insertion to prevent, vomiting and aspiration. Urinary catheter to measure urine output Weight important and has to be taken daily. Local treatment delayed till respiratory distress and shock controlled Complete blood count and bacterial cultures necessary  Local and systemic response to burn injury