burn managemnet 2022 (1)-25-50.pdf

Local and systemic response to burn injury  The local effect involves 3 burn zones 1- Zone of coagulation: The point of maximum damage. Irreversible tissue loss due to coagulation of constituent proteins. Characterized by coagulation, ischemia, and necrosis. 2- Zone of stas...

Local and systemic response to burn injury  The local effect involves 3 burn zones 1- Zone of coagulation: The point of maximum damage. Irreversible tissue loss due to coagulation of constituent proteins. Characterized by coagulation, ischemia, and necrosis. 2- Zone of stasis: Surrounds the central necrotic region and represents an area of cellular injury and compromised tissue perfusion Red blood cells and platelets aggregate and may form microemboli, further impeding local circulation. Unless adequate perfusion is restored within 1 to 2 days after injury, these cells will not survive. Problems such as prolonged hypotension, infection or edema can convert this area into one of complete tissue loss. N.B This process of widening and deepening of the original area of necrosis is known as conversion 3- Zone of hyperemia The outer edges of tissue affected by the burn injury. These tissues receive the least thermal energy and sustain only minimal cellular injury. Characterized by erythema due to vasodilation and generally recovers within 7 to 10 days of injury. Systemic effect of burn injury Signs and symptoms of hypovolemic shock Restlessness, anxiety Skin – pale, cold, clammy Temperature below 37 oC Pulse is weak, rapid, systolic BP Urinary output < 20 mL/hr Urine specific gravity >1.025 Thirst Hematocrit 35; Blood urea nitrogen (BUN) BURN MANAGEMENT EVALUATION FOR BURNED PATIENT Is a continuing process of collecting and organization relevant information in order to plan and implement an effective treatment. Components of evaluation 1- Patient 3- Edema and 5- Muscle 2- Burn severity 4- Sensory demographic limb strength index. assessment. data and history. circumference assessment. 8- Mobility and 10- Function 6- Joint ROM 7- Flexibility 9- Endurance ambulation activities assessment. assessment. assessment. assessment assessment. 11- Neurological and psychological factors assessment. 1- Patient demographic data and history 1-Personal history 1- Patient demographic data and history Date of burn. 2-Present Date of evaluation Date of admission. history Date of initial P.T. Date of operation. Extent and depth of burn 3-Special Associated injury history Skin graft (donor and receipt site) Previous disease Trauma Surgery and burn 4-Past Vision and hearing acuity history Balance and co- ordination. Neuromuscular or skeletal deficit. 2- BURN SEVERITY INDEX (BSI) The Abbreviated Burn Severity Index (ABSI) is a five variable scale to help assess burn severity. These variables are associated with increased burned patient mortality rate. (1) Percentage of total body surface area burned (TBSA) BSI (2) Presence of a full-thickness burn (3) Age (4) Sex (5)Presence of inhalation injury  1- EXTENT OF BURN (TBSA or BBSA)  To determine whether it is major or minor burn (triage)  There is a direct relation between the BBSA & the number of anticipated contractures to develop.  To calculate the mount of fluid needed for patient resuscitation {(2 or 4) ml x kg bodyweight x % BBSA} + 2000 ml saline of which 50% to be administered in the initial 8 hours.  Methods to calculate TBSA Lund & Palmar Rule of nine Browder method chart RULE OF NINE The rule of nines divides the integument into areas roughly equivalent to 9% of TBSA.. The fastest and easiest method of determining the percent of TBSA involved in a burn wound. Universally recognized method of assessing burn size Disadvantages The rule of nines consistently overestimates the size of a burn injury. There is also some variability in the estimates of burn size.  LUND & BROWDER CHART It considers the variations in the distribution of body surface area with age Infants and young children have different body proportions than adults, as infants and young children have larger heads and smaller lower extremities. More appropriate for children under 16 years of age. Disadvantages More complex PALMAR METHOD Uses the area of the palmar surface of the patient’s hand to determine the burn size. The size of the palm represents 1% of TBSA. Preferred for small burn areas. Most suitable to measure burn at anterior thigh and trunk. Disadvantage Unreliable method. DEPTH OF BURN HOW TO ASSESS BURN DEPTH? Subjective assessment of the characteristics of the burn to diagnose its depth. Sensation (pinprick Colour and test) appearance Bleeding 1st degree 2nd degree superficial 2nd degree deep 3rd degree 4th degree Depth od burn injury 1st degree burn Superficial partial thickness Deep partial thickness burn burn Fourth degree burn Third degree burn Signs and symptoms of smoke inhalation include Burns to the head and neck. Singed nasal hairs, darkened oral and nasal membranes, carbonaceous sputum, stridor, hoarseness, and difficulty swallowing. History of being burned in an enclosed space. Exposure to flame, including having clothing catch fire near the face out of doors. N.B The most critical period for patients with inhalation injuries is 24 to 48 hours post-burn. The airway becomes edematous and there is increased airway resistance. The respiratory mucosa sloughs, along with loss of ciliary function and poor diffusion of gases  What is the triage? It is a decision making about admission of Pt. to hospital or discharge Pt. should be admitted to hospital in the following cases:- 1. In major burn 2. In electrical or chemical burn 3. In inhalation injury 4. In burn of vital areas (face, hand, foot & genitalia) 5. In deep burns.