Burns for physiotherapy _240929_104105.pdf

BURNS Dr Salah Shaheen Professor of General Surgery Kasr Al-Ainy Hospital, Cairo University  Introduction thermal, Defined as tissue injury caused by electrical agent Chemical Inci...

BURNS Dr Salah Shaheen Professor of General Surgery Kasr Al-Ainy Hospital, Cairo University  Introduction thermal, Defined as tissue injury caused by electrical agent Chemical Incidence is variable from country to country, in Egypt about 0.1 % of total population are affected by major burns. Death rate is about 30%, Reconstructive surgery is usually needed in about 30-40 % Domestic causes are responsible for 75% of the injuries, mainly children and housewives. Scalds are commoner in children Cost of care and management of patients very expensive  Types of Burns 1) Thermal burn by flame (skin, inhalation), fluids and contact. 2) Electrical burn (high voltage lightning, Direct and alternating current of low voltage) 3) Chemical burn by acids, caustics, fumes (skin, inhalation, mucous membrane injury) 4) Radiation burn  Effects of Burns Destruction of tissue (skin or other organs)  Skin Largest body organ Protects underlying tissue from injury and invasion. Temperature regulation Acts as water-tight seal, keeping body fluid in Sensory organ Skin injuries and loss lead to Infection Inability to maintain normal water balance Inability to maintain body temperature.  Skin Two layers Epidermis Dermis Epidermis Outer cells are dead Act as protection and form water-tight seal. Basal layers divide to produce the stratum corneum Contain pigment to protect against UV radiation.  Skin Dermis consists of tough, elastic connective tissue which contains specialized structure  BURN CLASSIFICATION  Depth of Burn 1) Superficial 3) Deep partial-thickness only the epidermis epidermis & most of the dermis 2) Superficial partial-thickness 4) Full thickness epidermis and dermis, epidermis and excluding all the dermal appendages all of the dermis  Extent of Burns Rule of Rule of five for children & infants Nine  Extent of Burns % Total Body Surface Area Burn Be clear and accurate, and do not include erythema (Lund and Browder)  PATIENT ASSESSMENT  BURN MANAGEMENT  First Aid 1) Flame must be extinguished and move the patient away. 2) Assure a patent airway. 3) Cool the burnt area by saline or tap water for 15 minutes. – Advantage : relieves pain, decrease exudation & limits the depth of burn. – Disadvantage: Increase risk of bacterial contamination. 4) The burnt area should be covered with sterile towels e.g. ironed sheet. 5) With chemical burns, contaminated clothing is removed and copious quantities of running water applied to the area. Apply neutralizing agents when available. 6) With electrical burns, CPR may be required.  Definitive Treatment : Hospitalization General treatment Local treatment 1. Ensure an adequate airway 1. Removal of adherent clothing and Endotracheal tube is indicated if : cover with sterile cotton dressings. - evidence of airway obstruction. 2. Dressing (open & closed methods) - In smoke inhalation. 2. insert a wide bore l.V cannula or 3. Surgery (escharotomy, tangential better a central line. excision, excision and grafting) 3. Insert a Foley's catheter 4. Prevent joint contracture 4. Transfer to a burn unit or admit to ICU 5. Positioning 5. Strong analgesics e.g. pethidine 6. Antibiotics & tetanus prophylaxis. Resuscitative fluid 7. H2 blockers to avoid stress ulceration. therapy  Resuscitative fluid therapy Parkland’s formula 4 mL/kg/1”% of burn lactated Ringer's solution /day. Maximum up to 50% TBSA - 1/2 the amount is given in the first 8 hours. - The other 1/2 is given in the next 16 hours. - Half the original quantity is given in the second day - Add the daily caloric needs calculated as follow; ▪ 2000 ml glucose 5% in adults ▪ In children (100ml/kg for the first 10 kg, 50 ml/kg for the next 10 kg & 20 ml/kg for each kg above 20kg) – Follow by regular check-up of vital signs : Pulse, B.P and temperature. CVP in critical cases. Urine output/hour – Don’t give oral fluid intake  Positioning The position of comfort for the patient is usually joint flexion. Unfortunately, this allows scar contracture and deformities The aim is to ▪ Decrease edema ▪ Maintain soft tissue in elongated state Head and neck: ▪ Lying position, a towel roll behind the neck and/or a pillow under shoulders to maintain extension of cervical spine. ▪ Patients with facial burns may be in semi-sitting position to improve facial oedema.  Positioning Upper limbs - limb should be elevated on pillow with ▪ shoulder in abduction and slight flexion, ▪ elbow and wrist in extension, ▪ Hands: M/P joints in flexion, I/P in extension, and thumb in palmer abduction. This is done using static splints. Lower limbs - Elevation is obtained by raising the end of the bed ▪ hip joint in extension and slight abduction, ▪ knee in extension ▪ ankle in 90-degree dorsiflexion using foot drop splint.  Dressing Cleaning and debridement, ? blister evacuation Topical application of silver sulphadiazine cream. Silver nitrate solution, 2-3 times daily betadine cream…etc. Open method (face, perineum, one side of trunk or limb NOT applied to hand) Occlusive method Non adherent layer Absorbent layer Every 2-3 days Crepe pressure bandage Surgery Circumferential full-thickness burn Escharotomy Surgery THANK YOU