![ANATOMICAL CLASSIFICATION
1. First degree burns – erythema – redness –
sunburn – painful – n0 blister formation
[vesicle/bulla] – epidermis only
2. Second degree burns – blister formation – very
painful – damage to basement membrane –
epidermis & superficial dermis
3. Third degree burns – dermis – painless – aka =
full thickness burns
4. Fourth degree burns – subcutaneous tissue –
muscle & bone
A mixture is of the above is a common finding](https://image.slidesharecdn.com/burns-240221154939-2e60c12b/85/BURNS-pptx-lecture-presentation-surgery-4-320.jpg)
![PHASE 1 = RAPID RESPONSE SYSTEM = NERVOUS SYSTEM
• “Fight or flee”
• Governed by hypothalamus = autonomic
nervous system [sympathetic component]
• Release of adrenaline and noradrenaline
• Pupils dilate
• Heart rate rises
• Brain alert
• Airways dilate](https://image.slidesharecdn.com/burns-240221154939-2e60c12b/85/BURNS-pptx-lecture-presentation-surgery-8-320.jpg)
![CRITERIA FOR ADMISSION TO A BURNS
CENTER
1. Burns >20% bsa in adults
2. Burns >10% bsa in children & elderly >50
3. Electrical burns
4. Chemical burns [extensive]
5. Suspected child abuse burns
6. Inhalation burns
7. Special areas – face, hands, genitalia , major joints
8. Concomitant trauma – trauma center first
9. Co-morbidities – cardiopulmonary, dm, epilepsy
10. >5% deep burns](https://image.slidesharecdn.com/burns-240221154939-2e60c12b/85/BURNS-pptx-lecture-presentation-surgery-12-320.jpg)
BURNS.pptx lecture presentation surgery.
- 1. BURNS Presented By: Mr. Mwandalesa PREPARED DR. BANDA WISDOM CHILUFYA MBCHB (CBU)
- 2. DEFINITION Refers to coagulative necrosis of the tissues caused by heat transferred from the source to the body. NB: frostbite is coagulative necrosis caused by extreme degrees of cold
- 3. ETIOLOGICAL CLASSIFICATION OF BURNS • Thermal burns: Flame and Scald burns • Electrical Burns • Chemical Burns • Radiation Burns • Inhalation Burns • Friction Burns • FRICET
- 4. ANATOMICAL CLASSIFICATION 1. First degree burns – erythema – redness – sunburn – painful – n0 blister formation [vesicle/bulla] – epidermis only 2. Second degree burns – blister formation – very painful – damage to basement membrane – epidermis & superficial dermis 3. Third degree burns – dermis – painless – aka = full thickness burns 4. Fourth degree burns – subcutaneous tissue – muscle & bone A mixture is of the above is a common finding
- 5. DEPENDING ON THICKNESS OF SKIN INVOLVED I. Partial thickness burns: It is either first or second degree burn which is red and painful, often with Blisters II. Full thickness burns: It is third degree burns which is charred, insensitive, deep involving all layers of the skin.
- 6. JACKSON’S ZONES OF BURN
- 7. PATHOPHYSIOLOGY Heat causes coagulation necrosis of skin and subcutaneous tissue. Release of vasoactive peptides Altered capillary permeability Loss of fluid Severe hypovolemia Decreased cardiac output 1. Decreased renal blood -Oliguria (Renal failure) 2. Altered pulmonary resistance causing pulmonary oedema Infection Systemic Inflammatory Response Syndrome (SIRS) Multi Organ Dysfunction Syndrome (MODS).
- 8. PHASE 1 = RAPID RESPONSE SYSTEM = NERVOUS SYSTEM • “Fight or flee” • Governed by hypothalamus = autonomic nervous system [sympathetic component] • Release of adrenaline and noradrenaline • Pupils dilate • Heart rate rises • Brain alert • Airways dilate
- 9. PHASE 2 = LOCAL RESPONSE • Initial response is vasoconstriction by the catecholamine augmented by endothelin = most potent vasoconstrictor known • Soon this is replaced by vasodilatation and increased vascular permeability at injury site • Principal vasodilators include nitric oxide, prostacyclin, histamine, serotonin • This allows for the extravasation of inflammatory cells to come in to kill the invaders and clean up the mess
- 10. PHASE 3 = ENDOCRINE RESPONSE • Remember the bigger the insult or injury the bigger the response • Therefore limited injury will have no systemic response • The goal of all these responses is preserve intravascular volume • Any insult threatening intravascular integrity HYPOTHALAMUS-PITUITARY-ADRENAL AXIS • Low Bp is picked up by the baroreceptors => hypothalamus=>corticotrophin releasing hormone=> adrenacorticotropin hormone=> cortisol & aldosterone=> raises sensitivity of catecholamine & sodium reabsorption
- 11. RENIN-ANGIOTENSIN-ALDOSTERONE AXIS • Baroreceptors in the juxtaglomerular apparatus=> renin=> angiotensinogen=> angiotensin-1=> angiotensin converting enzyme=>angiotensin-2=> vasoconstrictor & stimulate aldosterone release by the adrenal cortex
- 12. CRITERIA FOR ADMISSION TO A BURNS CENTER 1. Burns >20% bsa in adults 2. Burns >10% bsa in children & elderly >50 3. Electrical burns 4. Chemical burns [extensive] 5. Suspected child abuse burns 6. Inhalation burns 7. Special areas – face, hands, genitalia , major joints 8. Concomitant trauma – trauma center first 9. Co-morbidities – cardiopulmonary, dm, epilepsy 10. >5% deep burns
- 13. ASSESMENT OF BURNS 1. WALLACE RULE OF 9
- 14. RULE OF PALM • “RULE OF THE PALM” = PATIENT’S PALM IS APPROXIMATELY 1% OF THE BSA IN BOTH ADULTS AND CHILDREN
- 15. INVESTIGATIONS • FBC. • U+E. • If inhalation suspected: chest X-ray, arterial blood gases, CO • estimation. • Blood group and crossmatch. • ECG/cardiac enzymes with electrical burns.
- 16. IN SUMMARY 1. ABCDE 2. Pain control 3. Tetanus prophylaxis 4. Secondary survey + % bsa + depth 5. Foley catheter 6. Fluid resuscitation => oral or intravenous 7. Proton pump inhibitors 8. Topical antibiotics 9. Daily wound care 10. Keep the room warm
- 17. OTHER ESGENERAL MEASUR • High protein diet • Blood transfusion • Physiotherapy • The use of a cradle • Always keep the patient warm
- 18. FLUID RESUSCITATION 1. PARKLAND FORMULA:- 1. 4ml x KG x % BURN AREA = MLS 2. Half is administered in first 8 hours 3. The next half is administered in the following 16 hours • This formula or any formula is not cast in stone and should be modified to achieve the desired urine output • Literature says don’t go beyond 8.4 liters. Maximum percentage for fluid should be less than 50% • But in practice (30-40%) E.g. 22years old student at Zera sustains 20% burns, he weight is 70 calculate his fluid requirement using parkland formula
- 19. 2. MUIR AND BARCLAY • =(%BSA x Kg) /2 Fluids are given over 36 hrs. as following
- 20. 3. MODIFIED BROOKES It calculates the deficity: =2 X %bsa x kg.
- 21. COMPLICATIONS OF BURNS Early complications • Airway obstruction • Shock • Hypoxia • RDS • Hypothermia Intermediately complications • Electrolyte imbalance • Infection • Anemia • Stress ulcers (Curling ulcers) • Paralytic ileus • Renal failure • Compartment syndrome
- 22. LATE COMPLICATIONS • Contractures • Hypertrophic scar • keloids • Margolis's ulcer