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Published on : Mar 14, 2014
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Slide 1 - Burn Injuries Adaobi Okobi, M.D.
Slide 2 - Learning Objectives Epidemiology Pathophysiology Classification of burns Red flags Treatment
Slide 3 - Epidemiology Burns are the 3rd leading cause of accidental death in the U.S. >120,000 children under 20 receive care for burns in the E.D. every year Under 5 years, scald burns cause 65% of thermal injuries
Slide 4 - Pathophysiology Zone of coagulation- maximal injury from coagulation of proteins Zone of stasis- decreased tissue perfusion; tissue is potentially salvageable Zone of hyperemia- increased tissue perfusion
Slide 5 - Classification of Burns
Slide 6 - First Degree Dry No blisters Minimal or no edema Erythematous, blanches Very painful Epidermis only Heals in 2-5 days without scarring
Slide 7 - Second Degree (Partial Thickness) Moist blebs, blisters Underlying tissue is mottled pink and white with fair cap refill Very painful Involves epidermis and reticular layers of dermis Superficial: 5-21 days Deep partial: 21-35 days with no infection; if infected converts to full thickness burn
Slide 8 - Third Degree (Full Thickness) Dry, leathery eschar White or waxy appearance No blanching or bleeding Sensation: deep pressure Includes epidermis and dermis and may go down to subcutaneous fat, muscle or bone Will not heal without skin graft
Slide 9 - Fourth Degree Extends into muscle or bone Sensation: only deep pressure Requires skin graft
Slide 10 - Size of Burn Palm method- palm of patient’s hand is ~1% TBSA Lund-Browder method (Rule of nines)
Slide 11 - ppt slide no 11 content not found
Slide 12 - Red Flags: Abuse
Slide 13 - Resuscitation Airway Breathing Circulation Disability Exposure Fluids
Slide 14 - ppt slide no 14 content not found
Slide 15 - Fluid Resuscitation Parkland formula: 4ml/kg/%TBSA (+ maintenance IVF if <5 years) Give 1st half in 8 hours Give 2nd half over next 16 hours D5LR is the fluid of choice in 1st 24 hours Colloids (ie albumin) may be added to restore oncotic pressure and intravascular volume after the first 24 hours Urine output should be >0.5-1ml/kg/hr
Slide 16 - Treatment Silver sulfadiazine cream- impedes epithelialization Topical antibiotics (Bacitracin) Chlorhexidine- antimicrobial skin cleanser Mafenide acetate- carbonic anhydrase inhibitor (treat patient with high bacterial load on wound) Providone-iodine ointment- controversial because of cytotoxicity and delay in wound epithelialization Bismuth-impregnated petroleum gauze (Xeroform) – helps prevent or control wound infection Skin graft
Slide 17 - Treatment Pain control Clean with soap and water Debridement (large or painful blisters may be ruptured) Glycemic control High protein diet Prophylactic antibiotics- controversial Rehabilitation
Slide 18 - Take Home Points Burns can be classified by size and depth First and superficial partial second degree burns are very painful Deep second, third and fourth degree burns are not painful because of damage to nerves Be suspicious of abuse for burns that do not match the mechanism of injury, immersion burns or cigarette burns Fluid resuscitation should be aggressive in the first 24 hours with monitoring of the urine output