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Burn Injuries

Burn Injuries . Dr. Eranda Epaarachchi . The layers of the skin . Anatomy of the skin . Classification of burns – By depth . What is shown here?. What is the diagnosis?. First degree burns . Characteristics . Epidermis is involved Appearance : Redness (Erythema) Dry & painful

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Burn Injuries

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  1. Burn Injuries Dr. Eranda Epaarachchi

  2. The layers of the skin

  3. Anatomy of the skin

  4. Classification of burns – By depth

  5. What is shown here?

  6. What is the diagnosis?

  7. First degree burns

  8. Characteristics • Epidermis is involved • Appearance : Redness (Erythema) • Dry & painful • Heals within 1 week • Complications : Risk of developing skin cancer in later life

  9. What are these lesions?

  10. Superficial – partial thickness burn (20)

  11. Second degree – Partial thickness

  12. Characteristics • Extends into superficial dermis • Red with clear blister & Blanches with pressure • Moist & painful • Heals within 2-3 weeks • Complications : Local infection, Cellulitis

  13. What are these lesions?

  14. What are these lesions?

  15. Deep partial thickness burn

  16. Characteristics • Extends into deep dermis • Red-and-white with bloody blisters & Less blanching • Moist & painful • May heal in weeks or progress into a third degree burn • Complications : Scarring, contractures (May need skin grafts)

  17. What are these lesions?

  18. Third degree burns (Full thickness)

  19. Characteristics • Extends through entire dermis • Stiff and white/brown • Dry, leathery to touch • Painless • Requires excision • Complications : Scarring, contractures, amputation

  20. What are these lesions?

  21. It’s a fourth degree burn

  22. Characteristics • Extends through skin, subcutaneous tissueand into underlying muscle and bone • Black (charred) • Dry • Painless • Requires excision • Complications : Amputation, significant functional impairment, possible gangrene, and in some cases death

  23. Classification of burns by causes

  24. Chemical • Most chemicals that cause burns are strong acids & bases • Acids : H2SO4, HNO3, HCl • Bases : NaOH • Acid burns : Most of the injury occurs at the point of impact • Alkali burns : Capable of deep penetration and can cause severe pain

  25. NaOH burn after 44 hours from exposure

  26. Electrical burns – Causes Workplace injuries Taser wounds Being defibrillated without a conductive gel Lightning

  27. Electrical burns • Human body is very vulnerable to application of supra-physiologicelectric fields • Some electrocutions produce no external burns at all, as very little current is required to cause fibrillation of the heart muscle • The internal injuries sustained may be disproportionate to the size of the burns seen (if any), and the extent of the damage is not always obvious • Such injuries may lead to • Cardiac arrhythmias • Cardiac arrest • Unexpected falls with resultant fractures or dislocations

  28. Electrical burns – Low voltage injuries • Low-voltage (<500 AC volts) injuries usually doesn’t have skin burns • This is sufficient to cause cardiac arrest and ventricular fibrillation

  29. VF (Can lead to aystole in minutes) – Defibrillation to save the life

  30. Electrical burns – High voltage (> 1000V) injuries • Common cause of third and fourth degree burns • Explosions caused by electrical faults produce high intensity Ultraviolet radiation which can also cause radiation burns

  31. Radiation burn – causes • Radiation burns are caused by prolonged exposure to • UV light (Sun exposure – the commonest) : Severity UVB > UVA • Tanning booths • Radiation therapy • Radioactive fallout • X-rays • More severe cases of sun burn result in what is known as "heatstroke“ • Microwave burns are caused by the thermal effects of microwave radiation

  32. Heatstroke

  33. Microwave burn

  34. Scalding • Caused by hot liquids (water or oil) or gases (steam) • Immersion scald is created when an extremity is held under the surface of hot water (Common form of burn seen in child abuse) • Scald burns are more common in children • Generally scald burns are first or second degree burns, but third degree burns can result, especially with prolonged contact(Diabetic neuropathy)

  35. Scald

  36. Immersion scald

  37. Child abuse?

  38. SSSS

  39. Inhalation injury • Steam, smoke and high temperatures can cause inhalational injury to the airway and lungs

  40. Inhalation injury

  41. Pathophysiology of burns injuries • Burn injury results in a local or systemic inflammatory response (Depends on the size of the burn) • Thelungs may be doubly compromised by smoke inhalation • Following a major burn injury, heart rate and peripheral vascular resistance increase • This is due to the release of catecholamines from injured tissues and the relative hypovolemia that occurs from fluid volume shifts

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