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Evaluation and Management of Burns. Geoffrey Lee Plastics Intern. Physiology. Anatomy. Types. Thermal Cold exposure Chemical Electrical current Inhalation Radiation. Severity. Size Depth Site. Size. Percentage of body surface area estimates Palm method = 1% Rules of Nines
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Evaluation and Management of Burns Geoffrey Lee Plastics Intern
Types • Thermal • Cold exposure • Chemical • Electrical current • Inhalation • Radiation
Severity • Size • Depth • Site
Size • Percentage of body surface area estimates • Palm method = 1% • Rules of Nines • Each leg represents 9 x 2 = 18% • Each arm 9% • Anterior and posterior trunk each 9 x 2 = 18% • Head 9% • Lund-Browder chart
Depth • Colour • Moist vs dry • Blanching • Blisters • Pain
Superficial • Only epidermal layer • Painful • Dry • Red • Blanch with pressure • Do not blister • Heal 5-7 days • No scarring
Superficial Partial Thickness • Epidermis and superficial part of dermis • Painful • Red • Weeping • Blanches with pressure • Heal in 7-21 days • Unlikely scarring, pigment changes may occur
Deep Partial Thickness • Epidermis and deeper dermis • Painful to pressure only • Blister • Wet or waxy dry • Mottled colorisation • Do not blanch with pressure • Heal in 3-9 weeks • Hypertrophic scarring likely
Full Thickness • Extend through all layers of dermis • Anaesthetic or reduced sensation • Appearance varies • Dry • Do not blanch with pressure • No vesicles • Severe scarring with contractures • Usually require grafting
Forth Degree • Deep and extend through skin into underlying tissues such as fascia, muscle and/or bone
Dangerous Sites • Face • Ears • Eyes • Hands • Feet • Genitalia • Perineum • Major joints
Management • Major vs moderate/minor • Major burns should be transferred to specialized burns centres • Victoria: • Victorian Adult Burns Service (VABS) at the Alfred • Burns Unit at RCH
Victorian State Burns Service Referral Criteria • Burns with associated inhalation injury • Burns greater than 10% total body surface area • Burns to special areas – face, hands, major joints, feet and genitals • Full thickness burns greater than 5% total body surface area • Electrical burns • Chemical burns • Circumferential burns of limbs or chest • Burns with associated trauma • Burns in the very young or elderly people • Burn injury in patients with pre-existing illness or disability that could adversely affect patient care and outcomes • Suspected non-accidental injury in children or the elderly • Burns in children under the age of 12 months • Small area burns - in patients with social problems, including children at risk • Burns occurring in pregnant women
Major burns • Primary survey • Assess extent of burns • Beware of circumferential full thickness burns • Analgesia • NGT insertion • Tetanus • Prevent hypothermia • Fluid resus
Fluid Resus • Parkland formula • Amount required in 24hrs = 4 x wt(kg) x BSA(%) • Half in first 8hrs • Half in next 16hrs • Maintenance fluids in addition for children weighing less than 30kg • Guided clinically and by urine output
Minor Burns • First aid • Cleaning burns • Blister management • Dressings • Analgesia • Tetanus • Follow up • Post burn skin care
Electrical Burns • Low voltage (<1000V) • High voltage (>1000V) • First aid • Turn power off • Ensure own safety • Dysrhythmias • Compartment syndrome • Fluid resus Full thickness exit wound to armpit post high voltage electrical burn injury
Chemical Burns • History • Type of agent • Strength and concentration • Site of contact, swallowed or inhaled • Manner and duration of contact • Mechanism of action of chemical • First aid • Prolonged irrigation of water • Remove contaminated clothing • Brush off metals and powders • Do not attempt neutralising without specialist advice Full thickness burns to the legs caused by kneeling in cement