Evaluation and Management of Burns

1. Evaluation and Management of Burns Geoffrey Lee Plastics Intern

2. Physiology

3. Anatomy

4. Types • Thermal • Cold exposure • Chemical • Electrical current • Inhalation • Radiation

5. Severity • Size • Depth • Site

6. 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

8. Depth • Colour • Moist vs dry • Blanching • Blisters • Pain

9. Superficial • Only epidermal layer • Painful • Dry • Red • Blanch with pressure • Do not blister • Heal 5-7 days • No scarring

10. 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

11. 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

12. 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

13. Forth Degree • Deep and extend through skin into underlying tissues such as fascia, muscle and/or bone

14. Dangerous Sites • Face • Ears • Eyes • Hands • Feet • Genitalia • Perineum • Major joints

15. 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

16. 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

17. Major burns • Primary survey • Assess extent of burns • Beware of circumferential full thickness burns • Analgesia • NGT insertion • Tetanus • Prevent hypothermia • Fluid resus

18. 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

19. Minor Burns • First aid • Cleaning burns • Blister management • Dressings • Analgesia • Tetanus • Follow up • Post burn skin care

20. 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

21. 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

22. Questions?