Burns

Burns

1. Skin

   • Skin Functions
   • skin layers
   • Immune components of the skin

2. Burn degrees

   • 1st Degree burn:
     • affects only the epidermis (the outer layer of the skin),
     • It’s signs and symptoms include: redness minor inflammation swelling Dry peeling skin occurs as the burn heals Painful for 48 to 72 hours and then feels better
   • 2nd Degree burn:
     • affects both the epidermis and the second layer of skin (dermis),
     • It’s signs and symptoms include: Blistered Wet and shiny Deep rediness Swollen Painful to the touch White or discolored in an irregular pattern in the burn area
   • 3rd Degree burn:
     • It affects epidermis, dermis and the fat layer below the dermis (subcutaneous layer), and it is also known as full thickness burn
     • It’s signs and symptoms include: Dry Swollen raised and leathery texture Changes color to black, white, brown, or yellow Is not painful
   • 4th Degree burn:
     • It is the most severe type of burn, and extends through the entire skin, and into underlying fat, muscle, tissue and bone.
     • It’s signs and symptoms include: Skin may be blackened or completely burned away charred with eschar Painless

3. The Rule of Nines

4. Wound healing

5. Burns treatment

   • In the Short term
     • Airway & breathing control & management
       • This should be done when we have facial burn with signs / symptoms of airway obstruction :
         • facial & neck burn singeing of eyebrows & nasal vibrissae carbon deposits & inflammatory changes in the oropharynx carbonaceous sputum hoarseness of voice history of mental changes or/& confinement in closed space explosions with burns to head & torso carboxyhemoglobin level more than 10 % if patient is involved in a fire
     • Stop the Burning process
       • All clothing should be removed . Chemical powders / material should be brushed out from the wound . The involved burned areas should be rinsed with copious amount of tap water , then with normal saline ( NS ) . Cover with warm , clean , & dry linens to prevent hypothermia
     • Intravenous Lines & Fluid resuscitation
       • Aggressive fluid resuscitation using Ringer Lactate Solution . Fluid Therapy in severe burn is basically
       • Principals of Fluid Requirement :
         • Basic daily IV fluid requirement of adult patient according to body weight is= 30 – 40 ml / Kg body weight / day . If Patients weight is 60 Kg then the daily IV fluid requirement is = 30 x 60 = 1800 ml fluid
         • Correction of Deficit ( pre - existing Dehydration ) : In burn patient there is loss of H2O , electrolytes , plasma & Plasma protein leading to dehydration & hypovolemic shock .
         • Correction of Ongoing Losses : In burn patient there will be continuous oozing ( leakage ) from the wounds .
     • Subsequent Management
       • Gastric tube insertion :
         • Indicated if patient experience nausea , vomiting , abdominal distension . In cases of burns that involves more than 20 % / 30 % of the TBSA .
       • Foleys catheterization :
         • For urine monitoring especially in major burn .
       • Antibiotics :
         • Prophylactic antibiotics are not indicated in the early post burn period , they should be reserved for infection . If you order , this should be single & against gram positive organism ( staphylococcus aureus ) .
       • Tetanus Prophylaxis :
         • Determination of tetanus status is very essential
       • Gastrointestinal protection :
         • The use of H2 blockers like Ranitidine or PPI ( Proton Pump Inhibitor ) like Omeprazole infusion 40 mg IV then oral tab. 40 mg .
       • Nutritional Support –
         • This should be started early with Enteral Nutrition .
       • Physiotherapy
         • For chest & Limbs to prevent joints contractures & stiffness .
       • Thrombo – Embolic Prophylaxis
         • Like using Enoxaparin ( Clexane ) LMWH – Low Molecular Weight Heparin according to body weight .
       • Wounds care
   • In the long term
     • autograft
     • Donor graft
     • Stem-cell derived skin
     • “Miracle spray”

6. Complications

7. Infections

   • Infectious disease: Infectious diseases happens because of microorganisms like bacteria viruses, fungi, and parasites. Microorganisms which cause disease are called pathogens.
   • Symptoms of infection:
     • Fever Coughing Diarrhea Fatigue Muscle aches
   • Causes of infection
     • Viruses (Viral infection)
       • Fungi (Fungal infection)
         • Parasites (Parasitic infection)
           • Bacteria (Bacterial infection)
             • Bacteria can spread in several ways including:
               • Spreading through body fluids, like the blood and saliva. For example, meningococcal disease (meningitis).
                 • Spreading by aerosols (through coughing and sneezing). For example Streptococcus
                   • Spreading by surface and skin contact. For example, Staphylococcus aureus
             • Types of Bacteria:
               • Harmful Bacteria
                 • Streptococcus Pyogenes, Escherichia Coli, Vibrio Cholerae, Enteritis Salmonella, Salmonella Typhi
               • Beneficial Bacteria
                 • Lactobacillus acidophilus, Bacillus subtilis, Bifidobacterium animalis, Streptococcus thermophiles, Lactobacillus reuteri.
               • Bacteria According to Gram Staining:
                 • Gram positive (bacteria with the cell wall)
                 • Gram negative (bacteria without cell- wall).
   • The way that infectious diseases can transmitted:
     • By direct contact: From one person to another person. From animal to person. From mother to unborn child. By indirect contact By insect bites By food contamination
   • Treatments for Infections

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