BURN INJURY and THERAPY

Arina Mana Sikana 030.08.039

Introduction
BACKGROUND Burn injuries represent a leading cause of unintentional injury mortality and morbidity and have been described as being one of the most devastating injuries among people of all age groups. Burn injury historically carried a poor prognosis. With advances in fluid resuscitation and the advent of early excision of the burn wound, survival has become an expectation ever for patients with severe burns.

Problems

Acute/ Emergency Sub acute

Resolution

DEFINITION

Injury to the skin and deeper tissues caused by hot liquids, flames, radiant heat, direct contact with hot solid, caustic chemicals, electricity, or electromagnetic( nuclear) radiation.

Thermal

Electrical

Cold Injury

ETIOLOGY

Inhalation Chemical Radiation

EPIDEMIOLOGY
Overall a decreased incidence in the number of burn injuries as well as hospitalization and death. Yet annually in the United State: approximately 1 million people require medical attention from burn injuries. Most burn injuries occur in the home. Population at highest risk pediatric and elderly.

Superficial partial thickness

Deep partial thickness

Full thickness

Classification of Burns
Classification Morphology Clinical appearance Cause

First degree

Only superficial layers of epidermis devitalized; dilatation and congestion of intradermal vessels. Destruction of varying depths of epidermis with coagulation necrosis; clefting of epidermis with fluid collection( blister formation); congestion and coagulation in subdermal plexus. Some skin elements remain viable( often only skin appendages), from which epithelial regenariton can occur* Destruction of all skin elements; coagulation of subdermal plexus

Erythema only blanches on pressure

Ultraviolet exposure( ultraviolet light, sun burn), very short flash

Second degree

Erythematous, Short flashes, spill weeping, painfull. scald Blisters and bullae often present. Superficial layers of skin can be readily wiped away. Remaining skin elements waxy white, soft, dry, insensitive. Dry, hard, inelastic, translucent, with thrombosed vein Flame, immersion scald, chemical contact, electric

Third degree

 Rule of Nines for estimating percentage of body surface involved in burns

Therapy
Group I: Minor burns to non-critical sites (<10% TBSA for children, <20% TBSA for adults) Care assigned: Dressing, tetanus prophylaxis, outpatient care Group II: Minor burns to critical sites (hands, face and perineum) Care assigned: Admit, short hospital stay, special wound care, early operations Group III: 20-60% TBSA burned Care assigned: Admit to burns unit, IV fluids, careful monitoring Group IV: Extensive burns (>60% TBSA burned), inhalation injury/associated trauma/illness Care assigned: Pain medication, psychological support, expectant category Group V: Minor burns with inhalation injury/associated injury Care assigned: Administer O 2 , intubation, ventilation, care of associated injuries

Management
Once the burning process has been stopped, and airway status is ensured, the patient should be volume resuscitated according to the Parkland formula. This formula dictates that the amount of Lactated Ringer's solution to deliver in the first twenty four hours after time of injury is:
Fluid= 4cc x % TBSA x weight in kg

Severe edema in full thickness burns may be treated by escharotomy.

Prognosis
Naturally, such forecast issues are by their nature unpredictable.

Prevention

Smoke alarms are known to decrease mortality from structural fires, but not all homes are equipped with proper smoke alarm, particularly in low- income household. Regulation of hot water heater temperatures has had some success, and may be even more effective in conjunction with community- based programs emphasizing education and inhome inspections.

Conclusion
Burn injuries are a serious public health problem with alarmingly high mortality and morbidity. These injuries are preventable through design and promotion of more aggressive prevention programs especially for flame injuries occurring in the home environment.

BIBLIOGRAPHY
Baxter CR, Shires T: physiological response to crystalloid resuscitation of severe burns. Ann N Y Acad Sci 150: 874, 1968. Janzekovic Z: A new concept in the early excision and immediate grafting of burns. J Trauma 10( 12): 1103, 1970. Practice Guidelines for Burn Care. J Burn Care Rehabil 22: 15, 2001. American Burn Association, Burn Incidence and treatment in the US: 2007 Fact sheet http://www.ameriburn.org/resource_factsheet.php: [accessed January 6, 2008]. Ballesteros MF, Jackson ML, Martin MW: Working toward the elimination of residaential fire deaths: The Centre for Disease Control and Preventions Smoke Alarm Installation and Fire Safety Education( SAIFE) Program. J Burn Care Rehabil 26: 434, 2005. DiGuiseppi C, Roberts I, Wade A, et al: Incidence of fires and related injuries after giving out free smoke alarm: Cluster randomised controlled trial. Br med J 325: 995, 2002. Fallat ME, Rengers SJ: The effect of education and safety devices on scald burn prevention. J Trauma 34: 560, 1993. Cagle KM, davis JW, Dominic W, et al: Result of a focused scald prevention program. J Burn Care Res 27: 859, 2006.

Thank You