Causes of burns and treatment
burn injuries often result in profound physical and metabolic insult those most at risk include alcoholics epileptics drug addicts and mentally handicapped .children under six are most liable to scald injuries from bath water hot drinks
and kettle spills the mortality associated with severe burn injury reaches 90% in patients with more than 40%surface area burns over 60 years of age and those with concomitant inhalation injury treatment involves an aggressive approach with close collaboration between the intensivist plastic surgeon and microbiologist to curb mortality from fluid loss and sepsis 1- fluid replacement a burn result in a substantial loss of fluid ,protein blood and heat the percentage of total body surface area burnt (%TBSA) and consequently the severity of the injury is estimated from the Wallace Rule of Nine chart one per cent of the patient,s TBSA is represented by the palmar surface area of the subject,s hand adults suffering burn greater than 15% surface area or children greater than 10%require admission and fluid resuscitation the Muir and Barclay regime calculates fluid replacement during the first 36 hours each of the six time periods requires an equal volume of fluid replacement in addition to normal requirements Requirement (ml\period)=surface area burnt %X weight(kg)!2 this formula is only a guide which must be adjusted according to regular measurement of haemoglobin , haematocrit ,electrolytes and urinary output another regime commonly used is the Parkland formula which suggests an approximate guide fluid resuscitation over the first 24 hours of 4 ml |kg of body weight |%area of surface burn sever burn injury predispose to a generalized increase in vascular permeability include ARDS with decrease in cardiac output 2- analgesia intravenous morphine is the most appropr
iate analgesic and can be administered from a patient - controlled system cool water (uncovered ice is harmful )is an effective analgesic for smaller burns and has been demonstrated to reverse tissue damage rectal paracetamol is useful for pyrexia in children 3- sepsis burnt surface provide an excellent culture medium for bacteria colonization is rapid and the associated immunosuppression with large burns makes septicaemia a common complication staphylococcal ,pseudomonas and candida
organisms are the commonest wound offenders severely burnt patient should be isolated and barrier nursed intravenous antibiotic are required 3- nutrition all burns require high energy dietary supplementation to facilitate healing in severely burnt patient basic metabolic rate can be double leading to severe catabolism fine bore nasogastric feeding should be used for patient with
large burns as it can deliver essential nutrition as well as bolstering the gut mucosal barrier to infection parenteral feeding lines present a high risk of infection and are best avoided 5- open or closed therapy burns of the face and perineum and superficial burns should be treated by exposure a dry eschar discourage bacterial colonization and often separates spontaneously after two weeks closed treatment involves covering the burns area with vazeline gauze and leaving the inner layers undisturbed for 10 days burns are often covered with topical silver sulfadiazine all closed treatment moisten the eschar thereby preventing spontaneous separation surgical debridement under general anaesthesia is consequently required 6- surgery the surgical approach depends upon the extent and depth of the burn where superficial burns heal by regeneration from undamaged keratinocytes in hair follicles sebaceous glands and sweat gland deep dermal burns mostly heal by repair but are capable of some regeneration from the deeper situated sweat glands the latter burns are treated by tangential excision (shaving) using a skin graft knife between the third and fifth day to preserve the deeper dermis that would otherwise die this occurs as the interface between viable and non viable tissue deepens from the time of injury due to thrombosis of the surrounding micro circulation grafts take well on this prepared surface the application of temporary synthetic skin substitute may also be used for superficial and dermal burn injuries where spontaneous healing is possible their use has been shown to significantly reduce healing time full thickness burns require excision and skin cover if small (1-2cm)the surrounding skin can be sutured directly over the defect full thickness burns over the face palms and pressure area or over denuded perichondrium ,perioesteum on require full thickness skin cover large defects are covered with allogenic meshed split skin grafts 7- Escharotomy deep circumferential burns of the chest or limbs require urgent incisions (escharotomies) to prevent respiratory or vascular compromise
tags: burns,causes,treatment
large burns as it can deliver essential nutrition as well as bolstering the gut mucosal barrier to infection parenteral feeding lines present a high risk of infection and are best avoided 5- open or closed therapy burns of the face and perineum and superficial burns should be treated by exposure a dry eschar discourage bacterial colonization and often separates spontaneously after two weeks closed treatment involves covering the burns area with vazeline gauze and leaving the inner layers undisturbed for 10 days burns are often covered with topical silver sulfadiazine all closed treatment moisten the eschar thereby preventing spontaneous separation surgical debridement under general anaesthesia is consequently required 6- surgery the surgical approach depends upon the extent and depth of the burn where superficial burns heal by regeneration from undamaged keratinocytes in hair follicles sebaceous glands and sweat gland deep dermal burns mostly heal by repair but are capable of some regeneration from the deeper situated sweat glands the latter burns are treated by tangential excision (shaving) using a skin graft knife between the third and fifth day to preserve the deeper dermis that would otherwise die this occurs as the interface between viable and non viable tissue deepens from the time of injury due to thrombosis of the surrounding micro circulation grafts take well on this prepared surface the application of temporary synthetic skin substitute may also be used for superficial and dermal burn injuries where spontaneous healing is possible their use has been shown to significantly reduce healing time full thickness burns require excision and skin cover if small (1-2cm)the surrounding skin can be sutured directly over the defect full thickness burns over the face palms and pressure area or over denuded perichondrium ,perioesteum on require full thickness skin cover large defects are covered with allogenic meshed split skin grafts 7- Escharotomy deep circumferential burns of the chest or limbs require urgent incisions (escharotomies) to prevent respiratory or vascular compromise
tags: burns,causes,treatment
.jpg)
.jpg)
0 comment:
Post a Comment