| ID | 229 |
|---|---|
| Name | BURN |
| Cause | |
| Signs Symptoms | |
| Diagnosis | |
| Investigations | |
| Management | Management: Emergency first aid- 1. Removal of pt. from source of burn. 2. Removal of clothings from burnt area. 3. Application of cold to burn, i. Immersion in cold water, ii. Covering with wet cloth. 4. Covering the bum area as quickly as possible by sterile dressing. (Some like to keep the burn area dry, clean and open i.e no dressing). 5. Strict aseptic precaution in all aspects. 6. Loose skin should be removed. 7. Washing of the burn area by normal saline to clean and remove foreign substances (if any, otherwise better to keep dry). 8. Intravenous infusion to be started according to severity of burn. General pinciples of burn treatment: A. Local treatment: To prevent infection & promote healing. Minor burns are cleaned with cetrimide or cetavlon & dressed. Major burns are treated by- a. Exposure method and b. Closed (dressing) method. Exposure method is done in burns efface, perineum, genitalia, & single surface of trunk. Here burnt surface is let open to the air, plasma exudate dries & forms a scab under which skin heals. Closed method- bum is cleaned with cetavlon, loose skin & blister are removed, penicillin or silver sulphadiazine ointment is applied, then covered with vaseline or tullegras gauze, cotton wool & bandage. Dressing is usually changed in the 3rd day. Dressing in 3 layers-i. Antiseptic, ii. Cotton wool, iii. Absorbent wool. B. General treatment: 1. Inj. morphine 15 mg i.v or i.m for pain, 2. Infusion of plasma or plasma substitute for shock, 3. Antibiotic therapy- proper antibiotic should be given orally or parenterally for 5-7 days, 4. Antibiotics should be changed according to C/S report. 5. Tetanus prophylaxis. Calculation of percentage of burn: (Or, Total body surface area (TBSA) burned): The percentage of burn is calculated by the rule of nine. Head neck- 9%, each arm- 9%, front of trunk- 9% x 2, back of trunk- 9% x 2, each leg- 9% x 2, & perinium- 1%. Fluid resuscitation: All adults with burns of 15% body surface & children 10% or more require intravenous fluid resuscitation. Most common fluid used is Haitmann’s solution or Ringer’s lactate. Simple & most commonly used formula is the Parkland formula: 4ml x wt in kg x % TBSA. Half of this volume is given in the first 8 hours, & then the second half is given in the subsequent 16 hours. |
| Introduction | Burn: A ‘burn’ is a tissue injury from tharmal (heat or cold) application or from the absorption of physical energy or chemical contact. General effects of Burn: 1. Pain- is very severe in superficial but painless or less pain in deep burn. 2. Loss of plasma. 3. Oligemic shock. 4. Toxemia due to plasma loss, infection, biochemical change, toxin from the burnt tissue 5. Anemia. |
| History | |
| Etiology | |
| Clinical Features | Burn: A ‘burn’ is a tissue injury from tharmal (heat or cold) application or from the absorption of physical energy or chemical contact. General effects of Burn: 1. Pain- is very severe in superficial but painless or less pain in deep burn. 2. Loss of plasma. 3. Oligemic shock. 4. Toxemia due to plasma loss, infection, biochemical change, toxin from the burnt tissue 5. Anemia. |
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