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复习。_301.pptx

This document discusses different types and classifications of burns. It defines burns as coagulative necrosis caused by heat transfer to the body above 44°C. Burns can be thermal (flame, hot water, steam, hydrothermal, hot metal), electrical, or chemical. Electrical burns make up a small percentage of burns but have special concerns. Classification is also based on depth of tissue damage, from I° affecting just the epidermis to IV° extending through the entire skin and into fat, muscle and bone. Treatment involves resuscitation using formulas like Parkland or Muir, wound treatment with bandaging or surgery, and wound coverage with skin grafts, preferably from sites like thighs, back, scalp or buttocks

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Definition of burns What is burns?  It is a type of coagulative necrosis caused by heat . transferred from source to the body.  It never occur at temperatures less than 44℃．
Inhalation injury The chemical damage caused by inhalation of toxic fumes or chemicals to the respiratory tract may directly damage the lung parenchyma.It occurs in a large area, especially in patients with head and face burn. ** Inhalation injury
Classification
Classification of burns  Flame  Hot water, steam Thermal burns (common type)
Classification of burns Thermal burns (common type) hydrothermal hot metal
Classification of burns Electrical burns By accident In daily life
Classification of burns Electrical burns make up only 4% of U.S. hospital admissions but have special concerns including the potential for cardiac arrhythmias and compartment syndromes with concurrent rhabdomyolysis. A baseline ECG is recommended in all patients with an electrical injury, and a normal ECG in a low-voltage injury may preclude hospital admission.
Classification of burns Chemical burns Acid, alkali, chemical liquid
Airway management Signs of impending respiratory compromise may include a hoarse voice, wheezing, or stridor; subjective dyspnea is a particularly concerning symptom and should trigger prompt elective endotracheal intubation. In patients with combined multiple trauma, especially oral trauma, nasotracheal intubation may be useful but should be avoided if oral intubation is safe and easy.
Rule of nines In adults  Head and neck：9％  Upper extremity ：9 x 2=18％  Anterior trunk = 18％  Posterior trunk = 18％  Lower extremity：18 x 2=36％ (front and back of each extremity is 9％)  External genitalis：l％
Involved area Pain Adnexa Appearance Healing I°Burn Only Epidermis ＋ ＋ Erythema/ oedema 3-5 days without scar II°Burn Varying depth of Dermis ＋＋ ＋ Blister, soft, waxy, white, elastic, pain sensation to needle prick present 3-5weeks, with hypertrophic scar III°Bur n Involvement of entire depth of Epidermis and Dermis — － Tough, dry, eschar, thrombosed subcutaneous vein, pain sensation to needle prick absent Prolonged (months) and incomplete IV°Burn Extends through entire skin, and into underlying fat, muscle and bone — Lost Amputation, significant functional impairment, and, in some cases, death Requires excision Differences between four degrees of burns
It depends upon several factors. The most important being percentage of burns and facilities of treatment. Factors affecting outcome 1. Extremes of age 2. Depth of burns 3. Inhalation of noxious fumes 4. Cardiopulmonary disease ** Prognosis
Resuscitation Parkland’s formula 4 ml /% of burns/Kg in the first 24 hours. ½ : In 1st 8 hours ¼ : Next 8 hours each Example: 40% burns patient weighting 60kg.
Resuscitation Muir and Barclay Formula 1 ration = 3 rations in 12 hours, 2 rations in next 12 hours, 1 ration in next 12 hours. Example: 40% burns patient weighting 60kg. 2 t body weigh burns of % 
Treatment of wound 1. Bandaging therapy: for small wounds, bandaging limbs or child burns is easier. 2. Exposure therapy: for easy dressing wounds scattered in the area, or extensive burns, adult burns. 3. Balneotherapy. 4. Surgical treatment: tangential excision, skin grafting, free flaps and so on.
Wound coverage There are promising developments in skin culturing techniques and engineered skin development, but no other products are Food and Drug Administration approved and commercially available. Thighs make convenient anatomic donor sites; they are easily harvested and relatively hidden from an aesthetic standpoint. The thicker skin of the back is useful in older patients, who have thinner skin elsewhere and may have difficulty with healing of donor sites. The buttocks are an excellent donor site in infants and toddlers; silver sulfadiazine can be applied to the donor site with a diaper as coverage.
Wound coverage The scalp is also an excellent donor site; the skin is thick and the many hair follicles allow rapid healing, with the added advantage of being completely hidden once hair regrows. Epinephrine tumescence is necessary for harvesting the scalp, for both hemostasis of this hypervascular area and also to create a smooth contoured surface for harvesting.