Surgery - Burns
Introduction Damage to tissue brought on by electrical, thermal, or chemical shock. Etiology contact with chemicals, electricity, liquids, fire, hot objects, UV light, or radiation. Epidemiology Annually, more than 12,000 admissions occur in Wales and England. History Burn circumstances; record duration of contact with agent, temperature, and time. Take into account the possibility of breathing in smoke and poisonous gas poisoning (carbon monoxide). Examine non-accidental injuries in children and adults who are at risk. Examination Watch out for symptoms such as stridor, shortness of breath, hoarse voice, soot in the nostrils, singed nose hairs, and carbonaceous sputum that indicate an inhalational injury or airway compromise. Analyze the burn's location, depth, and dispersion. Examine every surface area of the body. Seek for burns that are circumferential. Partially thick: separated into the deep and superficial layers. Painful symptoms include blistering and mottling in severe dermal burns and red, oedematous skin in superficial burns. Full thickness: Both the dermis and the epidermis are destroyed. a stiff, painless, leathery eschar that has lost all sensation due to burning. Burn size (percentage of body surface area): The Wallace "Rule of Nines" should be applied (arm or head: 9%, anterior or posterior trunk: 18%, leg: 18%, palm area: 1%, and perineum: 1%), or the Lund–Browder chart (for kids). Pathogenesis Burns that are superficially partial thickness cause damage to the epidermis; dead skin peels off after 7 days of recovery. Deep partial burns penetrate the dermis, but sweat and sebum glands are unaffected. Over the course of three weeks, epithelial regrowth heals the wounds, usually leaving no scars unless an infection arises. Completely destroying all skin layers in a full thickness burn necessitates skin grafting; else, scarring and contractures will result in healing. Investigations Bloods: In the event of an inhalational injury, carboxyhemoglobin, arterial blood gases, and O2 saturations. Crossmatch, FBC, U&Es, and G&S in cases of severe burns. ECG, urine myoglobin indicating muscle injury, and creatine kinase are tested for electrical burns. Management Emergency protocol: Airway security, oxygen administration, and prompt endotracheal intubation in case of inhalational harm are the ABCs. Determine the extent of the burn. If it covers more than 15% of the body's surface (10% in children), IV fluids are needed to avoid hypovolaemic shock. The following methods can be used to estimate fluid requirements: & the Parkland formula [4 ml weight (kg) %burn, with half the volume given over first 8 hours, the other half over next 16 hours]; or the Muir and Barclay formula [(% burn weight, kg)/2]½fluid (ml) per time period (each 4 hours from time of burn for 12 hours, then each 6 hours for 12 hours, and then over 12 hours). A sterile dressing should be applied to the burn, along with analgesic medication and tetanus prevention. There is no preventative use of antibiotics due to the possibility of resistance growing. nutritional assistance for severe burns because of the highly catabolic state. Early physical therapy helps stop contractures from forming. Think about moving to a specialized unit. Surgery: An escarotomy is a longitudinal incision made over circumferential burns to relieve constrictions that could impair perfusion in the limbs or chest movement. Skin grafting: After stability, for deep partial thickness or complete thickness Complications Early symptoms include dyspnea, hypothermia, cardiac depression, rhabdomyolysis, compartment syndrome, peptic ulcers (such as Curling's ulcer), or erosive gastritis. Late: Contractures and hypertrophic scarring. Prognosis Depending on the age of the patient, the depth and severity of the burn, and the emergence of complications (mortality risk is roughly equal to the product of age and burn percentage).
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