Burns Management: A CompendiumCorrespondence Address :
Dr Sanjay Saraf, Dept. of Plastic Surgery, NMC Speciality Hospital,Dubai, UAE.E-mail:firstname.lastname@example.org
Burns are one of the most devastating conditions encountered in medicine and have a catastrophic influence on people in terms of suffering, social life, disability, and financial loss. Burn injuries present difficult, diverse and varied challenge to medical and paramedical staff. The prognosis of a burn essentially depends on prompt and proper management. The ability to accurately evaluate and provide correct management is a must for all the health-care providers. The aim of this article is to provide a comprehensive burn management reference to all physicians and primary health-care providers.
Burns resuscitation, burns management, Parklandâ€™s formula, rule of 9s, electrical burns, chemical burns
Evaluation of patientâ€™s condition
1. Detailed history regarding cause of burns; date, time and place of burns; history of burns in closed space; mode of dousing fire; and primary treatment taken.
2. Marital status, duration of marriage and concomitant pregnancy in females.
3. History of addiction, alcohol abuse, smoking and associated/mental illnesses.
4. Any current medication and drug allergies to be noted.
5. Detailed general, systemic, local and any other associated injury examination.
6. Status of tetanus immunisation.
7. In paediatric burns, be aware of the possibility of child abuse.
8. Evaluation from medico-legal point of view.
Evaluation of magnitude of the injury
1. Age of patient, weight and general health.
2. Type of burns (thermal/chemical/electrical/radiation).
3. Accurate estimation of the TBSA of a burn is essential to guide management:
(a)The best-known method, the Wallaceâ€™s (1) â€śrule of nines,â€ť is appropriate for use in all adults and when a quick assessment is needed for a child (Table/Fig 1).
(b)The Lund and Browder(2) method covers all age groups and is considered the most accurate method to use in paediatric patients (Table/Fig 2).
(c)If Lund and Browder chart is not available
(i)for children <1 year: head = 18%, leg = 14%;
(ii)for children >1 year, add 0.5% to leg, subtract 1% from head, for each additional year until adult values attained.
4. Assessment of depth of burns and classification (IÂ°, IIÂ° superficial/deep, IIIÂ°, IVÂ°) (Table/Fig 3).
5.Any associated inhalation injury (history of burned in a confined space or patient found unconscious at the scene; burns to the face affecting nose, lips, mouth and throat; singed eyebrow or nasal hairs; and carbonaceous sputum, hoarseness and stridor).
6. Assessment of co-morbid factors like concomitant diseases such as pre-existing cardiovascular, pulmonary, renal, diabetes, epilepsy and fractures/other associated injuries.
7.The burn wound should never take precedence over potential life-threatening complications.
8.The burn wound should be cooled as soon as possible with cool water (preferably between 8Â°C and 23Â°C), but one should be careful of hypothermia.
9.The initiation of resuscitation is a priority. Detailed evaluation of patientâ€™s condition and magnitude of injury should be undertaken subsequent to restoring ventilatory and circulatory competence.
The summary of priorities in burns is (ABC approach) (3):
1.Check airway and breathing
2.Assess the severity of burns (primary survey)
3.Set up a drip and start a fluid regimen
5.Catheterize the bladder
6.Reassess the burn wound and the patientâ€™s general condition (secondary survey).
(Table/Fig 1):Rule of nines for establishing extent of body surface burned.
â€˘A quick way of estimating the surface area that is affected by a burn.
â€˘In children the head is more than 9% and a good way of estimating burns is that childâ€™s palm is 1% of its surface area.
â€˘Conventionally a single hatch is used for partial thickness and cross hatch for full â€“thickness.
Criteria for admission
1.Second-degree burns more than 15% body surface area (BSA) in adults or more than 10% BSA in children.
2.Third-degree burn more than 2% BSA.
3.Burns complicated by inhalation injury.
4.Burns associated with co-morbid factors.
6.Third-degree burn involving critical areas (hand, face and feet).
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