+12 more
Give me important points from these pages so I don't have to read them. Hmm.
Here is a concise summary of all 8 pages from Chapter 13 - Burn Injuries (General Surgery textbook):
🔥 Chapter 13: Burn Injuries - Key Points
DEFINITION & CAUSES
- Burn = tissue injury (coagulative necrosis) from thermal energy
- Causes: flames, hot contact, scalds, electricity, chemicals, friction, radiation
- Depth of necrosis depends on temperature + duration of exposure
EFFECTS OF BURNS
Local:
- Fluid loss from surface/blisters; increases from 15 ml/m²/hr → 200 ml/m²/hr
- Eschar (coagulum) forms; destroys barrier → bacterial invasion → sepsis
Regional:
- Circumferential eschar → venous obstruction → compartment syndrome
- Hot gases → airway burns above larynx → swelling → complete airway blockage
- Steam → below larynx → respiratory failure
- Carbon monoxide binds Hb with 280x affinity of Oâ‚‚; >10% carboxyhaemoglobin = dangerous; 60% = fatal
Systemic:
- Circulation: hypovolemia (main cause of early death)
- GI: ischemia, reduced motility, curling ulcers, gut bacteria translocation → sepsis
- Metabolic: up to 7000 kcal/day expenditure; weight loss 0.5 kg/day
- Renal: acute failure from hypovolemia + myoglobinuria
- Late effects: scar, contracture, disability, psychological trauma
CLASSIFICATION OF BURNS
| Type | Layer involved | Features | Healing |
|---|---|---|---|
| Superficial partial thickness | Epidermis + papillary dermis | Erythema, blisters, painful, blanches | Heals in 2 weeks, no scar, non-surgical |
| Deep partial thickness | Epidermis + reticular dermis | Dry, not moist, reduced sensation | Takes 3+ weeks, hypertrophic scar, may need surgery |
| Full thickness | Whole dermis destroyed | Hard/leathery, no capillary return, completely anaesthetized, thrombosed vessels visible | Requires skin graft or flap |
SEVERITY / PROGNOSIS
- % TBSA burned
- Inhalation injury
- Depth of burn
- Respiratory tree involvement
- Circumferential burn
- Age <2 or >60 years
Mortality formula:
(% BSA + Age) / 100BURN CENTRE REFERRAL CRITERIA
- Suspected airway/inhalation injury
- Needs surgery or fluid resuscitation
-
10% TBSA in patients <10 or >50 years; >20% TBSA in others
- Burns to hand, face, feet, or perineum
- Pre-existing medical conditions
- High-tension electrical burns, hydrofluoric acid burns, non-accidental injury
PRE-HOSPITAL CARE
- Ensure rescuer safety first
- Stop burning: drop and roll
- Follow ATLS (A, B, C, D, E)
- Cool wound 10 minutes within 1 hour; keep at 15°C; avoid hypothermia
- Give oxygen
- Elevate burned limbs
ASSESSMENT
- Rule of Nines: Body divided into 11 sections, each ~9% TBSA (genitalia = 1%). In children, head/neck = 18% (not 9%)
- Lund & Browder Chart: More accurate; adjusts for age
- Palm method: Patient's palm (palm + digits) = 1% TBSA (for small/patchy burns)
Burn depth by cause:
- Scalds → partial thickness
- Fat burns → deep dermal
- Flame → mixed
- Alkali → often full thickness
- Electrical/strong acid → full thickness
AIRWAY MANAGEMENT
- Symptoms of laryngeal edema: voice change, stridor, anxiety, respiratory difficulty
- Intubate early - secure airway for ~48 hours until swelling subsides
- Laryngeal edema develops 4-24 hours post-burn
- Late intubation may be impossible → consider cricothyroidotomy
- Treatment: chest physiotherapy, nebulizers, warm humidified Oâ‚‚, assisted ventilation
FLUID RESUSCITATION (Parkland's Formula)
- Indicated if burn >15% TBSA
- Volume = 4 ml × body weight (kg) × % TBSA burned
- Give 50% in first 8 hours (from time of injury), remaining 50% over next 16 hours
- Monitor with urine output: target 0.5-1.0 ml/kg/hr in adults
- Children: Modified Parkland = 4 ml × weight × %burn + maintenance fluid
- Fluid of choice: Lactated Ringer's (avoid colloids in first 24 hours)
WOUND TREATMENT
- Superficial partial: Antibacterial dressing; heals without sequel; avoid aggressive debridement
- Circumferential full thickness: Emergency escharotomy to relieve compartment syndrome
- Full/deep partial: Clean + antibacterial dressing; prepare for grafting
Common antibacterials:
| Agent | Notes |
|---|---|
| Silver sulphadiazine 1% cream | Broad spectrum; effective vs Pseudomonas + MRSA |
| Silver nitrate 0.5% | Change every 2-4 hours; can cause hyponatremia |
| Mafenide acetate 5% | Painful; associated with metabolic acidosis |
| Silver sulphadiazine + cerium nitrate | Best for full thickness; improves immunity |
Escharotomy placement:
- Upper limb: midaxial, anterior to ulnar nerve
- Hand: midline in digits
- Lower limb: midaxial posterior
- Chest: down lateral chest, across clavicle and at xiphisternum
OTHER HOSPITAL MANAGEMENT
- Contracture release: Late complication - managed by physiotherapy + skin grafting
- Analgesia: Small burns → paracetamol/NSAIDs; Large burns → IV morphine 2-5 mg
- Nutrition: Catabolic state - high requirements; nasogastric tube if >20% TBSA within 6 hours; monitor nitrogen balance
- Infection prophylaxis: Fever >38.5°C = infection; empirical antibiotics + culture; anti-tetanus prophylaxis; hand hygiene
- Additional: Nursing care, physiotherapy, psychological support
- Curling ulcers: H2 blocker/PPI prophylaxis
NON-THERMAL BURNS
Chemical Burns:
- Progressive damage until chemical inactivated
- Flush immediately with copious water for ≥15 min; remove clothing
- Do NOT use neutralizing agents (generate heat, deepen burn)
- Alkalis worse than acids (coagulative vs liquefactive necrosis)
- Hydrofluoric acid → life-threatening hypocalcaemia → treat with calcium (antidote)
Electrical Burns:
- Low tension (domestic): no significant injury
- High tension: flash/flame/current injury; entry + exit wounds; compartment syndrome; myoglobinuria → acute renal failure; cardiac damage
- Alternating current through heart → cardiac arrest (resuscitation usually successful)
Cold Injuries (Frostbite):
- Liquid nitrogen → epidermal + dermal destruction
- Affects peripheries; treat with rapid rewarming at 42°C
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