Burns Aneta Mrkvičková Burns2 Learning objectives ̶ Students will become familiar with various degrees of burns. ̶ Students will learn the procedure for first aid for burns. ̶ Students will learn how to assess the severity and extent of burns. Burns3 Definition ̶ Burn (lat. Combustio) = tissue damage caused by direct or indirect exposure to heat ̶ Skin, or deeper structures, are destroyed ̶ The tolerable contact temperature is 43.5 °C. ̶ Skin damage occurs at a temperature of 55 °C. The decisive factor is the duration of the heat exposure Burns4 Skin structure Burns5 Pathophysiology ̶ Thermal burns ̶ contact with heated objects, such as boiling water, steam, hot cooking oil, fire and hot objects Destruction of capillaries → → release of vasoactive substances → → generalized dysfunction of capillaries→ → plasma leakage into the interstitium, edema, hemoconcentration → → hypovolemic-distribution shock → → activation of the sympathetic nervous system → → acute systemic inflammatory response syndrome → → extreme loss of heat, fluids Burns6 Pathophysiology ̶ Inhalation of toxic substances ̶ Rapid development of airway swelling ̶ Intoxication of toxic substances (CO, CO2, etc.) Burns7 Pathophysiology ̶ Chemical burns (corrosions) ̶ Acids cause dry coagulation necrosis ̶ Alkalis cause wet necrosis Burns8 Types of burns ̶ DEPTH ̶ Superficial: preservation of follicles, sebaceous glands, capillaries and nerve endings ̶ Deep: loss of skin in all layers (possibly including subcutaneous tissue, muscle and bone), pale base means necrosis or ischemia ̶ DEGREES ̶ 1st) redness, edema ̶ 2nd a) superficial; blister ̶ 2nd b) deep ̶ 3rd) necrosis; full thickness ̶ 4th) charring Degrees Burns9 ̶ Redness, swelling: only epidermis is affected, increased sensitivity of the skin, painfull, spontaneous healing without scars 1st degree Burns10 Degrees ̶ 2nd a) Superficial: damaged epidermis and superficial part of dermis, blisters, spontaneous healing in 2-3 weeks by reepithelialization ̶ 2nd b) Deep: damaged reticular dermis, pale base, incipient necrosis, difficult healingcontractures, risk of infections Degrees Burns11 ̶ Necrosis: irreversible damage of the full thickness of dermis, including nerve endings, a skin graft is needed for healing 3rd degree Degrees Burns12 ̶ Charring: damage of the whole skin, subcutaneous tissue, including muscle fascia, muscles, bones, etc. Reccurent debridements of necrotic tissue are necessary, usually followed by numerous plastic reconstructions 4th degree Burns13 First aid ̶ Take care of your own safety ̶ Immediately get the person away from the heat, electrical, chemical source ̶ Transport to a safe place (excluding smoke, fumes,…) ̶ Follow SSS ABC, start CPR if the person is not breathing Burns14 First aid ̶ Gently remove loose clothing, shoes (do not remove anything that's stuck to the skin!) ̶ Remove any metal thing (watches, rings,…) which is near the burnt area of the skin ̶ Prevention of heat loss (foil, blanket) ̶ Call 112 ̶ Nothing to eat Burns15 First aid ̶ Burns: Cool burns with clean cold water for a long time (up to 20 minutes), up to a maximum of 5% of the body surface; especially the face, neck and hands CAVE: rapid development of hypothermia (especially in children) Cover with a sterile sheet ̶ Corrosion: Rinse with plenty of water, always remove contaminated clothing Cover with a sterile sheet Never induce vomiting! Burns16 The most common mistakes ̶ Cooling of the torso and large areas ̶ Cooling with ice ̶ Application of ointments and various lubrications on injured surfaces ̶ To give a drink or meal to a patient Burns17 Extent of burns ̶ RULE OF PALM (patient´s) ̶ RULE OF NINES Burns18 Serious localizations ̶ Burns on the face, neck, hands, feet and genitals ̶ Circumferential burn ̶ Inhalation trauma Burns19 Severity ̶ Mechanism of injury (polytrauma, electrical burn of high voltage) ̶ Extent and depth of burns ̶ Age ̶ children up to 2 years….………2nd - 5% TBSA ̶ children 3 - 10 years ………… 2nd - 10% TBSA ̶ children 11-15 years ……….... 2nd - 15% TBSA ̶ adults ………………………..... 2nd - 20% TBSA, 3rd 5% TBSA ̶ seniors over 70 years …………2nd - 10% TBSA ̶ Location ̶ Inhalation trauma ̶ Anamnesis of patient Burns20 Transport ̶ Major thermal trauma → Burn Centers ̶ Moderate thermal trauma → regional hospital Burns21 Learning outcomes ̶ Student knows how to provide first aid to the burnt person. ̶ Student is able to estimate the severity and extent of burns ̶ Student is able to list situations where medical treatment of burns is necessary. Burns22 Sources ̶ https://www.nhsinform.scot/illnesses-and-conditions/injuries/skin- injuries/burns-and-scalds ̶ Pictures: ̶ http://www.popaleniny.cz/ambulantni ̶ https://en.wikipedia.org/wiki/Integumentary_system#/media/File:Skin.png Simulation Centre, Faculty of Medicine, Masaryk University 2020