General data about burn

>> BURN MANAGEMENT

THE SEVEN PHASES OF BURN MANAGEMENT

Burns can be a severe insult to the body. A person can cope with small burn injuries if he/she is healthy and do not have other medical problems. In older people and small babies, even a small burn can be serious.

When a larger area of the skin is burned, the injury becomes more complex and will indirectly affect the whole body. The burn team will treat not only the skin damage but also support the rest of your systems.

The National Burn Care Review Committee describes seven steps present throughout the management of a burn injury.

 

RESCUE

If you have sustained a burn injury, friends, relatives or emergency services will rescue you if it was needed. First aid will be given at the place of incident and as soon as possible.Adequate and rapid first aid can have a significant effect on the survival of people who have suffered major burns.

 

RESUSCITATE

If you have sustained a small burn, your body can cope with the injury and it is unlikely that you will need resuscitation or transfer to a specialised unit.If you have sustained a moderate to large burn, you will need support to help your body to cope with the extensive injury. Resuscitation with fluids and support of other systems of your body will start at the place of incident, continued in the Accident and Emergency Department and Burn Unit / Centre. Pain will be alleviated with adequate medication.

 

RETRIEVE

If after accurate assessment in the Accident and Emergency department, a specialized treatment is required, you will be safely transferred to the closest available Burn Unit / Centre.

 

RESURFACE

The damage to your skin caused by burning will be repaired by allowing it to heal with dressings or with the help of burn surgeons.

Burns are painful and distressing injuries. Dressing procedures will require specialized materials and adequate pain relief.

When the burns are extensive, complete repair of the damaged skin may not happen without surgical input.

 

REHABILITATE

This starts on the first day of the injury! Rehabilitation and recovery consists of:

- A physical component (see physiotherapy)
- A psychological component
- A scar treatment component (see scarring)
- A psychiatric component.

Rehabilitation is a complex and essential part of burn management and requires a multidisciplinary team approach.

 

RECONSTRUCT

If you have sustained burns that left you with obvious scars or you have some areas where the function is restricted due to

scarring, further surgery will be needed. A team approach will increase the success of the surgery. (see Reconstructive Procedure)

REVIEW

After a complex burn injury, long term follow up is the normal requirement. Children with burns will often need to be followed up until adulthood. Problems related to scarring process (ulcers over the scars and function of the areas) might emerge much later and will need to be addressed accordingly.

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WHAT KIND OF INFORMATION SHOULD YOU GIVE TO THE MEDICAL STAFF?

- time and place of the accident
- how did it happen (mechanism)
- what caused the burns
- if smoke or toxic vapours were inhaled
- if it was a chemical burn, the substance that caused the burn
- age, any previous health problems
- any medications or allergies.

WHAT WILL THE DOCTOR ASSESS?

- the burn severity (depth, extent)
- if the burn is all around a limb or around the trunk
- if there is an inhalational injury
- the areas of the body affected by burn.


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WHAT WILL HAPPEN WHEN YOU HAVE A SMALL BURN?


1. When you have a small burn that is not on an important part of your body, you might

be treated by your GP or by your nearest Accident and Emergency department. In this

case you do not need to stay in hospital.

2. The burn wound will be dressed by a doctor or a nurse. If the burn is shallow, it

might take up to 2 weeks until the skin can repair itself and cover the burn. (see wound management).

3. You might need some painkillers.

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WHAT WILL HAPPEN WHEN YOU HAVE A SMALL BURN IN IMPORTANT AREAS OF YOUR BODY?

Some areas of the body are more important than the rest because of their specialized

functions. These areas are: hands, feet, face, neck, down below, elbows, knees, wrists,

ankles. If the burn affects the eyes, an eye specialist will see you and may prescribe

treatment.

1. When a burn involves these parts of the body, a specialist doctor from a Plastic

Surgery department or a Burn Unit/Centre should see you.


2. You might need to stay in hospital for a few days if the specialist decides that it is in

your best interest.


3. If the burn affects your face, it will be swollen and you will require nursing input for

1 or 2 days.


4. If the burn is deep, you may require surgery in order to remove the burned skin. For

more information about your burns follow this link.


5. Pain killers will be given as needed. In children Paracetamol and Ibuprofen are often

enough to make the child comfortable. For adults, other pain killers can be added.


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WHAT WILL HAPPEN IF THE BURNS COVER 10% OF THE SKIN SURFACE IN A BABY / CHILD OR 15% IN AN ADULT?

1. A child with burns of more than 10% of his/her skin surface area should be admitted to the Burn Unit.

2. An adult with burns involving more than 15% of his/her total skin surface area he/she needs admission.

3. Fluids will be given through a drip in order to make up the fluid loss from the burn surface.

4. An indicator of the body dehydration is the amount of urine that a person passes each hour. In order to monitor this, a flexible plastic tube (urinary catheter) may be inserted into your bladder. The tube will be attached to a plastic bag.

5.Pain killers will be given as needed. In children Paracetamol and Ibuprofen are usually enough to make the child comfortable. For adults, other pain killers can be added.

6. Your burn wounds will be dressed as required. If your burns are mostly shallow, dressings will be changed as necessary till complete healing.
If the burns are deeper, a decision will be taken as to whether the burn needs early surgery or can be left for 2 weeks to see what will heal on its own. (see wound management).

 

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Child 10% burns Adult 15% burns

 

Fluid loss and methods of replacement in an adult with more than 15% burns


WHAT WILL HAPPEN IF THE BURNS ARE EXTENSIVE?

When the burns are extensive (> 40% of total skin surface area), a patient loses a lot of fluid in a very short period of time. It is essential to maintain an adequate blood pressure.

If a drip is not set up as soon as possible (hours), the patient's blood pressure can fall and the vital organs (brain, heart, kidneys, lungs) may not have enough oxygen supply. A large volume of fluids will be required as soon as possible in order to replace the volume of fluids inside the blood circulation.


If the need arises, a special drip (central line) may be placed into your neck, groin or underneath the collar bone. Through this central line, medications and fluids can be given and certain indicators can be measured closely.

If the need arises, a special drip (central line) may be placed into your neck, groin or underneath the collar bone. Through this central line, medications and fluids can be given and certain indicators can be measured closely.

Stronger pain killers will be given in addition to the standard pain relief.

Your burn wounds will be dressed as required (see wound management).

 

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Fluid resuscitation on a severe burn injury


WHAT WILL HAPPEN IF THE BURNS ARE ALL AROUND A LIMB OR THE TRUNK
?

If the burns are deep all around the chest, they may restrict breathing. It may be necessary to split the burned skin surgically to allow the chest to move properly.

If a deep burn is all around an arm or leg, the muscle, nerves and blood vessels will be squeezed inside because the burned skin is stiff and not elastic. The limbs swell beneath the rigid deep burn and the circulation can be cut off. Two cuts may be carefully placed through the burned skin in order to decompress the tissues underneath.


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Escharotomy for chest and upper limbs


W
HAT WILL HAPPEN IF YOU HAVE BREATHING PROBLEMS AFTER THE BURN INCIDENT?

If you have been caught in a house fire, explosion or sustained facial burns, you may have breathing problems in the first 24 hours after the incident.
Air passages start from the nose and mouth, continue on the back of the throat and down to the wind pipe (trachea). The trachea splits into two and enters each lung where it divides into smaller air passages (bronchi). Breathing problems might be related to one of following causes: inhalation of smoke, airway burn and swelling of the air passages.

 

INHALATIONAL INJURY AND HOW IT WILL AFFECT YOU?

If you have inhaled smoke or toxic vapours, your face may be singed; soot may be present around and inside the mouth and nose. Toxic substances present in the smoke (carbon monoxide, acids) cause damage to the lining of the lungs.


A chain of reactions will be triggered in the lungs, reducing the ability of the blood to take up oxygen. The protective barrier that lines the lungs is broken and you will have higher chance of getting chest infections. The oxygenation of the body is also affected because carbon monoxide present in the inhaled smoke competes with oxygen for the same blood carrier. Breathing difficulty may develop in the next 2-3 days after the injury and can cause significant problems during the hospital admission.

 

WHAT IS THE TREATMENT?

Such an injury significantly increases the burn severity. If it becomes more difficult to breathe and the level of oxygen in you body decreases, a high concentration of oxygen and breathing assistance may be needed. A tube will be put into the windpipe through the mouth or nose under an anaesthetic and will be put through a breathing machine.
The soot present on the lining of the lungs may be washed away under direct vision through a special flexible tube (fiberoptic- bronchoscope). In the next few days, the lung will produce a considerable amount of secretions that will be sucked out regularly from the air passages to ease breathing.

You will have chest physiotherapy several times a day in order to help your lungs eliminate the secretions and to improve oxygen uptake. Breathing assistance may be required for a few days or longer.

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Inhalation injury

 

 

Treatment for inhalation injury


AIRWAY BURN AND HOW IT WILL AFFECT YOU?

Damage of the interior lining of the air passages by heat is an airway burn injury.
Your breathing will be affected in 24-48 hours after the incident. The lining of the upper air passages may be damaged by hot air. Larger and smaller air pipes may be affected and the inner diameter of the bronchi is decreased. The lungs may swell up and the breathing may require assistance.

 

WHAT IS THE TREATMENT?

If you find it difficult to breath, a tube will be put in the windpipe through the mouth or nose under an anaesthetic and will be put through a breathing machine.

In the next few days, the lung will produce a considerable amount of secretions that will be sucked out regularly from the air passages to ease the breathing. You will have chest physiotherapy several times a day in order to help your lungs eliminate the secretions and to improve the oxygen take up. Breathing assistance may be required for few days or more.

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Burn injury to the face

SWELLING OF THE AIR PASSAGES

When you have facial burns, you may expect that swelling will develop fairly quickly (in the first 24 hours). Facial burns may be an indicator of smoke inhalation and the air passages may be affected.
In this case, the inner diameter of the airways above the neck can be reduced rapidly due to swelling. Patency of the upper air passages is essential and early intubation of the windpipe is required.
A machine will push air and oxygen into your lungs. You will have chest physiotherapy several times a day in order to help your lungs eliminate the secretions and to improve the oxygenation. Breathing assistance may be required for few days or more.

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Treatment for swelling of the air passages

   

 

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