BURN

Definition: Burn is a thermal injury coagulative necrosis tissue.

BURN

Cause of burn:

Flame burn
Scald burn
Chemical burn
Electric burn

There are two type of burn:

Superficial burn- Pain is very severe in superficial burn
Deep burn- Pain less or less pain in deep burn, it goes up to bone and so serious.

Adult- More than <15% Pediatric- More than <10%

Percent of burn

Rule of nine.

Head and neck-----------------9%
Chest------------------------------9%
All back site---------------------18%
Both leg -------------------------18%
Both thigh----------------------18%
Both hand-----------------------18%
Abdomen------------------------9%
Genital organ-------------------1%
Total          100%

General effective:

Loss of plasma
Hypovolaemic shock
Toxemia due to plasma loss
a, Infection bio-chemical change.
b. Toxin from burn tissue.
Anaemia.




Complication of burn:

Immediate:

Infection
Gastric Ulceration
Hypovolaemic shock
ARF
Respiratory complication
Gastric dilatation

Late:

Hypertrophic scar(হাইপারট্রোফিক স্কার)
colloid
Post burn construction


Management

Emergency first:

Removal of patients from sours of burn.
Removal of clothing from burn area
Application of cold running water ideal 15° C
Covering the burn area as quickly as possible by sterile dressing
Strict aseptic precaution  in all aspects
Washing of the burn area by normal saline to clear and remove foreign substance.
IV infusion H/S or N/S to be stated according to severity of burn   

Investigation:

Blood for CBC, PCV%, grouping, Rh – factor, S. Electrolytes, urea Creatinine RBS, LFT, Protein profile, CXR, Urine for R/E, C/S, Wound Swab for C/S.

HOSPITALIZATION OF BURN:

1. Keep the patient in isolated and ventilation room.
2.Placed a soft rubber sheet all patient bed.
3. Air way clear by suction and keep tube in the mouth.
4. Check breathing and circulation immediately.
5. O2 inhalation 2 – 4 l/min state and SOS.
6. Patient set up cardiac monitor.
7. Set up i/v line in the normal saline / Hartman’s solution 3 – 4 ml % burn / ½ hrs within 8 hours from the time of burn. 
8. Catheterize the patient to maintain urine output (50 – 100) ml / hour.
9. Use all instrument and linen should be sterilizes.
10. Wash the burn area normal saline +butadiene solution concentration 50 / 50.
11. Tetanus prophylaxis TT / TIG stat. {TT – up to 24 hours, TIG – after 24 hours}.
12. Dressing in three layers.
Antiseptic.
Cotton wool.
Absolvent wool.
13. Infusion of plasma or plasma substitute for shock.
14. Blood transfusion if required immediately.
15. Maintain CVP line.
16. Anti biotic should be change according to wound swab for c/s report.
17.Inj. Traxon 1 gm i/v BD.
18. Inj. Penicillin 500 mg 06 hourly.
19. Inj Morphine 5 mg i/v state and 3 mg 3 hourly and SOS.
20. Inj. Motilon 10 mg i/v state and SOS.
21. Inj. Seclo 40 mg i/v BD.
22. Inj. Vitamin c 500 mg OD.
23. Inj. Vitamin B 1 amp OD.
24. Visitors restricted.
25. Patient dress and i/v line change every alternate day.
26. Change dressing every alternate day.
27. Intubated the patient and support the ventilator if required.
28. All treatment should given general surgeon / plastic surgeon.

Park land formula:

Pts body WT (KG) X % x 4ml.
[Say, Body wt = 50 kg, burn 2o%, so 50X20X4=4000 ml]

 2000 ml 1st 8 hours then 2000 ml in next 16 hours.
for advanced