BURNS

Nitrogen losses greatly increased due to tissue destruction and exudate.

In full thickness burns pressure sensation is preserved as Paccinian corpuscles are
beneath the dermis.
In burns Age, Depth, Volume, Exact location, Surface area Extra co-morbidity does
influence the out come
Childs head 9 + 9 = 19 , compare with adult just 9%.
Lower limbs 13 + 13 = compare with adult 36%
Heat up to 40*C tolerated by the skin for a brief period.
Jaksons zone of burns
Outer \zone of Hyperaemia skin will survive
Inner Zone of stasis survive for 24 hours or more if treatment is instituted.
Inner most zone of coagulation will necrose and will need excision and skin cover.
Metabolic response to burns is on the same lines as any other injury.- ADH
Aldosterone
Gastric stasis, gastric dilatation ileus is due to splancnic vaso constriction. Ther is a
danger of vomiting and aspiration. NG tube is required for burns over 20% BSA.
Gastrin bsecretion not increased but there is relative hyperacidity during the 1st 24
hours after burns. There is high Basel acid output. (Curlings Ulcer).
Prophylactic antibiotics are required against B haemolytic streptococcus during the
oedematous phase (72 hours)
Anti tetanus treatment is required,
Treatment
Analgesia
Fluid resuscitation
Brushing if powder or washing with soap and water.
Vaseline gauze non adherent dressing with outer absorptive Gamgee dressing
Flamazine (silver sulphadiazine )dressing Hands in bags
Skin cover Skin grafting or synthetic cover.
Temporary biological dressing Allograft skin / xenograft / amniotic membrane.
Priority inskin cover ; face & eye lids to avoid ectropion / flexor aspect ie popliteal
fossa to prevent flexion contractures.
Small blisters in a small wound can be left alone
Blisters in a large wound- debrided as it is difficult to maintain them intact.
Eschar separation occurs in 2 weeks due to bacterial autolysis
Electrical burns

Electrons seek path of least resistance VANS and TENDONS

Collisions of electrons with conductor particles change electrical energy into Thermal
Energy.
Joules Law Heat = Voltage x current generated.