BURNS 11

MANAGEMENT 3

   *  In the second 24 hours the fluid requirement is half of the

      first day.

   *  The colloid is administered in the form of plasma or plasma

      replacement depending on the depth of the burn.

   *  If a large percentage of burn area is full thickness than

      the colloids are increased and the electrolytes

      correspondingly decreased.The rate is adjusted so as to

      give half of the first day's requirement in the first 8

      hours.

   *  It must be stressed, however, that the time is calculated

      from the moment the burns are sustained, and that the fluid

      calculated as above and the daily metabolic requirement

      (2000 ml.) must be administered to the patient.

   *  Assessment of progress is best obtained by catheterizing

      the patient and if the urine output is near 50 ml per hour,

      it can be presumed that the fluid requirements are being

      met.

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BURNS 10

MANAGEMENT 2

.

Major  burns  of 15% or 10% in children need to  be  admitted  to

hospital  for  their  proper  care  and  treatment  and  may   be

considered under the following heads:

 

       1.  Check clear airway

       2.  Treatment of neuro-genic and olig-aemic shock

       3.  Tetanus Prophylaxis

       4.  Prevention and treatment of infection

       5.  Skin cover for the full thickness loss at the earliest

           opportunity

 

 PAIN

Adequate  sedation  in  the  form of  pethidine  for  adults  and

children is employed.

 FLUID

Wallace's  Rule  of nine" is used to estimate the  percentage  of

area burnt and fluid requirement is calculated.

 

                            

Detect  the  depth of burns - this is represented  by  the  three

degrees  depth  of skin burnt,  clinical  appearances,the  layers

affected.

   *  As a general rule 0.5 ml. of colloid and 1.5 ml. of

      electrolyte are prescribed for every 1% of burn per

      kilogram of weight per 24 hours.

 

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BURNS 9

2.3 MANAGEMENT

There are a couple of "Dont's" that need to be impressed upon for

those first coming in contact with these patients outside hospitals.

   *  Do not remove clothing

   *  Do not apply emolients or pastes of any description

   *  Put out the flames(burning clothes)

In the case of acid burns a weak solution of Soda Bicarb and  for

alkali burns a 1% solution of acetic acid should be used.

- Burnt area should be wrapped in clean sterile towels,if these

are available.

 

If  transport  to  hospital will take an hour a  drip  should  be

started.

In the hospital, minor burns of 10% or less may be dealt with  in

the out-patients department and discharged.

   *   The wound is cleaned and dressed with wide mesh veseline

       gauze and reinforcement with a lot of cottonwool to act as

       a pressure dressing.

   *   Necessary  analgesics and fluids are prescribed and the

       dressings are changed at 3-4 days interval.

 

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BURNS 8

PATHO-PYSIOLOGY(CONT)

* Red cells are lost in deep burns due to the effects of

heat, increased fragility and stagnation and sludging occurs in the

capillary bed.

This may be to the extent of 8 to 12% of RBC mass per day.

* There is an effect produced on the GI tract.

Ileus is always there in cases of over 25% burns of fluid treatment

is provided motility returns in 3-5 days.

Mucosal damage due to local ischaemia.

These areas may go on to become ulcers if untreated.

* Endocrine changes occur in the form of raised glucugon

cortisol and catacholamine levels.

Insulin and T3 levels are depressed.

* Immune response is also depressed.

This shows as reduction of lymphocytes 48 hours after the burns.

Thus infection occurs, serum globulin are also reduced, and return to normal

         

 

in 2-4 weeks.

 

 

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BURNS 7

PATHO-PHYSIOLOGY 1

The permeability of the capillary bed in the burn area is

increased and a protein rich filtrate passes into the

interstitial space in the burnt area.

This is because of histamine release.

Thromboxane A and cytokinins are also implicated.

Activation of the immune system also increases microvascular permeability.

* The rate of loss of fluid is most rapid in the first 8 hours

and continues till 48 hours.

* The fluid lost is of the same electeolytic composition as

plasma, but the protein content is about half that of plasma.

* From the third day fluid reabsorbtion starts.

* Thus in the first 48 hours there is a rise in protein

concentration in the plasma.

- In untreated cases this may lead to a massive shift of fluid

from the cells to extracellular space.

- This may lead to irreversible damage to renal tissue if not

treated early.

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