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Chapter-04 Burns

BOOK TITLE: Common Surgical Emergencies

Author
1. Kumar Richa
ISBN
9788184486537
DOI
10.5005/jp/books/10158_4
Edition
2/e
Publishing Year
2009
Pages
20
Author Affiliations
1. Metro Group of Hospitals, Noida, Uttar Pradesh, India
Chapter keywords

Abstract

Burn care encompasses a vast range of injury and diseases, from minor injuries through to devastating thermal trauma affecting every organ system. The first objective is to do no harm. Others are prevention and treatment of shock, control of bacterial growth, conversion of an open wound to a closed wound and maintenance and preservation of body function and appearance white achieving healing within minimal amount of time. Burn shock is a complex process of circulatory and micro circulatory dysfunction, not fully repaired solely by fluid resuscitation. Injury severity is difficult to define. The main indications are the size of burn, its depth and the pressure or absence of inhalational injury. Burn size is qualified as TBSA. Depth assessment has important implications for the remaining blood supply. At the site: The burning or burnt clothing’s are removed immediately to reduce the intensity of heat and also duration of contact which ultimately diminishes the depth of burn injury. Arrival: An ALTS approach should be adopted for assessment. Signs of inhalation injury or impending threats to airway should be sought and anaesthesist assessment obtained fluid therapy aims to replace “like with like” as far as possible. Resuscitation fluid replaces the losses and maintenance fluid aims to provide normal daily requirement of physiological fluid. Parkland formula: For first 24 hours: 4 ml × TBSA × body weight (kg). Half of this volume is given over first 8 hours (from time of injury). Other half is given over next 16 hours. Maintenance fluid: 100 ml/kg/24 hr for the first 10 kg body weight, 50 ml/kg/24 hr for the next 10 kg body weight, 20 ml/kg/24 hr for the each kg of body weight over 20 kg. Renal failure, pulmonary complications gastrointestinal complications, eye complications, thromboprophylaxis, Psychiatric problems. Chronic problems: Hypertrophied scar and kelod formation, hypertrophic calcification, Marjolin’s ulcer. Rehabilitation: This begins the moment patient is admitted to the hospital.

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