Fluid therapy and wound
care in burns,Complications
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of burnsFluid therapy in burns
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Why fluid therapy?Prompt fluid resuscitation is essential for survival in these patients.
Since the implementation of efficient, dynamic fluid replacement, fewer
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patients die in the first 24?48 h
All formulas are guides: Clinical decisions
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Assessment of Burn Area
The Rule of 9
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SimpleDue to differences in body
proportions, the percentage for
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each body area is different in
adults and children.
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Lund and Browder chartHand
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Fluid formulaParkland
Initial 24 hours: RL 4 ml/kg/% burn (adults)
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Next 24 hours: Begin col oid infusion of 5% albumin 0.3?1 ml/kg/% burn/per hourModified Brooke
Initial 24 hours: No col oids. RL solution 2 ml/kg/% burn in adults and 3 ml/kg/%
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burn in children
Next 24 hours: Col oids at 0.3?0.5 ml/kg/% burn and no crystal oids are given.
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Glucose in water is added in the amounts required to maintain good urinaryoutput.
Pediatric Galveston
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Initial 24 hours: RL 5000 ml/m2 burn + 2000 ml/m2 total (1/2 of total volumeover 8 hours, rest of the total volume in 16 hours)
Assessment of adequacy of fluid
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therapy
Urine output:
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1ml/kg/hour children0.5 ml/kg/hour adults
1.5-2 m/kg/hr electrical burn
Invasive monitoring
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Fluid therapy after 24 hoursColloids
Evaporative water loss
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Oral feeding
Type of Fluid :
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IsotonicHypertonic saline
Colloid
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Dextran
Wound Care
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Outpatient Burn Management
Who can be treated as outpatient
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burn?Blisters
Cleansing the wound
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Topical agents
Dressings
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Follow upAcute Burn wound management
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CleansingPain control
Topical agents
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Dressings
Dressings in Burn
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Synthetic dressingsBilogical dressings: Amniotic
membrane
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Skin substitutes: Alloderm,
Biobrane
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Debridement
Tangential excision:
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Tangential excision removes burned skin while preserving the underlying viabletissue
Full thickness excision
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Tangential
excision
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Wound coverage
Sk
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Complications of Burns
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Early complications
Burn shock
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Pulmonary complicationsInfection and sepsis
Organ failure
Death
Limb loss
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Curling's ulcerWound complication
Late Complications
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Joint contracturesHypertrophic scars
Keloids
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Psychological stress
Marjolin's ulcer
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Questions
1. What is the most common topical agent used for burn dressing?
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2. What is the fluid required for resuscitation of superficial burns involving 10%
TBSA in a 50 kg man?
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3. What is marjolin's ulcer?