Download MBBS Burns and Plastic Surgery PPT 5 Fluid Therapy And Wound Care In Burns Complications Burns Lecture Notes

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of burns

Fluid 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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Simple

Due 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 chart


Hand

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Fluid formula

Parkland

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 hour

Modified 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 urinary

output.
Pediatric Galveston

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Initial 24 hours: RL 5000 ml/m2 burn + 2000 ml/m2 total (1/2 of total volume

over 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 children
0.5 ml/kg/hour adults
1.5-2 m/kg/hr electrical burn

Invasive monitoring

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Fluid therapy after 24 hours

Colloids

Evaporative water loss

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Oral feeding

Type of Fluid :

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Isotonic

Hypertonic 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 up


Acute Burn wound management

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Cleansing

Pain control

Topical agents

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Dressings

Dressings in Burn

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Synthetic dressings

Bilogical 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 viable

tissue

Full thickness excision

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Tangential

excision

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Wound coverage

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Complications of Burns

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Early complications

Burn shock

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Pulmonary complications
Infection and sepsis
Organ failure
Death
Limb loss

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Curling's ulcer
Wound complication

Late Complications

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Joint contractures

Hypertrophic 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?