BURN-2

Department of Plastic Surgery

The First Teaching Hospital
Zhengzhou University
Clinical course in large area burns

Three stages ( or barriers)

Shock

Infection

Reparation
 Clinical course:
1.Stage of Shock (large area)
1. hypovolemic shock
●within first 48 hour;
●lost of body fluid in the wound surface
and/or tissue space--efflusion of body fluid,
oxygen deficit,evaporation;decrease of
circulation volume;
Clinical course:
1.Stage of Shock (large
area)
2. nervous shock ——For pain or
dread in early stage;

3.Septic Shock——for Septicemia;

 Clinical course:
2.Stage of infection
nfection is easy to happen in Three Stages
*Efflusion and necrotic tissues are good
medium of germ;
*For local metabolic block anti-infection
actors can’t arrive;
*Skin is destoryed,narural barrier is lost;
*The immune system is suppressed;
Clinical course:
2.Stage of infection
1.3~7 days after burn
resorption of edema: efflusion
2.3~4 weeks after burn
solution of eschar :dissolved tissue
3.1 month after burn
stage of recovery :power of resistence
is low
 Clinical course
3.Stage of Reparation
1.Stage of Wound Surface Reparation 　　
1 week after burn;
scars/pigment left;
solution of crust/eschar:autolysis
decrustion;(2~3weeks)
skin grafting;
☆to promote earlier healing
Clinical course
3.Stage of Reparation
2.Stage of Function Reparation (recovery)
*Reparation of whole body’s function;

*Reparation of partly function;

internal organs;
sweat glands;
scars---reshaping,training;
 Field first aid
nciples:
top the burning process;
*eliminate the factor of injury;
**escape from the spot;
Ensure patient’s life ;
*salvage poisoning,bleeding
rotect burn wound;
* wrapping;fixation
andle by condition;
 Treatment
Principles:
1. To protect the burned area and prevent it
from contamination
2. To prevent and treat hypovolemia and shock .
3. To manage local and general infection .
4. To promote wound healing and reduce
dysfunction and deformity caused by scars .
5. To prevent and treat MSOF.
 Treatment in Small area burns

1.General management:
*Salt beverage;
** Antibiotics;
*** TAT (Tetanus antitoxin);
 Treatment in Small area burns
2. Management of the burn wound:
*Debridement: germ free, pain is
relieved;blisters;
**The open
method:All part of body especially head,face
and perineum,or when number of patients is
large;
***The closed method(wrapping):The
extremities and trunk;
 Treatment-- Large area burn

1.Prevention and treatment of shock

2.Management of burn wound
3.Prevention and treatment of sepsis
4. Prevention and treatment of scars
1.Prevention and treatment of shock

Fluid infusion :
quality
1. Crystalloid liquid
2. Colloid liquid

*Adjust to the extent and depth

 1.Prevention and treatment of shock
Amount of fluid infusion : Evan’s Formula
First 24 hours Second 24 hours
Per 1% ,1kg BW Adult. 1.5ml,Children 1.8ml 1/2 of the
extra loss amount Inf. 2.0ml 1st 24h

Crystalloid:Colloid MD or SD 2:1 , ESD 1:1 same as left

A:2000ml C:60~80ml/kg same as left

Basic requirement I:100ml/kg
 1.Prevention and treatment of shock

The Principles of fluid infusion ：

“First fast, then slow ”

“First crystalloid, then Colloid”
“First salt,then suger”
“Give buck medicine and urinative early”
“Prevent transfusion complication”
 1.Prevention and treatment of shock

Adjustment of fluid infusion

A.Urine output adult >30 children> 20 Inf> 10 （ ml/h)
B.Psyche condition restlessness
C.sense of thirst
D.Peripheral circulation
Temperature of limb; Capillary filling
E.Pulse Adult<120/min. Children<140/min.
F.Blood pressure Adult: SP>12kPa (90mmHg)
Difference of SP & DP >2.67kPa(20mmHg)
G. CVP Normal : 0.5~0.98kPa (5~10cmH2O)
 1.Prevention and treatment of shock

Adjustment of fluid infusion

CVP↑,urine volume↑ ： blood volume is enough

CVP↓,urine volume↓ ： not enough 。
CVP↑,urine volume↓ ： heart failure ，
or renal failure 。
 2.Management of burn wound

Principles
First Degree : Keep the wound clean and relieve pain .
Superficial II : Prevent from infection .
Promote wound healing
Open or closed method .
Deep II : Prevent from infection .
Promote epithelial healing .
Reduce scars.
Third Degree : Prevent from infection . Protect eschar .
Perform escharotomy and skins grafting.
Rotating bed and Baking lamp
 2.Management of burn wound

In Ⅰ and SuperficialⅡ degree

The open method :
Burns in head , face , neck , shoulder ,
buttocks , perineum.
large area wound of trunk & extremities .
The closed method :
small area burn of trunk & extremities
 2.Management of burn wound

In deep II and III degree burn

1 .Earlier period removal of eschar and skingrafting
*excision of eschar: III<20%,3 ～ 5d;Deep II
**eschar shaving:deep II
***natural decrustation :“Stamp” grafting
after eschars dissolved
2.Staged excision of eschar and skingrafting
III>20%,3 ～ 5d, once/3 ～ 5d,1/4.
 2.Management of burn wound

Skingrafting
In a large area,III degree burn
Methods: 　 　　　　　　　　
１． Variant graft ；
２． Split-thickness autograft ；　　　　　　
３． mesh skin graft ；　 　　　　　
 3.Prevention and treatment of sepsis

*The common location of infection:

pressured,wet,concealed places.
**The common bacteria of infection:
pyocyanic bacteria , staphylococcus
staphylococcus aureus,colibacillus .
***Management:
change dressings,drainage,hydropathic compress
Drugs use in burn wound:
sulphanilamide(SN) ,chloromycetin et al
infection

Using
medicine
 3.Prevention and treatment of sepsis

Septicemia always occurred in three stages

1. In early stage :
< 24 hours --outbreak of septicemia
3~7 days --stage of resorption of edema
2. In eschar dissolved stage :
3~4 weeks after burns
3. In recovery stage :
1 month late , low resistance and
granulation cause infection
 3.Prevention and treatment of sepsis
Appearance in early stage
1. Signs of shock;
2. Temperature: >39 0C or <360 C 。
3. Heart rate ： >140 times/min.
Respiratory Rate ： >30~35 times/min.
4. Digestive tract,respiratory tract symptom
Nausea , vomiting , diarrhea , dyspepsia or dyspnea .
5. coated tongue
6. raw surface secretion;staling;ecchymosi
7. hemogram Leukocytosis (WBC>10000/mm3)
or leukopenia (WBC<2000/mm3)
Blood culture : Should be done , don’t rely on it .
 3.Prevention and treatment of sepsis

prevention and treatment

1. Increase anti-infection ability.
Nutrition;improve the immunity

2. Treat the burn wound correctly.

Remove the focus of infection

3. Use antibiotics correctly.

enough amount and time

4. Sterilize and isolate strictly.

 4. Prevention and treatment of scars

*To prevent and treat the wound infection

*To keep joint in functional position
*To graft skins early in deep burn wound
*To reinforce function exercises
*To perform plastic operation if necessary
 Complications

1. Respiratory infection
& Acute failure of respiratory
2. Stress ulcer & Acute gastrectasis
3. Acute renal failure
4. Malnutrition
5.Bedsore
6. Shock
7. General infection
Wish u good luck!