BURNSالحروق

OBJECTIVES

By the end of this lecture, the students would be able to:

Identify the characteristics of superficial, partial-thickness, and full-thickness burns.

Calculate the extent of burns using the Rule of Nines.

Explain how to assess the severity of burns.

Describe appropriate burn management.

FUNCTIONS OF THE SKIN:

The most important function of the skin is to act as a barrier كمعيق .against infection يعمل

The skin prevents loss of body fluids, thus preventing dehydration الجفاف .

The skin regulates يضبط the body temperature by controlling the amount of evaporation تبخر of fluids from the sweat glands العرقية . الغدد

The skin serves a cosmetic effect جمالي تأثيرby giving the body shape.

 

When the skin is burned, these functions are impaired تتضرر or lost ت?فقد completely.

DEFINITION OF BURNS:

Burns are wounds caused by excessive exposure to four categories of agents:1. Thermal2. Electrical3. Chemical4. Radioactive

SEVERITY OF BURNS:

The severity of the skin injury depends upon:the burning agent, the size of the injury, depth of the wound, part of the body injured, temperature of the burning agent, and how long a person is in contact with the

agent.

PATHOPHYSIOLOGY OF BURNS:

Burns cause the capillaries in the damaged area to dilate, resulting in capillary hyper-permeability

نفاذية . زيادة The increased cell permeability causes the fluid

to move out of the cells into the surrounding tissues, resulting in edema and vesiculation (blistering)

مائية .فقاعات The larger the burned area, the greater the

fluid loss. The fluid loss from the intravascular area to

the interstitial areas poses the greatest threat to life, because the cells become dehydrated.

The blood pressure drops, and blood flow to the kidneys is decreased → hypovolemic shock.

CLASSIFICATION OF BURNS BY DEPTH

الدرجة حروق) متوسطة ) الثانية

الدرجة حروقاألولى

) سطحية)

الدرجة حروق) عميقة ) الثالثة

Involves only the epidermis

Involves all the epidermis and much of the dermis.

Involves the entire epidermis and entire dermis down to the deeper layers.

) سطحية ) األولى الدرجة First Degree Burnsحروق الخارجية الجلد طبقة تتعدى ال و سطحية حروق هي القشرة(. )و . c مؤلما يكون و بسيط تورم مع الجلد في احمرار هيئة على تظهر. الجلد التئام بسرعة الحروق من األولى الدرجة تتميز

الجلد على آثارا تترك سريع ال بشكل األولية اإلسعافات تقديم تم لم وإذافقاعات .تتكون

الشمس لحرارة الشديد التعرض أسبابها الساخنة من الطبخ أدوات مالمسة .و ) متوسطة ) الثانية الدرجة Second Degree Burnsحروق

العمق متوسطة حروق جزء ،هي و البشرة لطبقة يحصل الضرر الطبقة من و. ) الجلد ) من األدمة الداخلية

. شديدة آالم و احمرار و الجلد على الحرق حول المائية الفقاعات بظهور تتميز. والشفاء العالج بعد الجلد على آثار بترك تتميز عن الحرق مساحة ازدادت لم% 20إذا إن الشخص بحياة الحرق يودي فقد

. عالجه يتم. األبخرة و الساخنة للسوائل التعرض أسبابها من

) عميقة ) الثالثة الدرجة Third Degree Burnsحروق عميقة حروق هي و ،و األدمة و البشرة طبقتي لكامل يحصل والضرر

. ما طبقة من جزء يشمل قد و واألوعية العضالت األعصاب، تشملالحرق أن c أحيانا يالحظ بحيث األدمة للدهون، تحت وصل العضالت قد

. العظام و . وعليه، مؤلم غير الحرق مكان الوخز، يكون باختبار العمق اختبار يتم

يعتبر بألم شعر فإذا المريض يوخز أو الحرق حيث األولى الدرجة منبألم يشعر لم إذا أما ل فالثانية وذلك الثالثة الدرجة من نهايات أيعتبر ن

الحروق بسبب تخريبها تم قد زادت. األعصاب الحرق عمق زاد وكلما.خطورته

الجلد الحاالت أغلب في يكون و الجلد في األنسجة من جزء يتآكليم أحيانا و c ومتنفخا c شمعيا و c الحاالت، يمصفرا بعض في األسود للون ل

. الصدمة تحدث قد و. والتشوهات واإلعاقة الوفاة إلى تؤدي قد الحروق هذه. الكهربائية للصدمة أو للنار التعرض أسبابها من و

SUPERFICIAL BURN (1ST DEGREE BURN)

PARTIAL–THICKNESS BURN (2ND DEGREE BURN)

PARTIAL–THICKNESS BURN (2ND DEGREE BURN)

FULL-THICKNESS BURN (3RD DEGREE BURN)

FULL-THICKNESS BURN (3RD DEGREE BURN)

ASSESSMENT OF AREA OF BURN:

This is done using the "rule of nines" قاعدة. التسعات

The body is divided up into eleven areas, each representing 9% of the total body surface.Body Area Percentage of Burn

Head and Neck 9%Anterior Trunk

ال الجذع ماميةأمنطقة 18%

Posterior Trunkالخلفية الجذع منطقة

18%

Rt. Upper Extremity 9%Lt. Upper Extremity 9%Rt. Lower Extremity 18%Lt. Lower Extremity 18%Ext. Genitalia and Perineumالتناسلية االعضاء منطقةوالشرج

1%

ESTIMATING BURNS - RULE OF NINES

EMERGENCY CARE OF SUPERFICIAL BURN (1ST DEGREE BURN)

Cooling: If the skin is not broken, run cool water over

the burned area or soak it in a cool water bath. Keep the area in the bath for five (5) minutes. If the burn occurred in a cold environment, DO

NOT apply water. A clean, cold, wet towel will also help reduce

pain. Reassurance تطمين : Burns can be extremely

painful, reassure the victim and keep them calm. Sterilization تعقيم : After flushing or soaking

the burn for several minutes, cover the burn with a sterile non-adhesive bandage or clean cloth.

Protectionحماية : Protect the burn from friction and pressure.

Medicationsأدوية : Over-the-counter pain medications may be used to help relieve pain; they may also help reduce inflammation and swelling.

Follow-upمتابعة : Minor burns will usually heal without further treatment.

EMERGENCY CARE FOR SEVERE BURNS (2ND DEGREE AND 3RD DEGREE BURNS)

DO NOT remove burnt clothing (unless it comes off easily), but do ensure that the victim is not in contact with burning or smoldering materials مشتعلة مواد . أية

Make sure the victim is breathing. If breathing has stopped or the victim's airway is blocked then open the airway and if necessary begin CPR.

Cover the burn with a moist sterile bandage or clean cloth. DO NOT apply any ointments and avoid breaking blisters.

If fingers or toes have been burned, separate them with dry sterile, non-adhesive dressings.

Elevate the burned area and protect it from pressure or friction.

Take steps to prevent shock. Lay the victim flat and elevate the feet

about 12 inches.Cover the victim with a coat or blanket.

Continue to monitor the victim's vital signs (mainly: breathing, pulse, blood pressure).

EMERGENCY CARE OF ELECTRICAL BURNS INJURIES

Activate EMS, take standard precautions. Make certain that you and the victim are in a SAFE ZONE.

Do not touch vehicle if downed wire is touching it.متدلي كهرباء سلك تالمس كانت إذا السيارة تلمس ال

Instruct victim to jump from the vehicle if it catches fire. اشتعلت حال في السيارة من يقفز أن المصاب أخبر

Ensure electrical equipment is unplugged.الحرق سبب الذي الكهرباء جهاز عن الكهرباء سلك أزل

Shut down power if victim is found in a pool.ماء بركة في واقع المصاب كان إن الرئيسي المقبس من الكهرباء أطفئ

If electrical item is in a bath tub with victim, unplug device before reaching for victim.

أزل االستحمام، حوض في المصاب مع الحرق سبب الذي الجهاز كان إذاالمصاب مساعدة قبل الجدار في الكهرباء نقطة من الجهاز كهرباء سلك

Provide basic cardiac life support as required. Care for shock and administer high–

concentration oxygen if available. Care for spine injuries, head injuries and

severe fractures (the victim may have been thrown by a high–voltage current).

Evaluate electrical burns. Cool the burn areas and smoldering clothing

the same as you would for a flame burn. Apply dry dressing to the burn sites. Transport as soon as possible.

EMERGENCY CARE OF CHEMICAL BURNS INJURIES

Difficult to assess depth and severity Chemicals continue to burn as long as in

contact with body Chemical burns are critical; treat

immediately.

Activate EMS, take standard precautions. Brush dry powder from skin, then flush with

water for at least 20 minutes (or until EMS arrives).Brush off all powder prior to flushing.Remove clothing, shoes, stockings, and

jewelry.Use soap and water if possible after

irrigation.When finished flushing, cover burned area

with dry sterile dressing.

GUIDE TO BURN MANAGEMENT BASED ON SEVERITY AS DETERMINED BY TOTAL BODY SURFACE AREA (TBSA) THAT HAS BEEN BURNED

Burns can be classified according to the total body surface area (TBSA) that is involved:Minor Burns involve 10% TBSA or lessModerate Burns involve 11% to 20% of

TBSAMajor Burns involve 20% to 60% of TBSASevere Burns involve > 60% of TBSA

BURNS SUITABLE FOR OUTPATIENT MANAGEMENT

No significant co-morbidities مصاحبة أمراضand:Partial thickness burns covering <10% of

total body surface area in adultsPartial thickness burns covering <5% of

body surface area in childrenFull thickness burns covering <1% of body

surface

WHEN THE VICTIM IS REFERRED TO THE BURNS UNIT?

الحروق لوحدة المصاب تحويل يتم متى

Partial thickness burns >10% TBSA, full thickness >5% total body surface area.

Partial/full thickness burns in children >5% TBSA. Priority areas are involved, i.e. face/neck, hands,

feet, perineum, genitalia تناسلية and major , أعضاءjoints.

Burns caused by chemical or electricity, including lightning ) البرق ) نتيجة كهربائية .صاعقة

Any circumferential محيطي burn. Burns with concomitant trauma مصاحبة or إصابات

preexisting medical conditions باطنية سابقة . أمراض Burns with associated inhalation injury استنشاق .إصابة Pregnancy with cutaneous burns.