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WOUNDS Congenital Cutis aplasia congenita This is a rare condition characterised by the congenital absence of epidermis, dermis and, in some cases, subcutaneous tissues, with underlying bony defects in 20%. Treatment depends on the severity of the presentati...

ADDITIONAL ASPECTS OF TREATING THE BURNED PATIENT Analgesia Acute Analgesia is a vital part of burns management. Small burns, especially superficial burns, respond well to simple oral anal gesia, paracetamol and non-steroidal anti-inflammatory drugs. Topical co...

ADDITIONAL ASPECTS OF TREATING THE BURNED PATIENT Analgesia Acute Analgesia is a vital part of burns management. Small burns, especially superficial burns, respond well to simple oral anal gesia, paracetamol and non-steroidal anti-inflammatory drugs. Topical co...

ADDITIONAL ASPECTS OF TREATING THE BURNED PATIENT Analgesia Acute Analgesia is a vital part of burns management. Small burns, especially superficial burns, respond well to simple oral anal gesia, paracetamol and non-steroidal anti-inflammatory drugs. Topical co...

ASSESSMENT OF THE BURN WOUND Assessing size The defining feature of any burn referral and usually the first question to seek clarification is ‘What is the size of the burn?’ From this simple question the burn team can establish the correct method of transfer a...

Breathing Inhalational injury Time is a major factor; anyone trapped in a fire for more than a couple of minutes must be observed for signs of smoke inhalation. Other signs that raise suspicion are the presence of soot in the nose and the oropharynx and a che...

Burn prevention Legislation, health promotion and appliance design have reduced the incidence of burns: regulations regarding flame-retardant clothes and furniture; the promotion of smoke alarms; the design of cookers and gas fires; the almost universal use ...

Burn size calculation: children The body proportions of children necessitate adjustment of the above-mentioned scales. An infant’s head is proportionally larger than an adult’s and this adjustment is represented on the modified Lund and Browder chart for child...

Changes to the intestine The inflammatory stimulus and shock can cause microvascular damage and ischaemia to the gut mucosa. This reduces gut motility and can prevent the absorption of food. Failure of enteral feeding in a patient with a large burn is a life-th...

Chemical injuries There are over 70 /uni00A0 000 di ff erent chemicals in regular use within industry . Occasionally , these cause burns. Ultimately , there destruction of the skin and the second is any poisoning caused by systemic absorption. The initial mana...

Cold injuries Cold injuries are principally divided into two types: acute cold injuries from industrial accidents and frostbite. Exposure to liquid petroleum gas (LPG), liquid nitro - gen and other such liquids will cause epidermal and dermal destruction. The ...

Colloid resuscitation The most commonly used colloid is human albumin solution. Plasma proteins are responsible for inward oncotic pressure that counteracts the outward capillary hydrostatic pressure. Albumin should be preferably administered after the first 12...

Crystalloid resuscitation Hartmann’s solution or Ringer’s lactate is the most commonly used crystalloid as it most closely replicates the osmolality of plasma. It is considerably less expensive than colloid and can maintain intravascular volume. The modified Pa...

Danger to peripheral circulation In full-thickness burns, the collagen fibres are coagulated. The normal elasticity of the skin is lost. A circumferential full- thickness burn to a limb acts as a tourniquet as the limb swells. If untreated, this will progress...

Delayed reconstruction and scar management Delayed reconstruction of burn injuries is common for large full-thickness burns. These techniques were pioneered by McIndoe and Gillies. In the early healing period, acute contractures around the eye need particular...

Energy balance and nutrition Any adult with a burn greater than 15% (10% in children) of TBSA has an increased nutritional requirement. All patients with burns of 20% of TBSA or greater should receive a nasogastric or nasojejunal tube and feeding should star...

Escharotomy Circumferential full-thickness burns to the limbs and torso require emergency surgery . The burn has a tourniquet-like e ff ect compromising respiration (torso) and peripheral circu lation (limbs). The tourniquet e ff ect of this injury is treated b...

FLUID RESUSCITATION As the understanding of ‘fluid shifts’ developed, the intro - duction of fluid resuscitation guidelines greatly improved the survival rates for patients with large burns. Standard guidelines and formulae are taught to emergency department a...