Basic Assessment and Management of the Burns

In this webinar, Dr. Zeshaan Maan discusses the basic approach to manage a patient with burns.

He discusses the basic structure of the skin, the largest organ in the human body. 

Skin consists of an epidermal layer and a dermal layer. It also contains structures like hair follicles, sweat, and sebaceous glands. These structures reside in the deepest part of the dermis along with the blood vessels and the nerve endings. These are part of the invaginations of the epidermis in the dermis. Proliferating epithelium and the keratinocytes are present here as well. These cells, in turn, are essential to resurface the injured areas of the skin.

Skin provides a barrier function to help protect the body from the pathogens outside. It also prevents the loss of fluids from the internal environment of the body.

After discussing the normal structures and functions of the skin, Dr. Maan discusses the pathophysiology of the burns and various zones that form in burn injuries. 

He discusses zones of:

1. Coagulation
2. Stasis
3. Hyperemia

Following the pathophysiology, he discusses the method to measure the total body surface area of the burn.

Cardiovascular system instability, fluid loss, vasoconstriction, and myocardial contractility reduction due to the tumor necrosis factor alpha is discussed.

Respiratory changes, for example, adult respiratory distress syndrome and metabolic changes like increased metabolic rate and splanchnic hypoperfusion are discussed.

Following this discussion, the classification of the burns is presented.

Burns are classified as:

1. Superficial
2. Superficial partial thickness
3. Deep partial thickness
4. Full thickness

A discussion of the possible outcome, healing process, and the scar formation in various classes are discussed.

A rigorous discussion of the calculation of the percent total body surface area (TBSA) burnt is presented. Palmer method and the rules of 9 method are discussed.

Classification of burns based on the causative agent is discussed next. Following important types are presented:

1. Thermal
2. Chemical
3. Electrical

Management Approach

1. First Aid
   1. Removal of the hot, burnt, or chemical infused clothing
   2. Cooling or irrigation of the burnt area
   3. Maintenance of the patient's body temperature
   4. Understanding that the trauma is an important factor to consider in a burns' patient. In fact, in the ATLS protocol, the burns are considered a distracting injury.
2. ATLS Protocol
   1. The airway is to be secured
   2. Consider the edema/swelling of the upper airway.
   3. Breathing and ventilation managed
   4. Circulatory system management. 
   5. Consideration for the escherotomy
   6. ETc.

Following management techniques are discussed in detail:

1. Parkland formula for the burns' management is discussed.
2. Topical applications of various creams, drugs, and grafts, etc. are discussed.
3. Surgical approach to the management is discussed in depth.
4. Split thickness skin grafting is discussed next.
5. Donor site choices, considerations, and limitations are discussed.
6. More modern approaches such as sprayed skin, cell culture to form skin, etc. are discussed.

A question-answer session is conducted at the end.

Part 2 of this Q&A will be published next.