and other thermal injuries 烧伤课件

Burns and other thermal Injuries,Dr. Yonglin Li(李永林), MD Director, associate professor Department of Plastic Surgery and Burns First Affiliated Hospital Soochow University,Four Classes & 160 minutes,Introduction of Burn Injury,Burns: thermal injury/ chemical injury/ electrical injury/ laser or radiation burns, etc. Thermal injury: fire or flame/ hot or boiling water/ fluid/ stream (scalding)/ hot subjects/ hot grease, etc. Local skin or mucosal injury and tissue/ organs injuries (whole body),Types of Burns (III & four-Method),Superficial Burn (First Degree): red/dry/painful Partial-thickness Burns (Second Degree): Superficial deep red/white with blisters Full-thickness Burn (Third Degree): eschar,Superficial Burn (First Degree),度,red/dry/painful,Partial-thickness Burns (Second Degree),浅度,Superficial: red with blisters,Partial-thickness Burns (Second Degree):,深度,deep: red and white with blisters,Full-thickness Burn (Third Degree),度,eschar,Electrical Burn,Determination of Severity (I),The extent of burn estimated: 100%TBSA (total body surface area) 1% (plum method) rules of nines and tens (Wallaces) The depth of burn assessed: III degrees and four types Respiratory tract injury in burns (inhalation injury ): complicated or not,Determination of Severity (II),Minor burn injury: 30%(adults)/20%(children)TBSA 10%TBSA (III degree) with complications, such as Major burn injury: 50%(adults)/30%(children)TBSA 20%TBSA (III degree),Pathophysiology of Thermal Injury,Vascular permeability: increased Edema Loss of intravascular fluid and protein Circulating volume: decreased Hypoproteinemia Cell energy and membrane potential: Hemodynamic stability,Metabolic Response to Burns,Pain/ stress/ sepsis, etc. Mediators of inflammation, cytokines and endotoxin The evaporative water loss: Hypermetabolism: increased metabolic rate Nutritional support,Clinical Stages of Burn Patients,Fluid exudation (shock stage): 36-48 hours Infection stage: burn hematosepsis/ burn wound sepsis systemic infection Stage of wound repair: superficial degree burn deep degree burn Principles of burn management: QOL (quality of life),First-aid of Burn Patients,Leave away Airway Cooling Therapy: 10 water/ 30 mins Clean sheets Assessment and diagnosis Fluid resuscitation (an isotonic crystalloid salt solution: Lactated Ringers),Resuscitation of Hypovolemic Shock,Fluid therapy: (First 24 hours) Urine output maintained at: Monitoring: mental status/ peripheral circulation/ pulse/ urine volume/ blood pressure/ Central venous pressure/ Swan-Ganz catheters Postresuscitation period: renal failure/ pulmonary edema/ cerebral edema,Care of The Burn Wound,Superficial degree burn: Dressing Exposure Semiexposure Deep degree burn: Escharectomy Tangential excision Escharectomy Skin grafting,Superficial Partial-thickness Burn,Deep Partial-thickness Burn,Full-thickness Burn,Full-thickness Burn,Tragential Excision and Xenograft,Topical Agents in Clinic,Antibacterial agents Silver sulfadiazine (SD-Ag): 1-3% Mafenide: 10% solution Temporary skin substitutes Biological dressing: porcine xenografts Synthetic dressing (film) Artificial skin: tissue engineering,Debridement and Grafting,Debridement: Mechanical/ Chemical/ Surgical Grafting: Xenograft/ Allograft/ autologous Autologous skin grafting: Epidermal skin graft Intermediate split thickness skin graft Full- thickness skin graft Microskin grafting (Chinese, 1982),Escharectomy and autoskin graft,Management of Complications,Acute gastroduodenal (Curlings) ulcers Renal failure Respiratory/ cardiac /hepatic response Central nervous system MOSF Others: scars, etc.,Electrical Injury and Others,Electrical current injury Electrothermal burns: flash or arc burns Chemical injury: acids(HF, H2SO4, etc.) /bases Frostbile,Electrical Current Injury:,Electrothermal Burn:,Tangential excision,Chemical Injury(acids): HF, H2SO4,Chemical Injury (base): NaOH,Burns and Burn Surgery,Surgical subjects: burn surgery/ plastic surgery Burn-plastic-cosmetic surgery Chinese Society of Burn Surgery Chinese Society of Plastic Surgery Plastic Surgery and Burns (Jiangsu Province), Branch of Chinese Medical Association,Burn Surgery/ Plastic Surgery:,Skin graft(burn plastic surgery and cosmetics),Scars after burn injury,Skin flap,Scar contracture,Local skin flap (5-plasty),Free flap,Upper arm free flap,Microsurgery,Scars and blade,Neck and c