Things You Need to Know in Surgical Dept1

9. Burn resuscitation (i) Pathophysiology of burn

(ii) Burn classification

‐ According to Lund and Browder

‐ According to depth (degree) I superficial  – epidermis: only erythema, no blister, heal in 3‐4

days IIA superficial  partial thickness – involved papillary dermis:

red warm, oedematous, blistered, sensory intact, heal less than 2 weeks IIB deep partial thickness – involved reticular dermis: damage

dermal appendages, sweat gland, nerves, hair follicles, heal at least 3 weeks III full thickness – burn involved all layers of skin and some

subcutaneous tissue initially painless in sensate dry surface that appear white crack with exposed underlying fat

Zone of coagulation: irreversible tissue loss (necrosis) Zone of stasis: reduced tissue perfusion, potentially salvageable tissue (loss of tissue in this zone can lead to wound deepening and widening) Zone of hyperaemia: increased tissue perfusion,

IV  full thickness with involvement of fascia, muscles, and

bones

‐ According to the surface area: Small area – rules of palm (1% patient’s palm SA) Large area – rules of nine

most likely recover tissue unless untreated severe sepsis and prolonged hypotension

Systemic response developed once the burn reaches 30% of TBSA, as a result of cytokines and other inflammatory mediators 

CVS

(i)

increased capillary permeability leads to

(ii)

(iii) Fluid resuscitation IV fluid in excess of maintenance is given to all patient with

loss of intravascular protein and fluid into

burn >20% body surface area using Parkland formula for

interstitial compartment

reducing the occurrence of burn‐induced shock

peripheral and organ vasoconstriction

Choice of solution = Ringer lactate/HM (crystalloid)

caused by TNF   myocardial contractility  systemic hypotension and organ

hypoperfusion 

Respi – bronchoconstriction  ALI



Metabolic – BMR 3, catabolism



Immune – down‐regulating

Parkland Formula = 4  BW  BSA % . *First half to be given in first 8hrs after injury *Second half to be given in next 16hrs after injury st

*Colloid should not be used in 1 24hrs post burn because it may lead to severe pulmonary complication (ARDS) due to excessive capillary leakage