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Burn and Wound Management PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "Burn and wound management" by C Balakrishnan, MD.

This medical PowerPoint presentation talks about Burn and wound management which involves the assessment, treatment, and ongoing care of injuries that affect the skin and underlying tissues. These injuries can range from minor cuts and scrapes to severe burns that require immediate medical attention.

Tags : wound healing, Burn management, management of wound, Emergency Medicine, Emergency Medicine PowerPOint presentation

Published on : Apr 12, 2023 | Views : 1422 | Downloads : 2

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Slide 1-

Burn and wound management C Balakrishnan, MD Associate Professor Division of Plastic Surgery Wayne State University Detroit, Michigan, USA
Slide 2-

Burn care and Wound care No financial interest Aim: Principles of Wound care principles, Burn care and Reconstruction and rehabilitation following burn injuries
Slide 3-

Burn care and Wound care Burn care and wound care – what is in common? Skin is the largest organ in the body Local and systemic changes are best studied for burns American Burn Association, Am Academy of Wound management, American College of certified Wound specialists (CWS, FCCWS)
Slide 4-

MOHC 2012, Grand Rapids, Michigan Types of wounds Acute wounds: Acute thermal injuries (Burns, Frostbite) Traumatic injuries Chronic wounds: Pressure sores Radiation injuries
Slide 5-

MOHC 2012, Grand Rapids, Michigan Burns
Slide 6-

MOHC 2012, Grand Rapids, Michigan Cold injuries Frost bite Trench feet
Slide 7-

MOHC 2012, Grand Rapids, Michigan American Burn Association criteria for transfer to Burn unit Major burns Burns associated with inhalation injury Burns of specific areas of the body – face, hand, feet, perineum Chemical injuries Electrical injuries
Slide 8-

MOHC 2012, Grand Rapids, Michigan Etiology of Burns Causes : Flame - damage from superheated, oxidized air Scald - damage from contact with hot liquids Contact - damage from contact with hot or cold solid materials Chemicals - contact with noxious chemicals Electricity - conduction of electrical current through tissues
Slide 9-

MOHC 2012, Grand Rapids, Michigan Etiology of Burns Incidence of work related burn injuries – 26.4 per 10,000 workers (Islam et al J T 2000) Male – Construction and mechanical Women – Service industry
Slide 10-

MOHC 2012, Grand Rapids, Michigan Work force involved Welders Cooks Laborers Food service Mechanics Electrician Fire fighters
Slide 11-

MOHC 2012, Grand Rapids, Michigan Area involved Hand, wrist – hot liquid Eyes – chemical Face flame, hot liquid Contact burns Firefighters – face and posterior neck
Slide 12-

MOHC 2012, Grand Rapids, Michigan Etiology Age groups - Younger cooks and food service personnel Depth – 1.3 per 10,000 deep Associated trauma – Inhalation injury, Fractures, Crush injuries
Slide 13-

MOHC 2012, Grand Rapids, Michigan Psychological problems associated with work related Burn injuries Depression PTSD Anxiety disorders Workers with electrical injuries had higher psychological sequlae (19%) JBCR 2011
Slide 14-

MOHC 2012, Grand Rapids, Michigan Depth of injury First degree - Injury localized to the epidermis Superficial second degree - injury to the epidermis and superficial dermis Deep second degree - injury through the epidermis and deep into the dermis Third degree - full-thickness injury through the epidermis and dermis into subcutaneous fat Fourth degree - injury through the skin and subcutaneous fat into underlying muscle or bone
Slide 15-

MOHC 2012, Grand Rapids, Michigan Depth of burn
Slide 16-

MOHC 2012, Grand Rapids, Michigan Depth of injury Incineration Fourth degree
Slide 17-

MOHC 2012, Grand Rapids, Michigan Physiology of depth of injury Three zones: zone of coagulation zone of stasis zone of hyperemia This is similar for a pressure ulcer
Slide 18-

MOHC 2012, Grand Rapids, Michigan Aim of management To limit the injure to zone of coagulation To prevent injury to zone of stasis Management actually aims at preventing a second degree or first degree burn to becoming a deeperinjury
Slide 19-

MOHC 2012, Grand Rapids, Michigan Burn size Rule of nine Charts
Slide 20-

MOHC 2012, Grand Rapids, Michigan Chemical burns Hydrofluoric acid Phenol Phosphorus - Calcium gluconate - Ethylene glycol - Copper sulfate
Slide 21-

MOHC 2012, Grand Rapids, Michigan Chemical burns Phenol – chemical peel Cardiac toxicity Monitor EKG Ethylene glycol
Slide 22-

MOHC 2012, Grand Rapids, Michigan Electrical injuries
Slide 23-

MOHC 2012, Grand Rapids, Michigan Electrical injuries Muscle injury without skin damage Myoglobinuria – treat to prevent renal failure Cardiac arrhythmia Tetany, rupture of tendons Neurological deficit Saliva good conductor of electricity
Slide 24-

MOHC 2012, Grand Rapids, Michigan Electrical Injuries Impaired attention span Memory problems (especially for short-term anterograde verbal information Persistent distress and frustration Mood disorders - often characterized by psychosocial difficulty and violent behavioral outbursts, accompanied by a background of generalized depression
Slide 25-

MOHC 2012, Grand Rapids, Michigan Electrical injuries Survivors of severe electrical injury have been noted to exhibit abnormal neuropsychologic findings several years after trauma. Late evaluation of patients with significant electrical injury has suggested a common constellation of symptoms involving both cognitive and affective disturbances.
Slide 26-

MOHC 2012, Grand Rapids, Michigan Systemic response to Burns Inflammation and edema Altered hemodynamics Immunosuppression Hyper metabolism Decreased renal flow Increased gut mucosal permeability
Slide 27-

MOHC 2012, Grand Rapids, Michigan Principles of management Burn Resuscitation Early management Wound care Surgical management Management of complications Management of Psychosocial issues
Slide 28-

MOHC 2012, Grand Rapids, Michigan Parkland formula Parkland 4 ml/kg per % TBSA burn Total fluid =4 x body wt x BSA ½ of which is given in first 8 hours from the point of injury Next half is given in the next 16 hours
Slide 29-

MOHC 2012, Grand Rapids, Michigan Wound management Escharotomy Excision Skin grafts Flaps Others
Slide 30-

MOHC 2012, Grand Rapids, Michigan Escharotomy Indications - Improve circulation
Slide 31-

MOHC 2012, Grand Rapids, Michigan Fasciotomy
Slide 32-

MOHC 2012, Grand Rapids, Michigan Wound care Silver sulfadiazine Mefenate acetate Silver dressings
Slide 33-

MOHC 2012, Grand Rapids, Michigan Wound care Biological dressings Allograft (cadaver skin) Xenograft Placental membrane Bilayered Cultured epidermal cells
Slide 34-

MOHC 2012, Grand Rapids, Michigan Wound healing Principles Burn wounds are potentially contaminated and needs debridement. Clean wound with out coagulum heals faster. Epithlialization occurs from the cells remaining in the dermis.
Slide 35-

MOHC 2012, Grand Rapids, Michigan Wound therapy Management of burn wounds can be divided into three stages: assessment, management, rehabilitation. Rehabilitation starts early in management Positioning and splinting Stretching of joints
Slide 36-

MOHC 2012, Grand Rapids, Michigan Surgical management Primary excision Early excision Excision with Skin grafting Excision with allograft Excision with skin substitutes Excision – Integra – Skin grafting Excision with flap coverage
Slide 37-

MOHC 2012, Grand Rapids, Michigan Surgical management Immediate excision Primary excision Early excision Delayed excision
Slide 38-

MOHC 2012, Grand Rapids, Michigan Excision and grafting of the Burn wound Early excision vs delayed
Slide 39-

MOHC 2012, Grand Rapids, Michigan Outcome in Burns Early, aggressive resuscitation regimens including early excision and wound coverage have improved survival rates dramatically. By decrease in Sepsis and Multi organ failure
Slide 40-

MOHC 2012, Grand Rapids, Michigan Outcome Hypertrophic scar Burn contractures Amputations
Slide 41-

MOHC 2012, Grand Rapids, Michigan Prevention of contractures!!!! Think neck and chest are a single unit when it comes to contracture Hand splints Position elbows and axilla Knee brace Prevent foot drop
Slide 42-

MOHC 2012, Grand Rapids, Michigan Pressure garments Pressure garments appear to help in : reduce scar thickness/lumpiness reduce scar redness reduce swelling relieve itching protect newly healed skin/graft prevent contractures/ maintain contours
Slide 43-

MOHC 2012, Grand Rapids, Michigan Silicone gel sheets The exact mechanism of action of silicone in the prevention and management of hypertrophic scars is unclear. Influences the collagen remodeling phase of wound healing Soften, flatten and blanch the scar, making it comfortable and improves appearance
Slide 44-

MOHC 2012, Grand Rapids, Michigan Custom Compression Garments 25 mm of Hg Constant use Clear masks for face
Slide 45-

MOHC 2012, Grand Rapids, Michigan Management of contractures Serial casting Surgical release Post operative splinting
Slide 46-

MOHC 2012, Grand Rapids, Michigan Lip deformity secondary to neck contracture
Slide 47-

MOHC 2012, Grand Rapids, Michigan Complications of Hand Burns Burn associated neuropathy Reflex sympathetic dystrophy Pain syndrome Amputations and loss of parts
Slide 48-

MOHC 2012, Grand Rapids, Michigan Hand burns - Principles Early excision and wound coverage Excision and skin grafting Flap coverage of exposed bones and joints
Slide 49-

MOHC 2012, Grand Rapids, Michigan Cross finger flap
Slide 50-

MOHC 2012, Grand Rapids, Michigan Radial forearm flap
Slide 51-

MOHC 2012, Grand Rapids, Michigan DISTANT FLAPS -Abdominal flap
Slide 52-

MOHC 2012, Grand Rapids, Michigan Abdominal flap
Slide 53-

MOHC 2012, Grand Rapids, Michigan Amputation of digits / Fusion DIPJs, PIPJs and possibly the middle phalanges. – Try to preserve length Both for toes as well as fingers. The thumb amputation deformity is treated either by pollicization or toe transfer.
Slide 54-

MOHC 2012, Grand Rapids, Michigan Primary amputation Electrical injuries Contact burns
Slide 55-

MOHC 2012, Grand Rapids, Michigan Complications of Hand Burns Loss of parts Adduction contracture
Slide 56-

MOHC 2012, Grand Rapids, Michigan Prevention of contracture by early excision and soft tissue coverage Soft tissue coverage of the knee joint following burns. Canadian Journal of Plastic Surgery 2006; 14:163.
Slide 57-

MOHC 2012, Grand Rapids, Michigan Elbow
Slide 58-

MOHC 2012, Grand Rapids, Michigan Elbow
Slide 59-

MOHC 2012, Grand Rapids, Michigan Elbow
Slide 60-

MOHC 2012, Grand Rapids, Michigan Axillary contracture
Slide 61-

MOHC 2012, Grand Rapids, Michigan Knee joint burns
Slide 62-

MOHC 2012, Grand Rapids, Michigan Knee joint burns
Slide 63-

MOHC 2012, Grand Rapids, Michigan Psychological problems associated with work related Burn injuries Depression PTSD Anxiety disorders Workers with electrical injuries had higher psychological problems (19%) JBCR 2011
Slide 64-

MOHC 2012, Grand Rapids, Michigan Occupational Burn injuries Preventable? Appropriate education Work place training PPE (Personal Protective equipment) Safe work place procedures
Slide 65-

MOHC 2012, Grand Rapids, Michigan Worker training Worker illness and Injury prevention programs Reporting all injuries First aids
Slide 66-

MOHC 2012, Grand Rapids, Michigan Back to work programs Can the worker return to previous occupation Is there any work place adjustments required Retraining
Slide 67-

MOHC 2012, Grand Rapids, Michigan Classification of Chronic wounds Pressure ulcers Vascular insufficiency Metabolic Infections Inflammatory disorders Hematologic Malignant Miscellaneous
Slide 68-

MOHC 2012, Grand Rapids, Michigan Pressure ulcers Decubitous ulcers Neuropathic ulcers Contributing factors include Pressure, Immobility, Shear, Moisture, Nutrition
Slide 69-

MOHC 2012, Grand Rapids, Michigan Etiology - nomenclature Pressure sore, decubitus ulcer, bedsore Unrelieved pressure, altered sensory perception, incontinence, exposure to moisture, altered activity and mobility, friction, and shear force.
Slide 70-

MOHC 2012, Grand Rapids, Michigan Staging and risk factors Pressure Ulcer Staging (depth & tissue type) Stage I Persistent redness (culturally sensitive) Stage II Partial thickness skin loss Stage III Full thickness skin loss (subcutaneous) Stage IV Full thickness skin loss (fascia) Norton scale: Physical condition, mental condition, activity, mobility, incontinence (score ≥ 12 is at risk) Norton scale: Activity, mobility, sensory perception, moisture, nutrition, friction, and shear
Slide 71-

MOHC 2012, Grand Rapids, Michigan Pressure ulcers
Slide 72-

MOHC 2012, Grand Rapids, Michigan Vascular insufficiency Acute vascular Chronic venous Artherosclerosis Lymphedema
Slide 73-

MOHC 2012, Grand Rapids, Michigan Fx pelvis – SP embolozation
Slide 74-

MOHC 2012, Grand Rapids, Michigan Lymphedema
Slide 75-

MOHC 2012, Grand Rapids, Michigan Metabolic Diabetes mellitus Gout
Slide 76-

MOHC 2012, Grand Rapids, Michigan Diabetes
Slide 77-

MOHC 2012, Grand Rapids, Michigan Infected wounds Bacterial Fungal Parasitic
Slide 78-

MOHC 2012, Grand Rapids, Michigan Bacterial infections Necrotizing fascitis
Slide 79-

MOHC 2012, Grand Rapids, Michigan Bacterial infection
Slide 80-

MOHC 2012, Grand Rapids, Michigan Inflammatory disorders Pyoderma gangrenosa Vasculitis Necrobiosis lipodica diabeticorum
Slide 81-

MOHC 2012, Grand Rapids, Michigan Hematologic disorders Sickle cell disease Polycythemia vera Hypercoagulable states
Slide 82-

MOHC 2012, Grand Rapids, Michigan Malignant ulcers Marjolin’s ulcers Primary cutaneous neoplasm Metastic Cutaneous neoplasm Kaposi’s sarcoma
Slide 83-

MOHC 2012, Grand Rapids, Michigan Radiation associated wounds Poor granulation Rule out Cancer ? Hyperbaric
Slide 84-

MOHC 2012, Grand Rapids, Michigan Radiation associated wounds Can develop Angiosarcoma Diagnosis by biopsy
Slide 85-

MOHC 2012, Grand Rapids, Michigan Toxic drug ulcers Extravasation injury Paint gun injuries
Slide 86-

MOHC 2012, Grand Rapids, Michigan Etiology of Chronic wounds Nutritional deficiency Tissue hypoxia Infection Metabolic Malignant change Immune compromise Mechanical factors
Slide 87-

MOHC 2012, Grand Rapids, Michigan Impaired wound healing – Intrinsic factors Ischemia Infection Foreign body Smoking Venous insufficiency Radiation fibrosis Repeated trauma Malignancy
Slide 88-

MOHC 2012, Grand Rapids, Michigan Impaired wound healing - Extrinsic Nutritional deficiency Diabetes mellitus Chronic renal sufficiency Steroids – reversed by Vit A Chemo Liver disease Old age Heredity
Slide 89-

MOHC 2012, Grand Rapids, Michigan Hyperbaric oxygen 2.5 atmospheres for 2 hours Tissue oxygen measured transcutanously. Oxygen tension of 30 mmHg required for normal cell division and wound healing. Optimal oxygen requirement for nonhealing wound is unknown. Reinisch suggested that the beneficial effect of hyperbaric oxygen is due to the vasoconstructive property of oxygen, which acts to close arteriovenous shunts and thus improves capillary circulation
Slide 90-

MOHC 2012, Grand Rapids, Michigan Categories of wound dressing Absorbents – to control drainage Impregnated dressings - Adaptic Transparent dressing- Opsite Foams Hydrogels – DuoDerm Gel Xerogels – Alginates, Sorbsan Hydrocolloids – Cutinova, DuoDerm Active dressing – hydrogel with antimicrobial VAC system – subatmospheric wound healing Biotherapy - maggots
Slide 91-

MOHC 2012, Grand Rapids, Michigan Fetal wound healing Contain few granulocytes Increased turn over of matrix Early gestation fetal skin heals by regeneration or growth rather than scaring. Extra cellular matrix rich in hyaluronic acid Low hyaluronidase activity and increased fibronectin production
Slide 92-

MOHC 2012, Grand Rapids, Michigan Fetal wound healing Highly organized collagen architecture TGF – induces acute inflammation and subsequent fibrosis in fetal wound Collagen type III increased
Slide 93-

MOHC 2012, Grand Rapids, Michigan Gene therapy Two methods: - Genetically engineered keratinocyte or fibroblast to over express growth factor genes - Transfer of DNA directly by gene gun or direct subcutaneous injection of DNA
Slide 94-

MOHC 2012, Grand Rapids, Michigan Transplantation Research to reality Partial vs total face Extremity
Slide 95-

MOHC 2012, Grand Rapids, Michigan Thank you