Burn wound / Stevens-Johnson

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Burn
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classification:

1st degree
-involves epidermis
-red, painful, dry
-blanch with pressure

2nd degree
-involves epidermis + dermis
-red, painful, wet
- (+-)blisters
-blanches with pressure

3rd degree
-involves epidermis + dermis + skin appendages
-white/black, insensate, dry
-does not blanch with pressure

4th degree
-involves epidermis + dermis + skin appendages + subcutaneous tissue / tendon / bone
-white/black, insensate, dry
-does not blanch with pressure

{mem tip:
pain / blanch/ colour / dry-wet

p b c d
}

indication for admission:
-partial-thickness burns of >10% TBSA;
-face, hands, feet, genitalia, perineum, or major joints;
-electrical burns, including lightning injury;
-chemical burns;
-inhalation injury;
-burn injury in patients with pre-existing medical disorders

Rx:

topical antibiotic prophylaxis
(Silver is an excellent antiseptic and is used in burn wound care
The silver helps to prevent infection and remains active for 3 to 4 days, allowing less frequent dressing changes.)

tetanus immunisation

morphine 10 to 30 mg orally every 3-4 hours when required

Fluid resuscitation:

If burns involve >15% of the body surface, loss of capillary integrity becomes significant, requirng fluid resuscitation.
Parkland formula is often used and suggests 4 mL/kg/% burn over the first 24 hours, half in the first 8 hours, generally as lactated

Ringer's solution. Capillary integrity is typically restored at approximately 24 hours.
(Young children should receive 5% dextrose in lactated Ringer's solution (D5LR) at a maintenance rate to ensure that they do not

develop hypoglycaemia.)

infected wound -> debridement + antibiotic

circumferential burns -> escharotomy

Nutrition / physio / occupational therapy


[dose: midazolam : 0.04 mg/kg IVI
morphine: 0.1 mg/kg IVI]

{Burn description 간략히

-깊이
-넓이
-어디
-EIC (에 이 씨) - electrical ( myoglobin inc -> renal impairment, hyperkalemia -> arrhythmia),  inhalational burn, chemical // open fire,

boiling water...
}

{Burn Rx 간략히

-Fluid
-Analgesic
-Antibiotic

-Dressing (Silver dressing)
-escharotomy
}

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Steven-Johnson syndrome
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Rx:

Stop offending agent ( common causative agent: sulfonamide (bactrim), NSAIDS (therefore NSAIDs should not be used for analgesic

unless other medicines, such as opioids or paracetamol, do not work), corticosteroids, etc)

ABC (airway edema -> obstruction)

Dressing (silver dressing (e.g. silver sulfadizine) )

Analgesic (avoid NSAIDs)

Fluid (Parkland formula)

Nutrition / physio / occupational therapy

morphine sulphate : children: 0.1 mg/kg orally/intravenously every 2-4 hours when required, maximum 15 mg/kg;
adults: 7.5-10 mg orally/intravenously every 4 hours when required


adjunct:

1) glucocorticoids

advese effect: may increase risk of infection - infection is the main reason for mortality
use: it can be used in - Adults with burn (%) less than 30 %. Don't use in paed pt, or burn > 30 %.
prednisone 2 mg/kg/day not more than 7 days ( or equivalent amount of prednisolone or methylprednisolone )

2) IV immunoglobulin