Burns and other thermal Injuries 烧伤.ppt

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) Partial-thickness Burns (Second Degree) Partial-thickness Burns (Second Degree): Full-thickness Burn (Third Degree) Determination of Severity (I) The extent of burn estimated: 100%TBSA (total body surface area) 1% (plum method) rules of nines and tens (Wallace’s) 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: 15%(adults)/10%(children)TBSA 2%TBSA (III degree) Moderate burn injury: 30%(adults)/20%(children)TBSA 10%TBSA (III degree) Severe 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: ↑increa