00:01
Management of burns if
you get in the exam,
it is no different to management
of a normal trauma patient.
00:07
Exactly the same principles
apart from couple of
things you need to add.
00:11
In the breathing,
and ventilation, you need to add
carboxyhemoglobin and escharotomy.
00:18
What's the difference between
escharotomy and fasciotomy?
Yeah, you right.
00:26
So what is the difference in
the incisions, for example?
So what if you have
a burn to the bone?
Burn yeah, so the depth is does not
create difference between the two
In fasciotomy,
you are going from the skin
all the way up to the fascia,
at least in the fascia,
In the burn,
it depends on the depth of the burn.
01:03
Usually,
you do for a full thickness burn
and you incise to
fresh bleeding tissue.
01:11
So that might be
in the deep dermis,
it might be the hypodermis,
it might be in the deep fascia,
muscle or even the bone.
01:19
So their depth is depending
on the depth of the burn.
01:23
The anatomical difference is,
for escharotomy, you make your
incisions along the axial lines,
pre axial and post axial
lines for escharotomy.
01:33
For fasciotomy is
a different line.
01:35
So just for lower
limb fasciotomy,
you make two incisions here,
2 cm in behind the medial
malleolus or behind the TBI here
and 2 cm behind anterior
border of the tibia.
01:47
So those are for you fasciotomy.
01:49
Okay, so escharotomy is
pretty much only for burns.
01:54
And deep burns.
01:56
Okay.
01:58
So A, B, C, D, E, fluid resuscitation,
specialist help, investigations,
then these standard things.
02:22
Anything you want
to ask in this?
I'll come to the rule of nine's
in the next couple of slides.
02:44
Yeah.
02:47
Okay.
02:50
Do you have a scenario or a
question on what dressing you apply?
Always go for cling film
before we transfer the patient.
02:56
For the exam,
make sure that don't mention
(inaudible)
or any of those the exam
Go for cling film,
that's what they expect you to answer.
03:08
Okay size of burns.
03:09
It affects the treatment
and predicts mortality.
03:13
This is what he said, JP,
palm of the hand is 1%
including the fingers
of the patient.
03:20
Okay, that's 1%.
03:22
Rule of nines is that 1%,
so 9 times in the hand,
in the leg is 18 times.
03:32
So this is all you
need to remember.
03:35
Just as a rough percentage.
03:37
They will never ask you to
estimate the accurate depth,
the total body
surface for the exam.
03:45
They'll just expected
no rough approximately
whether you are able
to calculate it.
03:49
So just remember
the rule of nines.
03:52
Rule of nines will apply
to an adult or to a child
more than 12 years old.
04:00
If they are less than 12,
the body proportion
is different.
04:04
For example in an adult
the head is nine percent,
but in the child is up to 18%.
04:11
In an adult, the leg is for 18%.
04:14
But in a child,
it's much smaller 14%.
04:17
Okay?
All you need to
remember for the exam is
this applies only for adults
and more on 12 years old.
04:25
For less than 12,
is a different formula,
which is called the
Lund and Browder chart.
04:32
Okay?
Lund and Browder chart is a
standard method in assessing burns.
04:38
In the burns,
we use the Lund and Browder chart,
because this is
much more accurate
than rule than rule of nines.
04:48
For the purpose of re-exam,
in any department rule of nines,
burns you need Lund and Browder.
04:56
Okay, you don't have
to know why it is,
but it is much more accurate
in estimating the burn.
05:02
Depth above the burns
affects of treatment,
predicts healing
time and scarring.
05:08
Now, be careful of this.
05:11
This is only depth they
will give you on the exam,
this is what you need to know.
05:15
Never get confused by
reading any American books
about first-degree,
second-degree, third degree.
05:19
They will never ask you
I never mentioned it.
05:21
It's always partial thickness,
full thickness or superficial.
05:26
So in the skin,
the epidermis is 5%
of the skin thickness
and the dermis is 95%.
05:35
So that part is superficial.
05:39
That's epidermal
burned or superficial.
05:42
Then this part is called
the papillary dermis.
05:44
This part is called
a reticular dermis.
05:47
So that papillary dermis
is superficial dermal
or also called superficial
partial thickness.
05:56
This is reticular dermis,
deep dermal or deep
partial thickness
or anything beyond
that is full thickness.
06:06
Okay,
why is it important to know?
Because for giving any scenario on
burns what they will ask you is,
what burn is this?
Superficial.
06:16
It might be either a sunburn,
it's not even a superficial burn.
06:20
It may be just a sunburn or
going into the superficial burn
or a epidermal burns.
06:24
So, this is probably
the earliest burn.
06:27
This one?
Partial thickness.
06:30
Why do you say
partial thickness?
Very good.
06:34
So superficial partial
thickness not deep,
because in deep partial thickness,
you don't get the redness
or unlikely to get blisters.
06:42
So if you have any
scenario on redness,
blisters,
superficial partial thickness.
06:47
This says, more of superficial
partial thickness areas here,
but here is becoming
more deeper.
06:56
A bit more deeper.
07:00
And well, pretty much deep
dermal to full thickness.
07:03
You're right full thickness,
you really see it scar.
07:06
Yeah, I agree with you.
07:07
This is more of deep
to full thickness.
07:10
This is again deep
dermal to full thickness.
07:13
Okay.
07:15
So in this, what is what?
Epidermal, superficial,
blisters, characteristic
features, superficial dermal,
white non-blanching skin,
those characteristic
spot for deep dermal
and that is full thickness.
07:38
So in the exam,
if they give you a burn
with blisters,
go for superficial dermal,
also called superficial
partial thickness.
07:54
Deep partial thickness.
07:56
Yeah, deep partial thickness
because the full
thickness they want to,
the anatomy definition
is hypodermis.
08:04
It has to involve the full
layer of the epidermis,
full layer of the dermis,
then you go beyond
that is full thickness.
08:12
So, hypodermis, fat,
muscle, fascia, bone,
are all full thickness.