MANAGEMENT OF A BURNED CHILD

BURN – ASEPTIC NECROSIS OF TISSUES

A burn that has the potential for significant physiologic derangement, functional impairment, or cosmetic impairment is defined as a MAJOR BURN.

2 Million burn cases per year in USA.

Among 92000 burn cases from 133 burn centres 30000 were children 1-8 years.

• IN BANGLADESH : No national data on burn

• IN DSH : Separate 12 bed burn unit started in 1999

- More than 500 patients admitted per year

- Burned area 5 – 70%

- Hospital stay 4 – 154 days

- Average 19.3 days

Classification of Burn

First degree - Superficial burn

Partial thickness burn

Second degree - Deep dermal

Third degree - Full thickness burn

The Rule of Nines

9%

9X2%

9%9%

1%

9X2% 9X2%

9X2%

18%

9X2%

9%9%

1%

13.5%

9X2%

13.5%

ADULT CHILD

Several factors directly affect the prognosis following burn injury and determine whether there is a need for hospitalization. The most important factors include:

1. The location of the burn

2. The depth of the burn

3. The extent of the burn

4. The age of the patient

5. General physical condition

Whom to admit

1. Total body surface more than 10%

2. Full thickness burn more than 5%

3. Circumferential burns

4. Immersion burns

5. Electrical burns

6. Special areasA. Face B. Feet C. Hands D. Perineum

7. Suspicion of child abuse

8. Parents unable to cope.

Age Incidence

60%

25%

15%

Upto 2 years2 - 5 yearsMore than 5 years

Sex Incidence

56%44%

Male PatientsFemale Patients

Causes of Burn

17%

15%

49%

19%

Hot WaterHot SoapBurning ClothesOthers

Economic Status

Higher Income Group- 10%

Middle Income Group- 49%

Lower Income Group - 41%

Management of Burn

1. Management of shock

2. Management of infection

3. Nutritional support

4. Psychological support

Burn Wound Management1. Open method

2. Dressing:a) Vaseline gauze

b) Sofra Tulle

c) Deo Derm

d) Amniotic membranes

Tissue Banking

Procurement, processing, storage and distribution of amnions, bones, skin, fascia lata etc. for clinical use.

Amniotic Membranes

• Decrease bacterial count of the wound

• Reduction of fluid loss

• Promotion of healing

• Tight adherence to the wound surface, increase in mobility and diminished pain

• Patient comfort

• Help in prediction of readiness for grafting

Advantages

AMNION MEMBRANE SEPARATED FROM PLACENTAL SAC.

ACTIVITIES – QC, QS/QMS (PROCESSING STEPS etc.)

CLEAN WITH STERILE SALINE SOLUTION

SHAKEN IN PLATFORM SHAKER WITH STERILE SALINE

SOLN.FOR 4/5 TIMES UNTIL REMOVE ALL KIND OF CELLS

& MUSCELINIOUS SUBSTANCES.

ACTIVITIES – QC, QS/QMS (PROCESSING STEPS etc.)

CLEANED AMNION MEMBRANE SPREAD ON STERILE

SURGICAL GAUZE AND MOUNTED IN PLASTIC FRAME OR

FREEZE DRYING RACK.

ACTIVITIES – QC, QS/QMS (PROCESSING STEPS etc.)

AMNION MEMBRANE DRIED AT 400C IN CONTROLLED

TEMPERATURE DRIER/OVEN FOR 14-15 HOURS OR FREEZE

DRY (6-8 HRS.)

ACTIVITIES – QC, QS/QMS (PROCESSING STEPS etc.)

DRIED AMNION MEMBRANE CUT INTO SIZES (10X15 cm), TRIPLE PACKED WITH POLYTHENE POUCH & VACCUM SEALED UNDER LAMINAR FLOW CABINET.

ACTIVITIES – QC, QS/QMS (PROCESSING STEPS etc.)