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Burns injury
In a burn, there is local response with progressive tissue loss and release of inflammatory cytokines
– Loss of capillary membrane integrity leads to fluid leading into interstitial space, leading to hypovolaemic shock
– There is increased risk of bacterial infections (S. Aureus), acute peptic stress ulcers and lung injury
Before treating the burn, it is essential to measure the extent and depth of the burn
Extent – Measured by Wallace’s Rule of Nines, divided body into 11 sections each measuring 9% surface area
– Used to generate burn measurement quantified by the total body surface area (TBSA)
Depth – This is measured by the depth it penetrates through the dermis
– 1st degree –> this is confined to the epidermis and is likely to be red and tender
– 2nd degree –>This is where the burn penetrates the dermis layer giving blisters and reducing feeling
– 3rd degree –> This is where the burn penetrates the full thickness of the skin. It will appear brown/black
Management – Perform first aid (Airway, breathing, circulation)
i) Immediate fluid resuscitation using Hartman’s solution if TBSA >15% – Uses the Parkland formula:
– Total fluid in 24 hours = 4ml x total burn surface area (%) x body weight (kg)
– 50% given in first 8 hours, and 50% given in next 16 hours
– Give fluids till urine output 0.5-1ml/kg/hr (insert urinary catheter)
ii) Maintenance fluids – After 24 hours, colloid infusion at 0.5ml x total burn surface area (%) x body weight (kg)
– Crystalloid (dextrose-saline) at 1.5ml x total burn surface area (%) x body weight (kg)
iii) Refer to hospital if: 2nd/3rd degree burn, deep dermal burns>5% TBSA (adults), electrical/chemical burn
Pressure Sores
These are wounds that develop when continuous pressure or friction damages the skin
– Constant pressure reduces normal blood flow, so cells die, and skin breaks down
– They develop in patients who are unable to move parts of their body
Risk factors: Immobility (bed-ridden or after surgery), poorly nourished, incontinent
Appearance – Painful ulcers over bony prominences, sacrum, hips, heels, elbows
Management – Waterlow Score is used to screen for patients at risk of pressure sores
– Keep the wound moisturised –> Avoid using soap and use hydrocolloid dressing
– Turning the patient over and encouraging them to move
Sebaceous Cysts
This is an umbrella terms which describes either epidermoid cysts or pilar cysts.
– Both are cavities of keratin, not sebum and neither originates from sebaceous glands.
a) Epidermoid Cyst – a proliferation of epidermal cells within the dermis
b) Pilar Cyst – keratin filled cyst which originate from the sheath of hair follicles
Cause: High levels of testosterone, anabolic steroids, idiopathic
Appearance
– Mobile masses usually seen on scalp, back and upper arm
– The centre of the lump can have a punctum
– Smooth and mobile lumps containing fluid or keratin with bad smell
– Can get infected and become red, painful and ooze material
Management
– Oral antibiotics if infected and then surgical removal of whole sac (else will recur)
Lipoma
This is a benign proliferation of adipocytes, occurring in age group (more in adults). They are asymptomatic but they cause pressure on other structures
Appearance
– Smooth, mobile, non-tender lump, mostly subcutaneous
– Usually found on the arms, back of neck, torso and the thighs
Management
– Most need no treatment, except surgical excision if symptomatic
– If they start to change size, are painful or situated deeper in tissue, remove due to risk of becoming malignant (liposarcoma).
