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8, Kennett Road Madurai, Tamil Nadu, India

Burns Centre

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Apply safety regulations to housing designs and materials, and encourage home inspections.

ABLS Centre

  • The Advanced Burns Life Support Centre (ABLS) at Grace Kennett Foundation Hospital is a well-established facility, equipped with modern technology and located in a convenient area for easy accessibility.
  • Our team of medical professionals is highly skilled, caring, and dedicated to providing comprehensive burns care services that cover preventive, promotive, curative, and rehabilitative aspects.
  • Having operated successfully for over three decades, we have treated an average of 300 patients annually, with an average bed occupancy of four patients per day.
  • Our patient population comprises both accidental and suicidal burns victims, reflecting the socioeconomic conditions prevalent in our region.
  • Our ABLS Centre occupies a dedicated floor, complete with ten beds, separate cubicles, a burns bath unit, a burns operation theatre, ventilators, dialysis units, and other essential life-saving equipment.
  • We have a competent and compassionate human resource team consisting of doctors, nurses, and other paramedical staff, all committed to providing the best possible care for our patients.
  • Learn to use a fire extinguisher.
  • Keep a working fire extinguisher in your home. *Place it high on a wall near an exit. Learn how to use the device properly.
  • Teach children to stop, drop and roll.
  • Teach children what to do if their clothes catch on fire.
  • Stop immediately and don’t run; drop to the floor and cover the face with hands; and roll on the floor to put out flames.
  • Practice an evacuation plan.
  • Create an evacuation plan and practice it every six months.
  • Determine two ways to exit each room and where to meet outside.
  • Determine two ways to exit each room and where to meet outside.
  • Don’t use lockable doorknobs on a child’s bedroom.
  • Teach your children to leave a smoky area by crawling on the floor.
Burns & Trauma Care Unit
Burns Ward
Skin Graft Mesher

Our Team

Dr Dodd

Medical Director

Dr A Mohammed Imran Khan

Plastic Surgeon

Magnitude

  • Burns pose a significant global public health challenge, with an estimated 180,000 deaths occurring every year.
  • The majority of these fatalities happen in low- and middle-income countries, particularly in the WHO African and South-East Asia regions. In high-income countries, burn-related deaths have been decreasing, and child mortality rates from burns are more than seven times higher in low- and middle-income countries compared to high-income countries.
  • Non-fatal burns are a leading cause of prolonged hospitalization, disfigurement, and disability, often accompanied by social stigmatization and rejection. Burns are also a leading cause of disability-adjusted life-years (DALYs) lost in low- and middle-income countries. In 2004 alone, approximately 11 million individuals worldwide suffered burn injuries severe enough to require medical attention.
  • Our patient population comprises both accidental and suicidal burns victims, reflecting the socioeconomic conditions prevalent in our region.
  • In India, which has a population of 1.34 billion, approximately 6-7 million burn injuries occur annually. This translates to an incidence rate of 0.005 per million population.
  • Given that the area surrounding Madurai district has a population of approximately 100 million, we can expect around 0.52 million burn cases annually in that region.

History

In the past 50 years, significant advances have been made in burn care, including the use of dressings, antimicrobials, fluid resuscitation, burn wound excision, skin grafting, and skin substitutes. However, the history of burn treatments dates back to ancient times, with cave paintings over 3500 years old depicting burns and their treatment. The Egyptian Ebers papyrus of 1500 BC recommended a 5-day treatment using a mixture of cattle dung, beeswax, ram’s horn, and barley porridge soaked in resin. Chinese physicians treated burn wounds with extracts from tea leaves in 600 BC. Hippocrates in 500 BC used porcine skin and resin of bitumen impregnated in dressings, alternated with warm vinegar soaks and tanning solutions. Celsus recommended wine and myrrh for burns in the 1st century AD, and in 300 AD, Hong Ge described a topical ointment made of calcarea and plant oil or pig fat cooked with willow bark. In the 16th century, Ambroise Paré used onions for burn treatment and described early burn wound excision. In the 17th century, Guilhelmus Fabricius Hildanus made unique contributions to the treatment of subsequent cicatricial contractures. Edward Kentish described pressure dressings for burn pain and blisters in 1797. Guillaume Dupuytren reviewed the treatment of 50 burn patients with occlusive dressings in 1839 and developed a classification of burn depth still in use today. He also recognized gastric and duodenal ulceration as a complication of severe burns, a concept described in more detail by Curling in 1842.

First Aid

Here are some guidelines for providing first aid for burns

What to do

  • Make sure you are safe before providing first aid. For example, turn off electrical sources or wear gloves for chemical burns.
  • Stop the burning process by removing any clothing and irrigating the burned area.
  • If the burn is caused by flames, extinguish them by allowing the person to roll on the ground, applying a blanket, or using water.
  • Use cool running water to lower the temperature of the burn.
  • For chemical burns, remove or dilute the chemical agent by irrigating with large volumes of water
  • Wrap the affected area with a clean cloth or sheet and take the person to the nearest medical facility for treatment.

What not to do

  • Do not provide first aid unless you have ensured your own safety.
  • Avoid applying paste, oil, turmeric, or raw cotton to the burn.
  • Do not apply ice as it can cause further injury. Do not use prolonged cooling with water as it can lead to hypothermia.
  • Do not open blisters unless directed by a healthcare professional.
  • Do not apply any material directly to the wound, as it can increase the risk of infection.
  • Avoid applying topical medication until the person has received appropriate medical care.

Who is at Risk?

There are several factors that increase the risk of burns, including gender, age, and socioeconomic status. Females and children are particularly vulnerable to burns, and people living in low- and middle-income countries are at a higher risk compared to those living in high-income countries. Other risk factors include certain occupations, poverty, lack of safety measures, underlying medical conditions, alcohol and smoking, access to chemicals for assault, use of kerosene, and inadequate safety measures for gas and electricity.

Prevention of Burns

Plan for burns prevention and care

  • Enclose fires and limit the height of open flames in domestic environments
  • Promote safer cookstoves and less hazardous fuels, and educate regarding loose clothing.
  • Apply safety regulations to housing designs and materials, and encourage home inspections.
  • Improve the design of cookstoves, particularly with regard to stability and prevention of access by children.
  • Lower the temperature in hot water taps.
  • Promote fire safety education and the use of smoke detectors, fire sprinklers, and fire-escape systems in homes.
  • Promote the introduction of and compliance with industrial safety regulations, and the use of fire-retardant fabrics for children’s sleepwear.
  • Avoid smoking in bed and encourage the use of child-resistant lighters.
  • Promote legislation mandating the production of fire-safe cigarettes.
  • Improve treatment of epilepsy, particularly in developing countries.
  • Encourage further development of burn-care systems, including the training of health-care providers in the appropriate triage and management of people with burns.
  • Support the development and distribution of fire-retardant aprons to be used while cooking around an open flame or kerosene stove.
  • In addition, there are a number of specific recommendations for individuals, communities and public health officials to reduce burn risk.

Prevention of Burns in Children

Burn safety at home
  • Many ordinary things in a home — including bath water, food and electrical outlets — can cause childhood burns.

Safety Outdoors

Burn safety outdoors
  • Avoid backyard fireworks. Don’t let children play with or near fireworks or sparklers.

Burns at Home

To prevent burns at home

  • Avoid hot spills. Don’t cook, drink, or carry hot beverages or foods while holding a child.
  • Keep hot foods and liquids away from table and counter edges.
  • Don’t use tablecloths or place mats, which young children can pull down.
  • Turn the handles of your pots and pans toward the rear of the stove and use back burners when possible.
  • Don’t leave the stove unattended when you’re cooking.
  • Reduce water temperature. Set the thermostat on your hot water heater to below 120 F (48.9 C).
  • Aim for bath water around 100 F (38 C).
  • Check the temperature of bath water with your hand before putting your child in the bath.
  • Establish ‘no’ zones. Block access to the stove, fireplace, space heaters and radiators.
  • Improve treatment of epilepsy, particularly in developing countries.
  • Don’t leave a child unattended in a room when these items are in use.
  • Keep hot devices out of reach. Store items designed to get hot, such as clothes irons or curling irons, unplugged and out of reach.
  • Test food temperature before feeding young children.
  • Be careful with food or liquids warmed in a microwave, which might heat foods unevenly. Never warm a baby’s bottle in the microwave
  • Address outlets and electrical cords. Cover unused electrical outlets with safety caps.
  • Keep electrical cords and wires out of the way so that children don’t pull on or chew on them.
  • Replace frayed, broken or worn electrical cords.
  • Choose fire-resistant fabrics.
  • Check labels to make sure mattresses and pajamas meet flammability standards.
  • Clean fire alarms monthly and push the button on the alarm every month to make sure it works.
  • Use long-life batteries or change them at least once a year. Replace smoke alarms that are more than 10 years old.

Effects of Burn ( Pathophysiology)

Local response

The three zones of a burn were described by Jackson in 1947.
  • Zone of coagulation—This occurs at the point of maximum damage. In this zone there is irreversible tissue loss due to coagulation of the constituent proteins.
  • Zone of stasis—The surrounding zone of stasis is characterised by decreased tissue perfusion. The tissue in this zone is potentially salvageable. The main aim of burns resuscitation is to increase tissue perfusion here and prevent any damage becoming irreversible. Additional insults—such as prolonged hypotension, infection, or oedema—can convert this zone into an area of complete tissue loss.
  • Zone of hyperaemia—In this outermost zone tissue perfusion is increased. The tissue here will invariably recover unless there is severe sepsis or prolonged hypoperfusion.

These three zones of a burn are three dimensional, and loss of tissue in the zone of stasis will lead to the wound deepening as well as widening.

Systemic response

The release of cytokines and other inflammatory mediators at the site of injury has a systemic effect once the burn reaches 30% of total body surface area.
  • Cardiovascular changes—Capillary permeability is increased, leading to loss of intravascular proteins and fluids into the interstitial compartment. Peripheral and splanchnic vasoconstriction occurs. Myocardial contractility is decreased, possibly due to release of tumour necrosis factor α. These changes, coupled with fluid loss from the burn wound, result in systemic hypotension and end organ hypoperfusion.
  • Respiratory changes—Inflammatory mediators cause bronchoconstriction, and in severe burns adult respiratory distress syndrome can occur.
  • Metabolic changes—The basal metabolic rate increases up to three times its original rate. This, coupled with splanchnic hypoperfusion, necessitates early and aggressive enteral feeding to decrease catabolism and maintain gut integrity.
  • Immunological changes—Non-specific down regulation of the immune response occurs, affecting both cell mediated and humoral pathways.

Referral guidelines

ABLS – (Advanced Burns Life Support)
  • Inhalation injuries ( all suspected)
  • Partial thickness burns (second and first degree) >/= 15% TBSA in patients aged 18-40 years old.
  • Partial thickness burns  (second and first degree) >/= 5% in children under the age of 18 or adults older then age 40.
  • Full thickness burns in any age (third degree burn).
  • Patients with partial or full thickness burns that involve the hands, feet, face, eyes, ears, perineum, and/or major joints.
  • Patients with high-voltage electrical injuries or lightning strikes.
  • Chemical burns.
  • Patients with burns complicated by other trauma in which the burn poses the greatest risk of morbidity or mortality.
  • Patients with comorbidities that could complicate management, prolong recovery, or affect mortality.
  • Patients who will require special social/emotional and/or long term rehab, including patients with suspected abuse, substance abuse, etc.

Selection for outpatient care

Several factors are relevant to the decision regarding the location of burn care. Airways must not be compromised. The wound must be small enough so that fluid resuscitation is unnecessary, which generally precludes outpatient care for burns over 10-15% of TBSA. The patient must be able to ingest adequate fluid orally. Typically, serious burns to the face, ears, hands, genitals, or feet should initially be managed in an inpatient setting.
The patient and family must be able to support an outpatient care plan. An adult caregiver should be available who can be with a child treated in an outpatient setting. A family member or visiting nurse must be available who can perform the necessary wound cleansing, inspection, and dressing applications because most patients cannot do this themselves. The family must have adequate transportation to return for clinic visits and unexpected emergency visits. If abuse is suspected, outpatient management is contraindicated. Finally, if the initial examination findings indicate that surgery is needed for a full-thickness wound area, the patient should be promptly admitted for surgery. Despite all of these qualifications, most patients with smaller burns can be successfully treated in an outpatient setting.

All major burn injuries are admitted in the ABLS unit.

Inpatient management

The management plan for patients with large burns that require inpatient care is usually determined by the physiology of the burn injury. Management  requires a coordinated approach that involves a specialized team. Hospitalization is divided into 4 general phases, including

(1) initial evaluation and resuscitation,

(2) initial wound excision and biologic closure,

(3) definitive wound closure, and

(4) rehabilitation and reconstruction.

FAQ in Burns

Dr Dodd’s Audio Links
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On arrival

Our 24×7 Accident and Emergency unit is one of the best equipped with  Triage and Critical care services by registered medical professionals and qualified staff.  Algorithms for resuscitation are applied to improve the speed and quality of treatment.

CAB ( Circulation Airway Breathing) approach

The aims of the CAB approach are:
  • To provide life-saving treatment.
  • To break down complex clinical situations into more manageable parts
  • To serve as an assessment and treatment algorithm
  • To establish common situational awareness among all treatment providers.

A uniform adoption of the CAB approach among members of a treatment team improves team performance.
Triage is the sorting of patients according to the urgency of their need for care.

Circulation

Guidelines
  • Adults and children with burns greater than  20% & 15% TBSA respectively, should undergo formal fluid resuscitation using estimates based on body size and surface area burned.
  • Wallace Rule of Nines – is used to assess the total body surface area (TBSA) involved in burn patients.
  • The Rule of Nines is a quick and easy tool used for the initial management of resuscitation in burn patients. The percentage TBSA can be determined by the Rule of Nines within a few minutes. We use pre printed pictorial charts for adults and paediatric patients.
  • The Parkland formula – is the used for Fluid replacement for burn injuries –
    It stipulates that 2 to 4 ml of Ringer’s Lactate per kilogram of weight per percentage of body surface area burned, with the first half given over the first 8 hours and the remainder given over the next 16 hours.
  • Parkland formula implies 4 mL/kg/%TBSA (3 mL/kg/%TBSA in children) = total amount of crystalloid fluid during the first 24 hours.
  • Ringer’s lactate is the fluid of choice for initial resuscitation in all age groups, but infant patients will also require dextrose due to their limited glycogen stores.
  • Fluid resuscitation, regardless of solution type or estimated need, is titrated to maintain a urine output of approximately 0.5–1.0 ml/kg/hour in adults and 1.0–1.5 ml/kg/hour in children.
  • Maintenance fluids should are administered to children in addition to their calculated fluid requirements caused by injury.
  • Increased volume requirements can be anticipated in patients with full-thickness injuries, inhalation injury and a delay in resuscitation.
Airway
  • Signs of airway burn/inhalation injury : stridor, hoarseness, black sputum, respiratory distress, singed nasal hairs or facial swelling.
  • Sign of oropharyngeal burn: soot in mouth, intraoral oedema and erythema.
  • Significant neck burn If above present, consider early intubation.
  • The Parkland formula – is the used for Fluid replacement for burn injuries –
    It stipulates that 2 to 4 ml of Ringer’s Lactate per kilogram of weight per percentage of body surface area burned, with the first half given over the first 8 hours and the remainder given over the next 16 hours.
  • Protect the cervical spine with immobilisation if there is associated trauma.
Breathing
  • Full thickness and/or circumferential chest burns may require escharotomy to permit chest expansion
  • ABLS unit – cubicles provide Protective Isolation (reverse barrier nursing) where the patient requires protection i.e. they are prone to infection.
  • We provide single beds for every individual in each cubicle for good hygiene, infection control and to reduce noise and light pollution. There is plenty of space for Ambulation.
  • Air-chamber burn bed – A burn recovery bed or burn bed is a special type of bed designed for hospital patients who have suffered severe skin burns across large portions of their body.
  • Generally, concentrated pressure on any one spot of the damaged skin can be extremely painful to the patient, so the primary function of a burn bed is to distribute the weight of the patient so evenly that no single bed contact point is pressed harder than any other
  • One type of weight-distributing burn bed uses a series of interlinked inflatable air chambers which have the surface appearance of an upside-down egg carton. Although inflatable, the air chambers are maintained in a partially deflated state so that the air pressure can freely distribute itself. Heavier parts of the patient’s body can sink deeper into the grid of chambers and the air moves to chambers with less weight.
  • To overcome negative effects of barrier nursing/isolation – We empower patients with accurate and meaningful information about their disease as a means of coping with their experience.
  • We provide accurate information for family and visitors in order to ensure or reduce their initial ill‑informed fear of becoming infected.
  • We ensuring patients have access to a telephone as a means of communication with the outside world, when required.
  • We have designed the facility with windows and free space that allow patients to see the outside world and mitigate their feelings of confinement.

முதல்உதவி

ஆபத்து குறைந்த தீக்காயம் (Minor Burns)

குளிர்ந்த நீரினால் காயம் பட்ட இடத்தை கழுவி சுத்தம் செய்யவும் (ஐஸ் தண்ணீர் உபயோகிக்கக்கூடாது). தீக்காயம் பட்டவுடன் பாதிக்கப்பட்ட இடத்தை குறைந்நது 5 நிமிடமாவது நீரில் வைத்திருக்க வேண்டும். சுத்தமான ஈரமான துணியை காயத்தின்மேல் சுற்றுவது வலியை குறைக்கும். பாதிப்பு ஏற்பட்டவரை அமைதி படுத்தவும். சுத்தமான துணிகட்டு (Bandage) துணியை சுற்றலாம். Paracetamol மாத்திரை வலியை குறைக்கும். Tetanus ஊசி தேவைப்படலாம்.

ஆபத்தான தீக்காயம் (Major Burns)

தீப்பிடித்து எரிந்து கொண்டு இருப்பவரை ஓடாமல் தரையில் படுத்து உருளும்படி கூறவேண்டும். கனமான போர்வை அல்லது சாக்கு உடன் இருந்தால் அதை உடம்பில் சுற்றி தீயை அணைக்கலாம். தண்ணீரை ஊற்றி தீயை அணைக்கலாம். விபத்து, நடந்த இடத்திலிருந்து தீக்காயத்தால் பாதிக்கப்பட்டவரை உடனடியாக அகற்ற வேண்டும். அவர் மேல் எரிந்து ஒட்டி உள்ள துணிகளை அகற்ற கூடாது. சுத்தமான Bandage கிடைக்கும் பட்சத்தில் அதைவைத்து சுற்றிக் கட்டலாம். நீர் குமிழிகள் இருந்தால் அதை உடைக்ககூடாது எந்த ஒரு மருந்து திரவங்களையும் தீக்காயத்தின் மேல் தடவக்கூடாது. பாதிக்கப்பட்ட பகுதியை இருதயத்திற்கு மேல் அளவு வரை உயர்த்தி வைக்கவும். மின்சாரத்தினால் பாதிக்கப்பட்டவரை காப்பாற்றும்போது முதலில் மின்சாரம் ஊடுருவாத பொருளால் அகற்ற வேண்டும்.

Shock (இரத்த அழுத்த குறைவு) உண்டான முதல் உதவி

பாதிக்கப்பட்டவரை படுக்க வைக்கவும். கால்கள் 12 அங்குலம் உயர்த்தி பிடிக்கவும். ஒரு போர்வை வைத்து தீக்காயம் ஏற்ப்பட்டவரை மூடவும். நாடிதுடிப்பு மற்றும் மூச்சுவிடும் தன்மையை நோக்க வேண்டும். மாவு மற்றும் மை போன்ற எந்த ஒரு பொருளையும் தீக்காயத்தின் மேல் தடவவோ, ஊற்றவோ கூடாது. நீர்குமிழ்கள் மற்றும் உறிந்த தோல் பகுதிகளை அகற்றக் கூடாது. குடிப்பதற்காக எந்தவிதமான திரவங்களும் கொடுக்கக் கூடாது. தலைக்கு அடியில் தலையனையை வைக்காதீர்கள். உதவிக்கு உடனடியாக 108 ஆம்புலன்ஸை அனுகவும்.

Respiratory Care in Burn Patients

  • Burn patients with burns usually have challenges beyond just the wounds to their skin. They often require respiratory care due to lung damage caused by smoke or steam inhalation. Failing to tackle lung or airway problems can lead to life-threatening and/or permanent complications. This can be true even if the burns to the skin are not extensive.

  • Respiratory care is essential in the acute phase of medical care following burn injuries. Arterial blood gases will be tested to check for oxygenation of the blood.
  • Mechanical Ventilation May be Necessary – Patients with burn injuries are sometimes kept in a medically-induced coma due to extreme pain or respiratory insult.
  • The respiratory care team may be involved in the early intubation of the burn victim to prevent loss of the airway caused by swelling. They may also assist with bronchoscopies to check for airway damage deeper in the lungs. As the treatment phase continues, the respiratory care team will perform ventilator management and airway maintenance until the patient’s functions improve.

Burns Bath

  • Patient Bathing ( Hydrotherapy) is done –

    1. to help in the initial assessment of TBSA.
    2. to enhance desloughing and to clean the wound surface.
    3. to drain pus and to help debride.
    4. to alter microbial flora.
    5. to ensure all topical medications are completely removed prior to applying new agents.
    6. to enhance healthy tisue formation and healing.
    7. to facilitate physical therapy.  &
    8. to comfort and psychologically uplift the patient.
  • The procedure is done in a separate cubicle designed for Burn Bath.
    We use warm water shower or immersion depending on the patient’s needs.
  • Analgesia and/or mild sedation are or are not administered, according to procedure planning and the patient’s pain tolerance.
  • Care should be taken to avoid damaging the new epithelial tissues and grafted area.
  • Post collagen application, the bath is recommended five days post procedure.
  • Bathing the patient helps to increase circulation, promote relaxation, provide a general stimulus, and aid in the wound healing process by reducing the microbial load.

Physio in Burns

Acute phase:
  • Respiratory Care, help to maintain or regain optimal respiratory function. Respiratory care is very important especially for cases of inhalation injury and burns to the chest. Chest physiotherapy is very important and the techniques are:
  • Breathing exercises
  • Manual techniques of chest physiotherapy – Percussion, Vibration
  • Postural drainage or Modified Postural Drainage
  • Suction (if necessary)
  • Thoracic mobility exercises
  • Positioning
  • Adjunct: Incentive spirometer, flutter if necessary
Positioning to the joint Involved
  • The correct position is at odds with the comfortable position and contractures. Performed on the first day of the patients admitted to hospital until the scars mature. Joint involved are positioned correctly to achieve goals such as:
  • Therapeutic Exercise: Exercise should be done on the first day of admission until the scars mature. The purpose is to:
  • Maintain Joint integrity
  • Maintain muscle flexibility and elasticity of the skin
  • Maintain range of motion to prevent contractures
  • Increase muscle strength and endurance.
  • Restore the musculoskeletal function to optimal level.
Sub-acute phase
  • Continue with respiratory care
  • Continue with therapeutic exercise
  • Continue with the joint involved in the correct position
  • Do mobility movement / ambulation
Ambulation
  • Ambulation will start once:
  • Haemodynamic status is stable There are no signs of active bleeding in the joint involved Bandaging of affected area is done.
  • Reduce swelling Prevent deep vein thrombosis Prevent further damage to the joints or exposed tendons Avoid damage to new skin graft.
  • Avoiding pressure sores occur in certain area – such as the styloid process, the medial malleolus, the lateral malleolus and the Achilles tendon.
  • Maintain range of motion to prevent contractures Positioning Techniques: Healing and scar maturation phase (Post Epithelial Healing) Therapeutic exercise for circuit training so that patients are more independent.
Stretching exercises
  • Muscles strengthening exercise such as using Theraband, weights, dumbbells, etc
  • Exercise to increase endurance. Examples of aerobic exercise such as climbing stairs.
  • Exercise to improve coordination such as Proprioceptive Neuromuscular facilitation (PNF)
Home exercise
  • Do exercise continuously until scars are matured
  • Elevation of the joints involved if there is swelling,
  • Encourage to do activities of daily living.

Nutrition

Nutritionist Following a burn injury protein caloric requirement of the patients increases steeply. The Burn patients have grossly deranged metabolism. Nutritional management is of utmost importance. Patients need more than double caloric and protein nutrition following a moderately severe burn injury. Since we are mostly treating critically injured patients nutritionist plays an important role and makes a very important member of the burn team. The services of Nutritionist are now utilized from the hospital dietitian.
Following a burn injury protein caloric requirement of the patients increases steeply. The Burn patients have grossly deranged metabolism. Nutritional management is of utmost importance. Patients need more than double caloric and protein nutrition following a moderately severe burn injury. Since we are mostly treating critically injured patients, nutritionist plays an important role and makes a very important member of the burn team.

Burns Patients Calorie Formula

ICMR – RDA Nutritional Requirements. (Curreri Formula)
Paediatric
  • < 1 year – RDA + 15 x % Total burned body surface area
  • 1 year – 3 years         – RDA + 25 x % Total burned body surface area
  • 4 years – 15 years – RDA + 40 x % Total burned body surface area
Adult

● > 18 years = 25Kcal x Body weight (Kg) + 40 x % Total burned body
surface area
● High protein = Body weight x 1.3 to 3.0 gm/Kg of protein.

Infants & Children

AGE CALORIE
KCAL / KG		 PROTEIN GM/KG
0 – 6 Months 92 1.5 – 2.0
6 – 12 Months 95 2.0 – 3.0
1 – 3 Years 82 2.0 – 3.0
7 – 9 Years 67.6 1.5 – 2.0

Adolescents

       AGE KCAL/KG PROTEIN
GM/KG
Boys Girls
10 – 12 Years 63.8 55.4 1.5 – 2.0
13 – 15 Years 57.7 50 1.5 – 2.0
16 – 17 Years 54.5 46.8 1.5 – 2.0

Burns Rehabilitation Process

Burns rehabilitation is a crucial part of treating burn injuries, and it starts from the moment the patient is admitted to the hospital. This process can continue for several months or even years after the initial event, and it involves a team approach that includes the patient and, if appropriate, their family. The term “Burns Rehabilitation” encompasses the physical, psychological, and social aspects of care, and burn patients may face challenges in one or all of these areas. If left untreated, burns can cause severe disability and deformities that can limit a patient’s ability to function. The goals of burn rehabilitation are to minimize the negative effects of the injury by maintaining range of motion, minimizing the development of contractures and scarring, maximizing functional ability, promoting psychological well-being, and facilitating social integration.

REMEMBER TOMORROW MIGHT BE TOO LATE!

It’s important for burn patients to begin their rehabilitation as soon as possible, even if they may not feel ready for it. Delaying rehabilitation can lead to more difficulty and pain in the long run, as well as a worse outcome. Once time passes, missed opportunities for rehabilitation cannot be easily regained, and joint stiffness and soft-tissue tethering can become increasingly severe. Sometimes, patients may resist treatment because of their pain or lack of understanding about the importance of rehabilitation. In these cases, it’s crucial for burn care professionals to provide support and encouragement to help patients through the process and help them understand how much their quality of life can improve with proper rehabilitation.

Scar management

Burn survivors can become frustrated that they still have issues with scarring after their initial burn injury has healed. Hypertrophic burn scars (raised scars in the area of the original burn) are the most common complication of a burn injury and can limit a survivor’s ability to function as well as affect their body image. It is difficult to predict who will develop scarring. Research shows that less severe burns that heal in less than 14 days generally have no scarring. More severe burns heal in 14 to 21 days and put you at a risk of scarring. Burns that take more than 21 days to heal are at very high risk for scarring and may require skin grafting.

Why do scars form?

Scarring is related to age, ethnicity, and the depth and location of the burn. Scars form when the dermal or lower layer of the skin has been damaged. The body forms a protein called collagen to help heal the damaged skin. Normally the collagen fibers are laid down in a very organized manner, but in hypertrophic scars these fibers are created in a very disorganized manner, which gives the new skin/scar a different texture and appearance. Scar healing can take a long time. Scarring usually develops within the first few months after the burn, peaks around 6 months and will resolve or “mature” in 12-18 months. As scars mature they fade in color, become flatter, softer and generally less sensitive.

What are hypertrophic burn scars?
  • Thypertrophic scars
  • Stay within the area of the original burn injury.
  • Develop within the first few months after the injury.
  • Often have a deep red to purple color and are raised above the surface of the skin.
  • Can be warm to the touch, hypersensitive, and itchy.
  • Are more prominent and noticable around joints where skin tension and movement are high.
  • Common problems with hypertrophic scars.
  • Scars across joints can cause a decrease in your ability to move. These are called contractures.
  • People with visible scars may feel self-conscious and avoid social situations. This can lead to isolation, depression and lower quality of life.
    Scars can be dry and result in cracking or breakdowns in the skin.
    Scars are more sensitive to sun and chemicals.
  • Contractures

Contractures can affect your ability to move and take care of yourself. If your contractures involve your legs, you may have difficulty squatting, sitting, walking, or climbing stairs. If your contractures involve your trunk and arms, you may have difficulty with grooming, eating, dressing and bathing as well as working with your hands. Some contractures are unavoidable, but many can be prevented with active involvement in your rehabilitation program. Here are a few reminders:

  • Stretching
  • Stretching should be performed a minimum of 5-6 times per day. To make stretching easier, first moisturize your scars with a moisturizer recommended by your doctor.
  • Your therapist may make a cast or splint to help position your scar in a stretched position. It is important that you wear the cast or splint as prescribed and tell your therapist if it becomes painful or causes skin irritation.
  • Do as much for yourself as possible such as getting dressed and self-grooming. It may take longer than you are used to, but movement and activity will improve your ability to move and take care of yourself.
  • Itching
  • Burns can damage or destroy the oil glands that normally keep skin from getting too dry. Partial thickness burns have few oil glands and full thickness burns or skin grafts have no oil glands. The lack of oil glands leads to dry skin. The chaotic organization of collagen in the healed skin may trap nerve endings, which also contributes to itching.
  • Many patients experience intense itching after their burn. Studies have shown that the larger the burn, the more likely that itching will be a problem.
  • Ask your doctor for recommendations on what moisturizer is best for you. Moisturizers with high water content, such as those that come in a bottle generally soak into the skin faster and will need to be applied more frequently. Moisturizers that come in a tube or jar are generally thicker and have less water, so they need to be applied less frequently. Be sure to avoid products that you may be allergic to, such as perfumed lotions.
  • Moisturizers can be applied to all healed areas frequently throughout the day. Moisturizers should be applied in thin layers and massaged in gently while the scars are more fragile. As your scars mature, you can begin to add more pressure to help your scars loosen so that they are not so stiff.
    Hot showers remove the natural oils from the skin. Therefore it is essential to re-moisturize well after showers. Bathing may feel good but also removes the natural oils. Adding baby oil to the water may alleviate some of this effect.
  • The approaches for itching are varied. Keep skin moist is the starting point. Also massage or pressing down firmly on the scars may help. Scratching increases inflammation and will make itching worse. Elastinet garments or custom pressure garments may also help with itching.
  • Medications such as gabapentin or pregabalin (which are commonly used for nerve pain) have been shown to be the first line medication for itching. Antihistamines may also be helpful. Talk to your doctor about what medication is right for you. You should never use mineral oil, Vaseline or antibiotic ointments to moisturize your skin. These can lead to allergic reactions and skin breakdown. Do not use antibiotic ointment to lubricate after the wound is healed.
  • Sun exposure
  • You should avoid exposing your healing scars to sunlight. Scars that are discolored and have not matured burn easily. If you go out in the sun, we recommend
  • Planning activities in the early morning or late evening when the sun is the least intense.
  • Apply a sunscreen with an SPF of at least 30 or wear protective clothing to minimize the exposure of your skin.
  • Reapply your sunscreen every couple of hours that you are outside.
    Treatment of hypertrophic scars
  • You will need to work closely with your doctor and therapy team to make sure your scars heal as completely as possible. A strong commitment is required from you and your family member to follow through with the treatment plan to ensure the best scar result.
  • No single treatment is ideal for treating scars. For many years, custom pressure garments were thought to be the best treatment for hypertrophic scars. Custom fit pressure garments may be useful for decreasing postburn itch and scar formation.
  • Treatment of hypertrophic scars
  • You will need to work closely with your doctor and therapy team to make sure your scars heal as completely as possible. A strong commitment is required from you and your family member to follow through with the treatment plan to ensure the best scar result.
  • No single treatment is ideal for treating scars. For many years, custom pressure garments were thought to be the best treatment for hypertrophic scars. Custom fit pressure garments may be useful for decreasing postburn itch and scar formation.
  • If you and your medical team decide to use custom pressure garments, they should be worn 23 out of 24 hours/day. Even though the use of pressure garments may not improve your scar, they can decrease itching and protect the skin from injury. Some burn survivors also feel that the pressure garments look better than the scars themselves.
  • Silicone gel sheets are pieces of thin, flexible medical grade silicone that are placed over the scars and may decrease itching and dryness. They are generally durable and comfortable to wear. They can be worn alone or underneath pressure garments, splints, or casts. Some people find they are sensitive to silicone, so check your skin frequently for irritation or rashes.
  • Your therapist may recommend custom-made inserts to be worn under gloves, compression bandages or custom garments to increase pressure on the scar and improve healing. These inserts can be made from a variety of substances, ranging from soft foam to a rubber consistency.
  • Massage can help soften and desensitize the scar. When combined with stretching, massage can make the scar looser, softer, and more comfortable. Talk to your therapist to learn about specific massage techniques.
  • Surgical treatment including laser treatment may be an option if scarring prevents you from performing certain activities. It is important to stay in contact with your treating burn physician for evaluation.
  • What can you do?
  • Be actively involved in your recovery by asking questions and participating in decision-making about your care. Take a list of questions or concerns to your medical appointments for your health care provider to address.
  • Always keep your skin clean and well moisturized.
  • Keep up your exercise program as recommended by your doctor.
    Massage your scars with lotion to keep them moist, make them less sensitive and make your stretching easier. This may also prevent skin breakdown.
  • It is important to follow your providers’ instructions for using pressure garments, inserts, splints or silicone gel sheets. If they do not fit properly or if they cause problems such as pressure or skin breakdown, let your health care provider know right away.
  • The healing process can often seem long and frustrating for a burn survivor and his or her family. If you have concerns or questions about your healing process or treatments, contact your health care providers.
  • Additional resources for garments and scar products: For more information regarding compression garments, wound care and scar management products, please contact your doctor or therapist so that they can make recommendations based on your specific needs.

Core training programmes

  • Basic Burn Care (BBC)is a face to face 1 day course covering prevention, first aid, initial treatment, and referral. It is ideal for use in remote rural areas or community level urban settings.
  • Essential Burn Care (EBC)The vast majority of burns are ‘mild’ or ‘moderate’. Essential Burn Care (EBC) emphasises the management of these cases to help reduce the morbidity and mortality from burn injuries.EBC is a face to face 1 or 2 day course for all those dealing with the burn patient including surgeons, nurses, therapists, and nutritionists, typically from secondary and tertiary level hospitals. It covers all key aspects, from emergency care through to rehabilitation with sections on psychosocial care linked to pain, suffering and stigma, and paediatric burns.
    The focus is on putting KNOWLEDGE into ACTION through participatory team work around a multi-modal interactive approach.
  • Advanced Burn Care (ABC)Advanced Burn Care (ABC) is a 5 day ‘hands on’ training programme in separate modules – Rehabilitation, Nursing and Surgery supporting core members of the burn team.
    ABC focusses on developing real world skills and decision-making abilities that can be put into practice in challenging environments with limited resources.

Skin Bank

Devi Cropscience – Rotary Community Skin Bank GG 2012692 Run by – Grace Kennett Foundation Hospital

Gift skin - Gift life

The butterfly represents organ donation as a symbol of change and is also well established as representing new life and hope.
The butterfly is one symbol most associated with The Gift Of Life; organ donation.
Here you see an orange butterfly with a broken wing repaired. The yellow area denotes the gift of life – the donated skin.

FAQ?

What is skin donation?
Who can donate?
How is it done ?
Why skin ?
What is skin donation?

Life is skin deep. Loss of skin can lead to loss of life. Cover provided with the donated skin in the first three weeks of injury can reduce the number of burns victims dying by almost 50%.

Who can donate?

Any one can donate skin irrespective of sex & blood group, the minimum age of the donor should be 18 years but there is no upper age limit.

How is it done ?

Skin can be donated after death within 6 hours from the time of death.
The Skin Donation whole procedure takes only about 30 – 45 minutes.
Skin Bank Team will come to the donor’s home or hospital.

Why skin ?

One of the important factors in Burns 🔥 is metabolic response to trauma. The trimodial pattern of death seen in poly trauma is prominently seen in Burns. If they survive 3 weeks, they are very likely to survive. The third peak of death is the 3rd week.

What is a Skin Bank?
Who cannot donate ?
What documents are necessary?
The three significant and measurable results of early skin cover are
What is a Skin Bank?

Skin banking is a facility where the skin is collected from eligible deceased donor and processed as per international protocols. Skin can be stored in the skin bank at 4-8o Celsius up to 5 years. The stored skin can be used for burns patients who have deep burns.

Who cannot donate ?

Skin of persons suffering from AIDS, Hepatitis B & C, Sexually Transmitted Diseases, Skin Cancer, Active Skin Disease and Septicemia are considered unfit for donation.

What documents are necessary?

A.Death certificate and B.Consent are mandatory.
Proir registration is not required.

The three significant and measurable results of early skin cover are

1. Reduction of pain
2. Reduction of morbidity
3. Reduction of mortality.
The availability of skin from the skin bank has an anticipated 50% reduction in pain score 30% reduction in mortality and 30% reduction in morbidity.
The one significant factor in making the difference shall be the availability of temporary skin cover from the skin bank.
Pediatric burns patients will benefit the most.

Myths

  • Myth: Skin donation mutilates the body.
    Fact: Donated organs and skin are removed surgically, which doesn’t disfigure the body. The donor’s body is dressed and clothed, so there are no visible signs of donation.
  • Myth: Religion bars organ donation.
    Fact: Most religious beliefs permit organ donation or leave it to the individual’s discretion. Religions endorse the act of giving and what bigger form of giving can there be than giving life.
  • Myth: The donor’s family is charged for donating organs.
    Fact: A donor’s family is never charged for donating organs.
  • Myth: Only the heart, liver and kidneys can be donated.
    Fact: Besides skin, other organs such as the pancreas, lungs, small and large intestines, and the stomach can also be transplanted. Moreover, tissues such as bone, heart valves and tendons can be donated too.
  • Myth: If the ICU doctors know I’m an organ donor, they won’t work hard to save me.
    Fact: If you are admitted in a hospital – sick or injured, the priority is to save your life.
  • Myth: What if I recover from brain death?
    Fact: This doesn’t happen. The standards to determine if a person is brain dead are very strict and people who have agreed to donate their organs are given additional tests to confirm that they are truly dead.
  • Myth: I’m too old to be a donor.
    Fact: There is no set age limit for organ and tissue donation.
  • Myth: Skin donation cannot be done when Alive.
    Tissue That Can Be Donated While Alive

    You may be able to donate: Skin—after surgeries such as a tummy tuck. Bone—after knee and hip replacements. Healthy cells from bone marrow and umbilical cord blood.

Requirement

  • In India, there is a significant problem of burns injuries, with around 7 million cases occurring each year. Out of these, 0.14 million people die annually. The majority of burn injuries (70%) happen to people in the most productive age group of 15-35 years, and women and children account for around 80% of all cases. Kitchen-related accidents are the most common cause of burns, responsible for 80% of all admissions.

  • The region that our program aims to benefit includes Madurai district, with a population of 32 million, as well as the adjoining districts of Theni (13 million), Ramnad (13 million), Dindigul (22 million), and Sivagangai (13 million). To meet the needs of this region, our program will require approximately 5,000 donations per year.

Methodology

  • The process of skin harvesting for donation involves a team consisting of a doctor or trained skin bank technician, two nurses, and an attendant. Before beginning the procedure, the team doctor evaluates the death certificate and its photocopy. The next of kin of the donor is asked for consent, and a witness is required to sign the consent form. The procedure, which involves the use of a special instrument called a dermatome, harvests only the uppermost 1/8th layer of skin from the legs, thighs, and back without causing bleeding or disfigurement. After harvesting, the skin is processed, screened, and preserved in an 85% glycerol solution at a temperature of 4 to 8 degrees Celsius for up to 5 years. Skin from any donor can be transplanted onto any patient without any need for matching blood type, color, or age, as long as all blood reports are negative. The skin is then supplied to burns surgeons for transplanting onto burn patients.

Functions

  • The Skin Bank has several functions, which include retrieval, processing, storage, distribution, and medical documentation.

  • The retrieval process involves various steps such as shaving and cleaning the skin, scrubbing it with Betadine, shower washing, draping with a sterile sheet, cleaning with sterilium, lubricating with paraffin, procuring skin of different thickness, preserving the harvested skin in 50% glycerol, and keeping it in a refrigerator for two hours at 4-6°C.

  • During the processing stage, the harvested skin is checked for quality, and all pieces are placed in 85% glycerol. The skin is then shaken with glycerol for three hours at 33°C in a shaking incubator. After this, the skin is stored in a freezer at 8°C for 4-6 weeks until serological reports are available.

  • Once the skin has been processed and tested, it is stored in containers with 85% glycerol, graded according to thickness, and made ready for use. Any remaining cut pieces are sent to a research lab.

  • To run a skin bank, it is necessary to have four to six personnel, including a head, a quality systems coordinator, two skin processing personnel, and two trained teams for skin retrieval, each consisting of three members.

Skill Training

The Grace Kennett Foundation has launched a unique Skin Banking and Burns Management Course to provide healthcare workers with the necessary skills. The first batch of 20 students has already completed the training successfully. Every year, multiple batches of healthcare workers from various districts will be trained at the Grace Kennett Foundation Hospital. These workers will then return to their communities to apply the knowledge and skills acquired during the training to achieve the project’s objectives. Additionally, the Foundation plans to collaborate with voluntary organizations, the Indian Medical Association, Eye donation programme units, Rotary International, and other relevant agencies. To increase awareness, the Foundation will conduct regular social and print media campaigns.

காரணங்கள்?
எங்கு,எதனால் ஏற்படுகிறது?
காயத்தின் அளவு எவ்வாறு நிர்ணையிக்கப்படுகிறது?
காயத்தின் ஆழம்?
பரப்பளவு எவ்வாறு தீர்மானிக்கப்படுகிறது?
நுரையீரல் காயம் என்றால் என்ன?
கார்பன் மோனாக்ஸைடு வாயுவினால் ஏற்படும் சேதம்?
தீக்காயம் உண்டானதற்கான அறிகுறிகள்?
நுரையீரலில் காயங்கள் ஏற்பட்டவர்களுக்கு உண்டான அறிகுறிகள்?
வாய் மற்றும் உதடுகளில் தீக்காயங்கள்?
காரணங்கள்?

தீ சூடான திரவங்கள் மற்றும் நீராவி மின்சாரம் இரசாயன பொருட்கள்.

எங்கு,எதனால் ஏற்படுகிறது?

வீட்டில் மற்றும் தொழிற்ச்சாலைகளில் ஏற்படும் விபத்துக்கள் பட்டாசுகளால் ஏற்படும் விபத்துக்கள் வாகன விபத்து தீப்பெட்டியுடன் விளையாடுதல் சமையல் அறையில் ஏற்படும் திரவ விபத்துக்கள்.

காயத்தின் அளவு எவ்வாறு நிர்ணையிக்கப்படுகிறது?

காயத்தின் ஆழம், காயத்தின் பரப்பு.

காயத்தின் ஆழம்?

இது நான்கு வகையாக பிரிக்கப்படுகிறது. முதல் அளவு நீர் குமிழ்கள் காணப்படாது. தோலின் நிறம் மாற்றம் மட்டும் காணப்படும். இரண்டாம் அளவு நீர் குமிழ்கள் காணப்படும். வலி உண்டாகும். மூன்றாம் அளவு இதில் முழு ஆழத்தில் தோல் பாதிக்கப்படுகிறது. நரம்புகள் பாதிக்கப்படுவதால் தோலில் வலி காணப்படுவதில்லை. நான்காம் அளவு தோலுக்கும் கீழ் சதை மற்றும் எலும்பு வரை உண்டான காயங்கள்.

பரப்பளவு எவ்வாறு தீர்மானிக்கப்படுகிறது?

இது Rule of 9’s என்ற அடிப்படையில் தீர்மானிக்கப்படுகிறது. ஒரு உள்ளங்கையின் பரப்பளவு ஒரு சதவீதத்திற்கு (1%) சமமாகிறது.

நுரையீரல் காயம் என்றால் என்ன?

புகை, நீராவி, சூடான காற்று, மற்றும் இரசாயன புகையை சுவாசிக்கும் போது நுரையீரலின் சவ்வு பாதிக்கப்படுகிறது. இதனால் பிராணவாயு உள்வாங்கும் தன்மை பாதிக்கப்படுகிறது. ஒரு சராசரி மனிதனின் பிராணவாயு உள்வாங்கும் சவ்வின் அளவு ஐந்து சென்ட் நிலப்பரப்பு அளவிற்கு ஈடானது. தீக்காயத்தின் போது முகத்தில் காயம் ஏற்பட்டாலோ, மூக்கின் முடி, புருவங்கள் கருகிவிட்டாலோ, நுரையீரல் பாதிக்கப்பட்டு உயிர் வாழ்வதற்கான வாய்ப்புகள் குறைந்து விடுகிறது.

கார்பன் மோனாக்ஸைடு வாயுவினால் ஏற்படும் சேதம்?

தீவிபத்தின் போது கார்பன் மோனாக்ஸைடு வாயுவை சுவாசிப்பதனால் இரத்தத்தில் விஷத்தன்மை கூடி உயிர் சேதம் ஏற்பட வாய்ப்பு உள்ளது.

தீக்காயம் உண்டானதற்கான அறிகுறிகள்?

தோல் நிறமாற்றம் நீர் கொப்புளங்கள் தோல் உரிதல் Shock (இரத்த அழுத்த குறைவு, நாடித்துடிப்பு கூடுதல், அதிகமான வியர்வை, மயக்க நிலை, கை மற்றும் கால் விரல்கள் நீல நிறமாக மாறுதல்).

நுரையீரலில் காயங்கள் ஏற்பட்டவர்களுக்கு உண்டான அறிகுறிகள்?

தலை, முகம், கழுத்து, புருவங்கள் மற்றும் மூக்கில் உள்ள முடி கருகிவிடுதல்.

வாய் மற்றும் உதடுகளில் தீக்காயங்கள்?

இருமல், மூச்சுத்திணறல், கருப்புநிறம் மற்றும் இரத்தம் கலந்த சளி, குரல் மாற்றம், இளைப்பு.

தீர்மானிக்கக்கூடியவை
தீக்காயத்தின் நிலைகள்?
மருத்துவ உதவி?
ஆபத்து குறைந்த தீக்காயம் (Minor Burns)?
மருத்துவமனையில் செய்ய வேண்டியவை?
தீக்காய சிகிச்சை (Burns Management)?
அறுவை சிகிச்சை
உயிர்சேதம் உண்டாவதற்கான காரணங்கள்?
பின்விளைவுகள்?
வடு ஏற்படுவதை எவ்வாறு குறைக்கலாம்?
தீர்மானிக்கக்கூடியவை

காயத்தின் ஆழம், காயத்தின் பரப்பளவு, நுரையீரல் காயம், கார்பன் மோனாக்ஸைடு விஷவாயுவின் அளவு, நீரிழிவு, HIV.

தீக்காயத்தின் நிலைகள்?

ஆபத்து குறைந்த தீக்காயம் (Minor Burns) 15% க்கும் குறைந்த பரப்பளவுள்ள தீக்காயம், அல்லது நுரையீரல் காயம் மற்றும் கார்பன் மோனாக்ஸைடு விஷவாயு பாதிப்பு இல்லாத பட்சத்தில் ஆபத்து குறைந்த தீக்காயம் (Minor Burns) என்றும் கருதப்படுகிறது. ஆபத்தான தீக்காயம் (Major Burns) 15% க்கும் அதிக பரப்பளவுள்ள தீக்காயம், அல்லது கார்பன் மோனாக்ஸைடு விஷவாயு பாதிப்பு மற்றும் நோயின் தாக்கம் உள்ளவர்கள் (நீரிழிவு நோய்) உள்ள தீக்காயம் ஆபத்தான தீக்காயம் (Major Burns) என்றும் கருதப்படுகிறது.

மருத்துவ உதவி?

CAB
C – Circulation உடனடியான இரத்த நாளம் வழியாக ஐஏ குடரனை செலுத்தவும்.
A – Airway சுவாச வழிகளில் அடைப்பு உள்ளதா என்பதை அறியவும்.
B – Breathing பாதிக்கப்பட்டவரின் சுவாசத்தை நிர்ணயித்து அதற்கு ஏற்றவாறு ஆக்ஸிஜன் அல்லது செயற்கை சுவாசம் தர வேண்டும்.

ஆபத்து குறைந்த தீக்காயம் (Minor Burns)?

சிகிச்சையின் போது வலி கூடினாலோ, தோலில் சிவப்பு நிறம் ஏற்பட்டாலோ, வீக்கம் ஏற்பட்டாலோ, சலம் ஏற்பட்டாலோ, சிறுநீரின் அளவு குறைந்தாலோ, தலைவலி, தலைசுற்றல், வாந்தி, ஏற்பட்டாலோ உடனடியாக மருத்துவர் உதவியை நாடவேண்டும்.

மருத்துவமனையில் செய்ய வேண்டியவை?

முதல் உதவிக்குப் பிறகு டீரசளெ ஊநவெநச க்கு அனுப்பவும். தீக்காயம் அடைந்தவர் முதலில் மருத்துவமனைக்கு அனுமதிக்கப்பட்டபொழுது தேவையான இரத்தப்பரிசோதனை, சிறுநீர் பரிசோதனை, நெஞ்சுப்படம் (X-Ray), இதய ஸ்கேன் (ECHO), போன்றவைகள் மூலம் அவரின் தற்போதைய நிலையை நிர்ணயிக்க முடியும்.

தீக்காய சிகிச்சை (Burns Management)?

தீக்காயத்தினால் உடம்பின் நீர்சத்து குறைவதால் இரத்த நாளத்துக்குள் திரவம் செலுத்த வேண்டும். திரவ அளவு நிர்ணயிக்க Parkland formula என்பதன் படி தீக்காயத்தின் சதவீதம், உடல் எடை வைத்து மொத்த அளவில் ஒருபாதியை முதல் 8 மணி நேரத்திலும் இன்னொரு பாதியை அடுத்த 16 மணி நேரத்திலும், அடுத்த நாள் மொத்த அளவில் பாதி என்றும் பகுத்து அளிக்க வேண்டும். தாதுஉப்புகள் சோடியம், பொட்டாசியம், போன்றவைகளின் அளவை சரிசெய்ய வேண்டும். அமிலகார சமன் சீர்செய்ய வேண்டும்.வலிக்கு தக்க வலிநிவாரணம் வழங்க வேண்டும். சத்தான உணவு புரதம் அதிகமுள்ள உணவு வழங்க வேண்டும். T.T எனப்படும் தடுப்பூசி போடவேண்டும். தீக்காயத்தின்மேல் Silver Sulfadiazine எனப்படும் களிம்பு தடவவேண்டும் தேவைபட்டால் நோய்கொல்லி மருந்துகள் களிம்புகள் பயன்படுத்தலாம். பாதிக்கப்பட்டவருக்கு உடற்பயிற்சி சிகிச்சை அளிக்க வேண்டும்.

அறுவை சிகிச்சை

Collagen எனப்படும் செயற்கை தோலை இடலாம். Excision and Grafting பாதிக்கப்பட்டவருக்கு பலநிலைகளில் தோல் அகற்றப்பட்டு மாற்றுத்தோல் பொருத்தப்படுகிறது.

உயிர்சேதம் உண்டாவதற்கான காரணங்கள்?

காயத்தின் ஆழம், காயத்தின் பரப்பளவு, நுரையீரல் தீக்காயம் நீரிழிவு, இரத்த அழுத்தம், காசநோய் போன்ற உடனிருக்கும் நோய்கள் நுரையீரல் காயம் ஏற்பட்டவர்கள் 50மூ மேல் உள்ளவர்கள் முதல் வாரத்திலும் மற்ற ஆபத்தான தீக்காயம் உள்ளவர்கள் உயிர்சேதம் ஏற்பட வாய்ப்புள்ளது. மூன்று வாரங்களுக்கு மேல் உயிர்பிழைத்தவருக்கு உயிர் சேதம் ஏற்பட வாய்ப்பு குறைவு.

பின்விளைவுகள்?

காயங்கள் ஆறிவரும்போது வடுக்கள் ஏற்படுவதினால் கை, கால், கழுத்து அசைவுகள் பாதிக்கப்படுகிறது. இவ்வாறு பாதிக்கப்பட்டவருக்கு மீண்டும் அறுவை சிகிச்சை செய்ய நேரிடலாம்.

வடு ஏற்படுவதை எவ்வாறு குறைக்கலாம்?

தோல் மீதான நுpiவாநடயைட வுளைளரந உள்ளவரை வடு ஏற்படாமல் இருக்க வாய்ப்புள்ளது. காயங்கள் (Healing by Primary Intension) Epithelial Tissue உதவியுடன் ஆறும் போது வடுக்கள் ஏற்பட வாய்புகள் குறைவு Skin Grafting (மாற்றுத் தோல் ஒட்டுதல்) தோல் ஒட்டுவது இல்லாமல் Epithelial Tissue இல்லாமல் வடுவுடன் ஆறும். வடுக்களை குறைப்பதற்கு Gel, Gel Sheet மற்றும் ஊசிமூலம் செலுத்தும் மருந்துகள் உள்ளன. ஆறுமாதத்திற்கு மேல் வளர்ந்து வரும் வடு Keloid எனப்படும். Keloid ஏற்படும் பட்சத்தில் தீக்காய சிகிச்சை அளிக்கும் சிறப்பு மருத்துவமனையை அனுகவும்.ஆறாத காயங்களில் Marjolin Ulcer என்ற புற்றுநோய் ஏற்பட வாய்ப்புள்ளது.

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