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Burns & cosmetic surgery

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Burns & cosmetic surgery

  1. 1. BURN INJURIES & ITS MANAGEMENT BY MR. AHMED SODHA M.Sc.(N) – M.S.N. 4/1/2011 1
  2. 2. BURNS 4/1/2011 WOUNDS CAUSED BY EXPOSURE TO: 1. EXCESSIVE HEAT 2. CHEMICALS 3. FIRE/STEAM 4. RADIATION 5. ELECTRICITY
  3. 3. BURNS 4/1/2011 RESULTS IN 10-20 THOUSAND DEATHS ANNUALLY SURVIVAL BEST AT AGES 15-45 SURVIVAL BEST BURNS COVER LESS THAN 20% OF TBA
  4. 4. TYPES OF BURNS 4/1/2011 THERMAL EXPOSURE TO FLAME OR A HOT OBJECT CHEMICAL EXPOSURE TO ACID, ALKALI OR ORGANIC SUBSTANCES ELECTRICAL RESULT FROM THE CONVERSION OF ELECTRICAL ENERGY INTO HEAT. (EXTENT OF INJURY DEPENDS ON THE TYPE OF CURRENT, THE PATHWAY OF FLOW, LOCAL TISSUE RESISTANCE, AND DURATION OF CONTACT) RADIATION RESULT FROM RADIANT ENERGY BEING TRANSFERRED TO THE BODY.
  5. 5. CHEMICAL BURN 4/1/2011
  6. 6. ELECTRICAL BURN 4/1/2011
  7. 7. BURN WOUND ASSESSMENT 4/1/2011 CLASSIFIED ACCORDING TO DEPTH OF INJURYAND EXTENT OF BODY SURFACE AREA INVOLVED BURN WOUNDS DIFFERENTIATED DEPENDING ON THE LEVEL OF DERMIS AND SUBCUTANEOUS TISSUE INVOLVED 1.SUPERFICIAL (FIRST-DEGREE) 2.DEEP (SECOND-DEGREE) 3.FULL THICKNESS (THIRD AND FOURTH DEGREE)
  8. 8. 4 /1 /20 1 1 8
  9. 9. 4 /1 /20 1 1 8
  10. 10. SUPERFICIAL BURNS (FIRST DEGREE) EPIDERMAL TISSUE ONLYAFFECTED ERYTHEMA, BLANCHING ON PRESSURE, MILD SWELLING NO VESICLES OR BLISTER INITIALLY NOT SERIOUS UNLESS LARGE AREAS INVOLVED I.E. SUNBURN 4/1/2011
  11. 11. 4/1/2011 12
  12. 12. 4/1/2011 13
  13. 13. 4/1/2011 14
  14. 14. DEEP (SECOND DEGREE) *INVOLVES THE EPIDERMIS AND DEEP LAYER OF THE DERMIS FLUID-FILLED VESICLES –RED, SHINY, WET, SEVERE PAIN HOSPITALIZATION REQUIRED IF OVER 25% OFBODY SURFACE INVOLVED I.E. TAR BURN, FLAME 4/1/2011
  15. 15. 4/1/2011 16
  16. 16. 4/1/2011 17
  17. 17. 4/1/2011 18
  18. 18. FULL THICKNESS (THIRD/FOURTH DEGREE) DESTRUCTION OF ALL SKIN LAYERS REQUIRES IMMEDIATE HOSPITALIZATION DRY, WAXY WHITE, LEATHERY, OR HARD SKIN, NO PAIN EXPOSURE TO FLAMES, ELECTRICITY OR CHEMICALS CAN CAUSE 3RD DEGREE BURNS 4/1/2011
  19. 19. 4/1/2011 20
  20. 20. 4/1/2011 21
  21. 21. Calculation of Burned Body Surface Area 4/1/2011
  22. 22. TOTAL BODY SURFACE AREA (TBSA) 4/1/2011 SUPERFICIAL BURNS ARE NOT INVOLVED IN THE CALCULATION LUND AND BROWDER CHART IS THE MOST ACCURATE BECAUSE IT ADJUSTS FOR AGE RULE OF NINES DIVIDES THE BODY – ADEQUATE FOR INITIAL ASSESSMENT FOR ADULT BURNS
  23. 23. 4/1/2011
  24. 24. LUND BROWDER CHART USED FOR DETERMINING BSA 4/1/2011
  25. 25. RULES OF NINES 4/1/2011 HEAD & NECK = 9%  EACH UPPER EXTREMITY (ARMS) = 9%  EACH LOWER EXTREMITY (LEGS) =18% ANTERIOR TRUNK= 18% POSTERIOR TRUNK =18% GENITALIA (PERINEUM) = 1%
  26. 26. 4/1/2011
  27. 27. 4/1/2011
  28. 28. 4/1/2011 24
  29. 29. 4/1/2011 IN PATIENTS WITH SCATTERED BURNS, A METHOD TO ESTIMATE THE PERCENTAGE OF BURN IS THE PALM METHOD. THE SIZE OF THE PATIENT’S PALM IS APPROXIMATELY 1% OF TBSA.  PALM METHOD
  30. 30. 4/1/2011 
  31. 31. VASCULAR CHANGES RESULTING FROM BURN INJURIES 4/1/2011 CIRCULATORY DISRUPTION OCCURS AT THE BURN SITE IMMEDIATELY AFTER A BURN INJURY BLOOD FLOW DECREASES OR CEASE DUETO OCCLUDED BLOOD VESSELS DAMAGED MACROPHAGES WITHIN THE TISSUES RELEASE CHEMICALS THAT CAUSE CONSTRICTION OF VESSEL BLOOD VESSEL THROMBOSIS MAY OCCUR CAUSING NECROSIS  MACROPHAGE: A TYPE OF WHITE BLOOD THAT INGESTS (TAKES IN) FOREIGN MATERIAL. MACROPHAGES ARE KEY PLAYERS IN THE IMMUNE RESPONSE TO FOREIGN INVADERS SUCH AS INFECTIOUS MICROORGANISMS.
  32. 32. FLUID SHIFT 4/1/2011 FLUID SHIFT OCCURS AFTER INITIAL VASOCONSTRICTION,THEN DILATION BLOOD VESSELS DILATE AND LEAK FLUID INTO THE INTERSTITIAL SPACE KNOWN AS THIRD SPACING OR CAPILLARY LEAK SYNDROME CAUSES DECREASED BLOOD VOLUME AND BLOOD PRESSURE  OCCURS WITHIN THE FIRST 12 HOURS AFTER THE BURN AND CAN CONTINUE TO UP TO 36 HOURS  [MAJOR BURNS >30%TBSA]
  33. 33. FLUID IMBALANCES 4/1/2011 FLUID IMBALANCES OCCUR AS A RESULT OF FLUID SHIFT AND CELL DAMAGE HYPOVOLEMIA METABOLIC ACIDOSIS HYPERKALEMIA HYPONATREMIA HEMOCONCENTRATION (ELEVATED BLOOD OSMOLARITY, HEMATOCRIT/HEMOGLOBIN) DUE TO DEHYDRATION
  34. 34. FLUID REMOBILIZATION 4/1/2011 OCCURS AFTER 24 HOURS CAPILLARY LEAK STOPS SEE DIURETIC STAGE WHERE EDEMA FLUID SHIFTS FROM THE INTERSTITIAL SPACES INTO THE VASCULAR SPACE BLOOD VOLUME INCREASES LEADING TO INCREASED RENAL BLOOD FLOW AND DIURESIS  HYPOKALEMIA OCCUR
  35. 35. CURLING’S ULCER 4/1/2011 ACUTE ULCERATIVE GASTRO DUODENAL DISEASE OCCUR WITHIN 24 HOURS AFTER BURN DUE TO REDUCED GI BLOOD FLOW AND MUCOSAL DAMAGE TREAT CLIENTS WITH H2 BLOCKERS, MUCOPROTECTANTS, AND EARLY ENTERAL NUTRITION WATCH FOR SUDDEN DROP IN HEMOGLOBIN
  36. 36. 4/1/2011 MUCOPROTECTANTS - SALIVATION INDUCING AGENT
  37. 37. PHASES OF BURN CARE 4/1/2011 EMERGENT (24-48 HRS) ACUTE REHABILITATIVE MANAGEMENT:-
  38. 38. 4/1/2011  EMERGENT OR IMMEDIATE RESUSCITATIVE FROM ONSET OF INJURY TO COMPLETION OF FLUID RESUSCITATION • FIRST AID • PREVENTION OF SHOCK • PREVENTION OF RESPIRATORY DISTRESS • DETECTION AND TREATMENT OF CONCOMITANT INJURIES • WOUND ASSESSMENT AND INITIAL CARE ACUTE FROM BEGINNING OF DIURESIS TO NEAR COMPLETION OF WOUND CLOSURE • WOUND CARE AND CLOSURE • PREVENTION OR TREATMENT OF COMPLICATIONS, INCLUDING INFECTION • NUTRITIONAL SUPPORT REHABILITATION FROM MAJOR WOUND CLOSURE TO RETURN TO INDIVIDUAL’S OPTIMAL LEVEL OF PHYSICAL AND PSYCHOSOCIAL ADJUSTMENT • PREVENTION OF SCARS AND CONTRACTURES • PHYSICAL, OCCUPATIONAL, AND VOCATIONAL REHABILITATION • FUNCTIONAL AND COSMETIC RECONSTRUCTION • PSYCHOSOCIAL COUNSELING
  39. 39. 4/1/2011 
  40. 40. PLASTIC SURGERY
  41. 41. WHAT IS PLASTIC SURGERY?  THE NAME IS TAKEN FROM THE GREEK WORD “PLASTIKOS”, WHICH MEANS TO FORM OR MOLD!  PLASTIC SURGERY IS A SPECIAL TYPE OF SURGERY THAT INVOLVES BOTH A PERSON'S APPEARANCE AND HIS OR HER ABILITY TO FUNCTION.  IT INTENDS TO IMPROVE PATIENTS' APPEARANCE, SELF-IMAGE, AND CONFIDENCE THROUGH BOTH RECONSTRUCTIVE AND COSMETIC PROCEDURES.
  42. 42. WHY DO PEOPLE GET PLASTIC SURGERY? 1. TOIMPROVE THE APPEARANCE. 2. SOME PEOPLE ARE ADDICTED TO COSMETIC SURGERY 3. TOCORRECT A PHYSICAL DEFECT OR TO ALTER A PART OF THE BODY THAT MAKES THEM FEEL UNCOMFORTABLE 4. TOFEEL BETTER ABOUT THE WAY THEY LOOK
  43. 43. THERE ARE TWO MAIN KINDS OF PLASTIC SURGERY: 1. RECONSTRUCTIVE SURGERY - IS USUALLY EMPLOYED FOR MEDICAL PURPOSES, AND SOME COMMON EXAMPLES INCLUDE: *CLEFT LIP SURGERY *BREAST RECONSTRUCTION SURGERY FOR THOSE WHO HAD MASTECTOMY * CONTRACTURE SURGERY FOR BURN SURVIVORS 2. COSMETIC SURGERY - IS DONE MOSTLY FOR AESTHETIC 3. ENHANCEMENT AND INCLUDES: - DIFFERENT TYPES OF COSMETIC SURGERY INCLUDE: TUMMY TUCK (ABDOMINOPLASTY) * LIPOSUCTION * BREAST LIFT * CHEEK AUGMENTATION * BREAST REDUCTION/ENLARGEMENT (AUGMENTATION MAMMAPLASTY) *
  44. 44. WHICH ARE THE MOST COMMON PLASTIC SURGERIES ? 1. TUMMY TUCK 2. EYELID SURGERY 3. LIPOSUCTION 4. BREAST AUGMENTATION  BREAST RECONSTRUCTION  BREAST IMPLANT  BREAST LIFT  BOTOX
  45. 45. GETTING A TUMMY TUCK  TUMMY TUCK (ABDOMINOPLASTY) HELPS TO REDUCE THE APPEARANCE OF A PROTRUDING ABDOMEN, LOOSE SKIN.  STRETCH MARKS IN THE ABDOMINALAREA.  MANY PEOPLE TURN TO A TUMMY TUCK AS A RESULT OF PREGNANCY.  THE ALSO TURN AS E RESULT OF AGE OR OBESITY.
  46. 46. EYELID SURGERY  IS PERFORMED ON ADULTS OF ANY AGE TO CORRECT PROBLEMS ASSOCIATED TO AGING OR TO RECEIVE TREATMENT FOR INHERITED TRAITS.  THEY MAY HAVE LOOSE SKIN HANGING DOWN FROM THE UPPER EYELIDS AND POSSIBLY IMPAIRING VISION  A PUFFY APPEARANCE TO THE UPPER EYELIDS THAT MAKE THE EYES LOOK TIRED  EXCESS SKIN AND FINE WRINKLES OF THE LOWER EYELIDS,  DARK CIRCLES UNDER THE EYES  EYELID SURGERY CAN NORMALLY FIX THESE TYPES OF PROBLEMS, BUT SOMETIMES AN EYELID SURGERY MAY BE NEEDED IN COMBINATION WITH ANOTHER TREATMENT.
  47. 47. GUIDE TO GETTING LIPOSUCTION  LIPOSUCTION (LIPOPLASTY) IS THE ELIMINATION OF UNWANTED FAT.  EVERY YEAR, HUNDREDS OF THOUSANDS OF AMERICAN MEN AND WOMEN UNDERGO LIPOSUCTION PROCEDURES TO ELIMINATE UNWANTED AND PERSISTENT POCKETS OF FAT IN THE:  ABDOMEN  HIPS  THIGHS  BUTTOCKS  ARMS
  48. 48. BREAST AUGMENTATION  BREAST IMPLANTS ARE USED DURING AUGMENTATION TO INCREASE THE SIZE OF THE BREAST.  TO INCREASE SHAPE OF THE BREAST.  TORESTORE BREAST VOLUME LOST AFTER WEIGHT REDUCTION OR PREGNANCY.
  49. 49. PROS AND CONS OF PLASTIC SURGERY  COSMETIC SURGERY IS PURSUED TO ENHANCE THE MAGNIFICENCE OF THE PERSON.  PLASTIC SURGERY IS TO LOOK ENERGETIC AND TO PLEASE HIMSELF.  THERE IS A DEVELOPMENT OF SELF-ESTEEM IN THE PERSON IF THE PLASTIC SURGERY IS SUCCESSFUL  LEAVES SOME MARKS OR SPOTS ON THE BODY WHICH CAN BE RECTIFIED BY PERFORMING ANOTHER PLASTIC SURGERY  RISKS DEPEND ON THE TYPE OF PLASTIC SURGERY. (BREAST AUGMENTATION, BLEEDING OF GEL)  THE RISKS OF LIPOSUCTION INCLUDE DISCOLORATION, DEPIGMENTATION, NUMBNES S, BRUISING AND PAIN.  FACELIFT PLASTIC SURGERY INVOLVES VARIOUS SIDE EFFECTS: NERVE DAMAGE WHICH MAKES THE PERSON’S FACE INSENSIBLE.  THE PATIENT ALSO SUFFERS FROM MILD SIDE EFFECTS: FEELING PAIN IN THE AFFECTEDPART AND INFLAMMATION. BENEFITS DRAWBACK
  50. 50. THEREFORE, PLASTIC SURGERY HAS TWO SIDES – ONE IS BENEFIT SIDE AND THE OTHER ONE IS THE DRAWBACK SIDE AND THE PATIENT HAS TO EXPERIENCE BOTH THE SIDES.
  51. 51. THANK YOU!

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