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This lecture deals about the complications of burns in the following subcategories;
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1. Cardiorespiratory complications
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2. Septic complications
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3. Gastrointestinal complications
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4. Other complications

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At the end of this lecture the students will be able to;
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Explain the complications of burn in different systems level.
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Compare & contrast the complications of burns between different systems.

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Acute Lt ventricular failure
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Congestive cardiac failure
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Myocardial infarction
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Pneumonia
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Pulmonary embolism.

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Burn wound sepsis
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Virus infection
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Bacteremia
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Septic shock

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Hepatic dysfunction
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Pancreatitis
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Calculus cholecystitis
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Renal complications

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Neurological complications
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Vascular complications
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Skeletal complications
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Amputation

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Circulatory disruption occurs at the burn site immediately after a burn injury
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Blood flow decreases or cease due to occluded blood vessels
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Damaged macrophages within the tissues release chemicals that cause constriction of vessel
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Blood vessel thrombosis may occur causing necrosis
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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.

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The most frequent complications of the major burn are due to bacterial, fungal infection.
Burn wound sepsis is an imbalance in the equilibrium between bacterial and host resistances resulting in numerical increase in bacteria.
As bacteria increase from normal level of 10 3 organism per gram of tissue to level of greater than 10 5 organism per gram of tissue. So they break out the hair follicles and the glands and migrate through colonizing a long dermal subcutaneous interface.
Level of growth in excess of 10 5 organism per gram. Of tissue constitute ( burn wound sepsis).
Level of 10 8 to 10 9 organism per gram may be associated with lethal burn.
In rare cases, an infected burn can cause blood poisoning ( sepsis ) or toxic shock syndrome (TSS) . These are serious conditions that can be fatal if not treated. Signs of sepsis and toxic shock syndrome include a high temperature, dizziness and vomiting.

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Un treated hypovolemia leads to acute renal failure.
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Acute renal failure that may occur if the principles of fluid resuscitation are not understood
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Following an acute burn, oliguria or anuria shouldn't be diagnosed as renal failure but only ( insufficient volume replacement).
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To be sure that patient takes adequate fluid resuscitation, the amount of urine output must be ( 30-50 ml per hour).

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First group of patients are die at site of fire within moments of injury because of:
 Asphyxia ( as the o
2 will be consumed)
 At concentration of 2%, the death ensues in 45 sec.
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The inspired air contain co that can reach to 3000 ppm, combine with Hb and decrease availability of tissue to o
2
.
Inhalation of HCN contained in smock, this cause rapid tissue hypoxia plus hyperventilation.
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Inhalation of sulphur dioxide and hydrochloric acid that cause bronchospasm.
 The edematous response of larynx.

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The next group of patients with pulmonary complications develop respiratory symptoms several hours after admission.
 These group of patients develop hypoxia and hypercapnia and high levels of carboxyhaemoglobin, restlessness, wheezing.

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It is a leading cause of death in burn victim.
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Multiple blood transfusions add to risk of infection.
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Several anesthesia may be required during the course of management, exposing the patient to the dangers of drug induced hepatitis.

PERIARTICULAR
CLASCIFICATION
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Complications involving bone
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Exposed bone
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Fractures
 Osteoporosis
 Bone spurs
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Bone growth retardation
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Heterotopic ossifications: - Formation of new bone in tissue that manually don't ossify

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Complications involving joint
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Septic arthritis
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Capsular tightness
 Dislocations
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Complications involving tendon
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Exposed tendon
 Tendonitis
TENDON DESTRUCTION
FOOT DROP -
CONTRACTURE
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Structural deformities subsequent to scarring and scar management.

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A scar is a patch or line of tissue that remains after a wound has healed. Most minor burns only leave minimal scarring. You can try to reduce the risk of scarring after the wound has healed by:
 applying an emollient , such as aqueous cream or emulsifying ointment, two or three times a day
 using sunscreen with a high sun protection factor (SPF) to protect the healing area from the sun when you are outside

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Hypertrophic scar = continued production of collagen
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Keloid = ….with extension into surrounding tissues
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Scar contracture

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The hypertrophic scar is defined as a widened or unsightly scar that does not extend beyond the original boundaries of the wound. Unlike keloids, the hypertrophic scar reaches a certain size and subsequently stabilizes or regresses.
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Keloid scars are defined as an abnormal scar that grows beyond the boundary of the original site of a skin injury. It is a raised and ill defined growth of skin in the area of damaged skin.

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Weakness of muscles
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Lack of sensations
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Types:
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Generalized peripheral neuropathy (poly neuropathy) - Patient complains of fatigue and lack of endurance, distal weakness in upper and lower extremity.
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Local neuropathy: - It is caused by a stretch or compression injury to a single nerve.

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Heart problems
Inhalation injuries
Pneumonia
Adult respiratory distress syndrome - ARDS (shock lung)
Infection of the wound site
Infection of the urinary tract
Septicemia
Renal and liver failure
Joint effusion and periarticular swelling
Calcification of periarticular tissues
Contraction of scar tissue causing joint deformity
Psychological trauma to the patient