1. BURN DISEASES
ONAZI THERESA
SOURCES:U.S. Department of Health & Human Services
National Library of Medicine
WORLD HEALTH ORGANIZATION
PubMed Citations

2. Burns: Instinct, Assessment, Triage, Time
 Partial or complete skin
destruction by energy, usually
thermal.
 Dry vs Wet (Scalds)
 First response: First Aid to
Hospital to Burn Centre.
 Primary assessment- ABCDE
 Secondary Assessment- Degree of
burn.
 Decision under pressure, many
patients
 Golden hour, critical 6 and 24hr
surveillance.

3. BURNS: As Simple as ABCDE
 Primary Assessment
 Removal from source, area
survey.
 Airway– Obstruction
 Breathing- Hypoxia
 Circulation- Shock
 Disability- Compartment
Syndrome
 Exposure- Total Body Surface
Area (TBSA)

4. BURNS: A-Airway and B-Breathing
 Airway.
 Extensive Burns >35-40% TBSA
 Head, Mouth and Nares
 Hoarse voice
 Accessory Respiratory muscles
 Early Endotracheal Intubation
 Inflammation and Oedema
 High Anxiety
 Intubation Complications
 Breathing
 Fire Oxygen Consumption
 CO poisoning: Non-Diagnostic (PaO2, Oximeter, ‘cherry red’) vs. Diagnostic
(Carboxyhaemoglobin <10%=normal; >40%=intoxication). 100% oxygen
required.
 Smoke inhalation: singed facial hair, soot in sputum or saliva, oedema,
erythema, ulceration. Bronchoscopy, early chest x-ray, early blood gases.
Supportive pulmonary treatment, aggressive respiratory therapy.

5. BURNS: C-Circulation and D-Disability
 Circulation.
 Massive Capillary Leak
 Fluid Shift
 Fluid requirements directly proportional to TBSA,
degree, comorbidity and inhalation.
 >20% TBSA, IV access with 2 large-bore cannulas in:
Unburned>>Burned>Central access*>Cut-downs**.
Blood assessment.
 Peripheral circulation. Circumferential burn.
 Foley Catheter. 24-hr Urine output 0.5ml/kg/hr in
adults and 1ml/kg/hr in children. >20% TBSA.
 Ringer’s Lactate solution. Isotonic, cheap, easy
storage.
 Parkland Formula: 4 x weight in kg x %TBSA burn.
Give 1/2 of that volume in the first 8 hours
 Give other 1/2 in next 16 hours
 Disability: Neurological (GCS) and Compartment
Syndrome
 Severe pain (worse with movement), numbness, cool
extremity, tight feeling compartments.
 Palpable arterial pulse.
 pressure >30 mmHg may compromise muscle/nerves
 Measured by arterial line monitor (place needle into
compartment)
 Escharotomy. Fasciotomy. Expertise. Homeostasis.
 High index of suspicion in completely circumferential
burns. Foley catheter for abdominal pressure.

6. ESCHAROTOMY IN CIRCUMFERENTIAL BURN

7. BURNS: E-Exposure
 TBSA % of burn.
 Rule of 9’s
 Lund-Browder diagram
 Degree of burn, secondary
assessment bridge.
 If the burned area is small,
assess how many times your
hand covers the area.
Morbidity and mortality rises
with increasing burned
surface area. It also rises
with increasing age so that
even small burns may be
fatal in elderly people.

8. 1^Assessment
Algorithm

9. BURNS: Secondary Assessment
 Degree of Burns
 Head to toe examination to look for
any concomitant injuries
 Depth Assessment. 4th degree.

10. BURNS: Treatment and Follow-up
 Wound care. Secondary importance.
 Cooling. Keeping the patient warm. >5%
TBSA
 Covering with and dry clean gauze or sheet.
 Prolonged care: debridement, soap and
water, temp. maintenance.
 Topical antimicrobials: Silver sulfadiazine,
bacitracin.
 Tetanus prophylaxis. Systemic antibiotics,
avoid prophylaxis.
 IV.
 Skin grafting.
 Electric burns (internal), chemical burns
(irrigation).
 Contracture prevention in children. NG tube
6000kcal/day.

11. THANK YOU