Skin is the largest organ in the body and isolates
chemically, thermally, biologically and
mechanically the inside from the outside.
3. Initial Assessment of Burns
• Secure the airway first.
• Get history as much as reasonably possible
• Soot or singed nasal hairs?
4. B. Breathing:
• High flow Oxygen for all.
• Listen: verify breath sounds
• Assess rate & depth.
• Monitor Blood Pressure, Pulse, and Skin color.
• Establish IV access.
• Warm IV fluids.
• Monitor peripheral pulses in circumferential
5. D. Disability:
• Associated Injuries?
• CO poisoning?
• Substance abuse?
• Pre-existing medical condition.
• Remove clothes and jewelry.
• Ensure warm environment.
• Clean dry blankets.
• It is OK to use water to stop the burning process
but not at the expense of reducing body core
6. • Secondary Survey:
– Repeat primary survey.
– Complete History of Present Illness (HPI).
• What type of burn (flame, chemical, scald)
• Duration of exposure
• What time did burn occur?
• What treatment already provided?
(chemical brushed off, water to cool, etc)
• Did burn occur in house fire/enclosed space? (think
7. Order labs and x rays
CBC, KFT, LFT,
Chest X-ray (CXR)
EKG (especially in electrical injury)
• Abuse patterns
– Children, elderly
• Concomitant trauma
– C-spine precautions
– Trauma protocols if trauma is majority
8. Major Steps in Burn Treatment
IV fluids for burns > 10% TBSA
Wound cleaning, dressing, and serial
assessment (Use Hibiclens and sterile water
(not saline – it stings more when mixed with
Transfer or referral of selected patients to
Surgery and physical therapy for deep partial
thickness and full-thickness burns
9. Commence Fluid Resuscitation
Fluid resuscitation is recommended for the
– Adults (>15%TBSA burn)
– Children (>10%TBSA burn)
The goal of fluid resuscitation is to anticipate
prevent hypovolemic shock.
A variety of fluids have been recommended
for use, such as plasma, human albumin
solution (HAS), dextran and Hartmann’s
10. Commence Fluid Resuscitation
The amount of fluid given in the first 24h (mls)=
3 – 4 mls/kg/TBSA%
½ in the first 8h
¼ in the second 8 hrs
¼ in the third 8 hrs
11. Commence Fluid Resuscitation
Maintenance fluids should also be added over
and above the Modified the formula for
children weighing less than 30kgs.
Use 5% Dextrose in Lactated Ringer's (D5LR):
hypertonic (pH: 4-6.5)
– Each 100ml contains 5g of Dextrose
Monohydrate, 600mg of Sodium Chloride,
310mg of Sodium Lactate Anhydrous, 30mg of
Potassium Chloride, and 20mg of Calcium
12. Rule of Nine
13. Inhalation Injury
14. First Degree Burn
A first degree burn is confined exclusively to
the outer surface and is not considered a
No skin barrier functions are altered.
The most common form is sunburn which heals
by itself in less than a week without a scar.
15. Second Degree Burn
Second degree burns cause damage to the
epidermis and portions of the dermis.
Since it does not extend through both layers, it
is termed partial thickness.
There are a number of depths of a second
degree or partial thickness burn which are used
to characterize the burn.
16. Third Degree Burn
Full thickness buns
Both layers of skin are
leaving no cells to heal.
Any significant burn will
require skin grafting.
Small burns will heal with
Entire destruction of the
epidermis and dermis,
leaving no residual
epidermal cells to