The extent of burns is expressed as percentage of the total surface area.
Scalds are the leading cause of burn injuries during the first 3 years of life.
Burns lead to alterations in the function of all organ systems. There is inability to thermoregulate because of the skin’s abnormal evaporative loss. In very extensive burns, the amount may reach 8-10 L/day. For every ml evaporated, 0.5 calorie is needed to restore the body temperature to normal since evaporation cools the body.
Infant Rule of Nines (for quick assessment of total body surface area affected by burns) 1% Perineum 9% Each Arm 14% Each Leg 18% Posterior Torso 18% Anterior Torso 18% Head Surface area Anatomic structure
Burn Photos Chemical (Acid) Burns Radiation (Flash) Burns
Burn Photos Electrical Burns Entrance Wounds Electrical Burns Exit Wounds Entrance wound of electrical burns from an overheated tool Severe swelling peaks 24-72 hrs after Electrical burns mummified 1 st 2 fingers later removed
The initial period of hypofunction manifests as: (a) Hypotension, (b) Low cardiac output, (c) Metabolic acidosis, (d) Ileus, (e) Hypoventilation, (f) Hyperglycemia, (g) Low oxygen consumption and (h) Inability to thermoregulate
This ebb phase occurs usually in the first 24 hours and responds to fluid resuscitation
The flow phase, resuscitation , follows and is characterized by gradual increases in (a) Cardiac output, (b) Heart rate, (c) Oxygen consumption and (d) Supranormal increases of temperature
This hypermetabolic hyperdynamic response peaks in 10-14 days after the injury after which condition slowly recedes to normal as the burn wounds heal naturally or surgically closed by applying skin grafting
Renal blood flow and GFR decrease soon after due to hypovolemia, decreased cardiac output, and elevated systemic vascular oliguria and antidiuresis develops during 1 st 12-24 hours
Followed by a usually modest diuresis as the capillary leaks seal, plasma volume normalizes, and cardiac output increases after successful resuscitation and coinciding with onset of the postburn hypermetabolic state, and hyperdynamic circulation
Extinguish flames by rolling in the ground, cover child with blanket, coat or carpet
After determining airway is patent, remove smoldering clothes and constricting accessories during edema phase in the 1 st 24-72 hours after
Brush off remaining chemical if powdered or solid then wash or irrigate abundantly with water
Cover burn wounds with clean, dry sheet and apply cold (not iced) wet compresses to small injuries; significant burns (>15-20% BSA) decreases body temperature which contraindicates use of cold compress dressings
If burn caused by hot tar, mineral oil to remove it
General assessment and cardiopulmonary stabilization
Establishment of IV lines and blood studies
Wound care and infection control
Pain relief and psychological support
Physical Therapy/Occupational Therapy
Airway compromise? Respiratory distress? Circulatory compromise? Intubation, 100% O 2 IV access, fluids Multiple trauma? Yes No Evaluate & treat injuries Burns >15% or complicated burns? Yes No Burn care, tetanus prophylaxis, analgesia IV access; fluid replacement Circumferential full thickness burns? Escharotomy Yes Yes No No