2.
Burns and scalds are injuries caused to skin by heat.
Burns are injuries due to dry heat, scalds are due to
moist heat.
BURNS AND SCALDS
3.
Most of our contacts with environment are through the
skin. Skin has many functions. It covers the body and
protects the deeper tissues from drying and injury. It
protects from invasion by infectious organisms. It regulates
body temperature and contains many nerve endings for
sensations. It also acts as an excretory organ to some extent.
Skin consists of two layers. Epidermis and dermis.
TYPES OF BURNS
4.
Superficial burns. In this type of burn only the
epidermis is burnt. It is very painful since epidermis
contains most of the nerve endings. Through it is
painful but it heals easily.
Deep Burns. In deep burns epidermis and dermis
both are burnt. There is little or no pain but it takes
longer time to heal and will leave a scar.
5.
Dry heat like fire, flame, a piece of hot metal or the
sun.
Electric burns. From electric shock, from electric
mains or lightning.
Friction. Such as continuous friction on the rope or
moving wheel.
CAUSES OF BURNS
6.
Chemical burns. Due to strong acids such a sulphuric acid and
nitric acid. Due to strong alkalies such as caustic soda and
strong ammonia.
Radiation burns. Due to X-ray radiation, and nuclear radiation.
Wet Heat. Burns due to wet heat are called scalds and are
caused by moist heat due to boiling water, steam, hot oil or hot
tar
7.
The rules of nine fives the relative distribution of total body area
surface. Depending on the body surface burnt, percentage of
burns can be calculated.
Head & neck 9%
Anterior trunk 18%
Posterior trunk 18%
Upper extremity (9x2) 18%
Lower extremity (18x2) 36%
Perineum 01%
Total 100%
EXTENT OF BURNS
9.
First degree burn is epidermal burn alone which normally
present as erythema/redness only. Typical example is
sunburn. Burns due to any other cause is rarely a true first
degree burn. They are very painful. There is no blister
formation. It resolves in 3-5 days without scarring.
Second degree burn involves epidermis and a portion of
dermis but not the complete dermis. This is further divided
into superficial or deep.
UNDERSTANDING THE DEPTH OF
BURN
10.
Second degree superficial is associated with
involvement of epidermis & papillary dermis. It is
characterized by severe pain, hyperaesthesia and
blister formation. It heals in 10-20 days with minimal
scarring.
Second degree deep or deep dermal burn involves
epidermis, papillary dermis & a part of reticular
dermis. Wound is waxy white, soft & elastic. It heals
in 3-5 weeks and usually causes hypertrophic scar.
They are in danger of getting converted to full
thickness due to infection or drying
11.
Third degree burn is also known as full thickness
burn which involves the full thickness of skin, whole
epidermis and dermis. It appears as tough, dry,
inelastic, translucent & parchment likes eschar.
13.
Red raw skin, blister formation, swelling in the area
around the burnt part, oozing of fluid from burns. Patient
may complain of intense pain, he may be in shock in case
of severe burns. Sometimes the casualty may become
unconscious.
Increased pulse rate (Tachycardia)
Signs and symptoms
14.
Dryness of mouth and skin (Dehydration)
Cold clammy extremities (Hypothermia)
Fall of blood pressure (Hypotension)
Decreased urine output(Oliguria)
15.
The principles of treating a burn are to reduce heat caused by the
burn, to prevent infection and to replace the fluid which has oozed
from the body.
Removal of cause.
Reduce Heat
Management of minor burns and scalds
Clean the area lightly with clean water.
Soak the burnt area in cold water for 10-15 minutes.
Management by first aider
16.
Cover with dry dressing. Dressing can be improvised by clean
washed and ironed handkerchief or hand towel.
Do not apply any greasy substance.
Give warm drinks like tea, coffee, Horlicks or milk.
Give rest to the burnt area & keep it elevated for sometime
If fingers or hands are involved, remove the finger rings and
bangles
17.
Any clothing which has been affected by the chemicals
should be removed immediately.
Wash thoroughly the burnt part with cold water
Do not apply any greasy ointment.
Apply clean dressing
Give rest to the burnt area.
Give warm drinks if the casualty is not vomiting.
If more than 10% body surface is affected, send the casualty
to nearest medical aid.
Management of chemical burns
18.
Management of severe burns
Body area more than 30% burnt is severe burns.
1. Remove the cause if casualty is still on fire.
2. Reassure the casualty.
3. Do not remove burnt clothing which sticks to the body
surface.
Management of electrical burns
19.
4. Cover the casualty with clean sheet/blanket, to keep him
warm.
5. If the hands or feet are involved, they should be kept
elevated on a pillow, to reduce swelling.
6. If casualty’s face is burnt, keep him in upright position.
20.
7. Remove quickly from the body anything of constricting
nature like rings, bangles, belt, shoes. If the limb begins to
swell, it will be difficult to remove them and area around
constriction may feel strangulated.
8. Do not break blisters.
9. Do not give anything by mouth.
10. Call for an ambulance and send the patient to the nearest
medical aid as soon as possible.
21.
a. Initial 24 hours: Ringer’s lactated (RL) solution 4 ml/kg/%
burn for adults and 3 ml/kg/% burn for children. RL solution
is added for maintenance for children:
4 ml/kg/hour for children weighing 0–10 kg
40 ml/hour +2 ml/hour for children weighing 10–20 kg
60 ml/hour + 1 ml/kg/hour for children weighing 20 kg or
higher
This formula recommends no colloid in the initial 24 hours.
Parkland formula
22.
b. Next 24 hours: Colloids given as 20–60% of calculated
plasma volume. No crystalloids. Glucose in water is added in
amounts required to maintain a urinary output of 0.5–1
ml/hour in adults and 1 ml/hour in children.
Modified Parkland formula
a. Initial 24 hours: RL 4 ml/kg/% burn (adults)
b. b. Next 24 hours: Begin colloid infusion of 5% albumin
0.3–1 ml/kg/% burn/16 per hour
