2. SOME TERMS
• Burn is a type of coagulative necrosis caused by heat transferred
from the source to the body.
• Frost bite is also a coagulative necrosis but is caused by extreme
degrees of cold.
• Scald is a burn caused by moist heat(steam)
Burn never occur at T0< 440c.
3. Types of burn
Thermal burn:- severity depend on Temprature, duration of exposure,
and thickness of the skin.
eg. Flame, hot liquid, hot solid objects and steams
Chemical burn:- caused by a wide range of caustic reactions, including
alteration of PH, disruption of cellular membranes, and direct toxic
effect on metabolic processes.
:- severity depends on nature of the agent in addition to
the
duration of exposure
Electrical burn:- severity depends on the path way of the current, the
resistance to the current flow through the tissue, and the strength and
durtion of the current flow
Inhalational burn:- toxic product of combustion injure airway tissues
and frequently occur with flash burns from fire and steam.
Radiation burn:- most common cause is sun burn. Often associated with
due to ability of ionizing radiation to interact and damage DNA.
4. Classification of burn
Based on the depth of tissue injury cutaneous burns can be
classified into
1. Superficial (first degree burn)
-only epidermal layer
- no blister but painful red ,
and blanch with pressure.
- heals with in 6 days with out
scar
eg, sun burn
flame
flash from explosion
5. 2, partial thickness( second degree)
involves the whole epidermis and
parts of the dermis.
:- superficial
-epidermis and
papillary layer of dermis.
-painful red, and weeping,
blanch with pressure
-heal in 7-21 days
-scaring is unusual but
pigment change may occur.
6. :- deep second degree burn
- involve up to the reticular layer
of the dermis
-damage hair follicles and
glandular tissue
-painful to pressure only, blister
(easily unroofed)
- wet or waxy dry, not blanch with
pressure
- patchy cheesy white to red
7. 3, full thickness ( third degree)
burn
-involve the whole layers of the
dermis and often injure the
subcutaneous tissue.
- usually anesthetic or
hypo esthetic
- waxy white to leathery gray to
charred and black
- skin is dry and inelastic and
does
not blanch with pressure.
-no vesicles or blister
- hair follicles pulled off easily
8. 4 , fourth degree burn
• Extends to muscle
• Loss of function
• Black, charred appearance
• May require amputation
• May require escharotomy and
fasciotomy
• Causes: very prolonged exposure
to flame, chemicals, and high
voltage
10. Percent body surface area estimates
A thorough and accurate estimation of burn size is essential to
guide therapy and to determine when to transfer a patient to a burn
center.
The two commonly used methods of assessing TBSA in adults are
the Lund-Browder chart and "Rule of Nines," whereas in children,
the Lund-Browder chart is the recommended method because it
takes into account the relative percentage of body surface area
affected by growth.
“rule of nine”
Each leg represents 18 percent TBSA
Each arm represents 9 percent TBSA
The anterior and posterior trunk each represent 18 percent
TBSA
The head represents 9 percent TBSA
11. continued
Palm method
Small or patchy burns can be approximated by using the surface
area of the patient's palm. The palm of the patient's hand,
excluding the fingers, is approximately 0.5 percent of total body
surface area and the entire palmar surface including fingers is 1
percent in children and adults
12. Classes of burn based on severity
MINIOR BURN
• Less than 15% of TBSA in adults
• Less than 10% of TBSA in children or older population
• Less than 2% full thickness burn
• No functional loss to:
• Eyes
• Ears
• Face
• Hands/feet
• Perineum
13. Moderate burn
• Partial-thickness of 15-25% TBSA in adults
• 10-20% TBSA in children or older person
• Full thickness of 2-10% TBSA
• No loss of function to:
• Eyes, ears, face, hands, feet or perineum
• Excludes:
• High-voltage electrical burns
• Inhalation injury
• Requires hospitalization
14. Major burn
• Partial thickness burns > 25% of
TBSA in adults
• 20% of TBSA in children/older
persons
• Full-thickness of 10% of TBSA
• Involving:
• Face, eyes, ears, hands, feet or
perineum
• Burns caused by:
• Caustic agents
• High-voltage electrical
• Complicated inhalation injuries
• Requires specialized care
15. Initial evaluation and treatment
• Initial evaluation involves
-ATLS
-estimation of the burn size
-diagnosis of CO and cyanide poisoning.
- early transfer to burn center injuries meet the criteria
16. Guidelines for referral to a burn center
• Partial-thickness burns greater than 10% TBSA
• Burns involving the face, hands, feet, genitalia, perineum, or
major joints
• Third-degree burns in any age group
• Electrical burns, including lightning injury
• Chemical burns
• Inhalation injury
• Burn injury in patients with complicated pre-existing
medical disorders
17. Guidelines …….
• Patients with burns and concomitant trauma in which
the burn is the greatest risk. If the trauma is the greater
immediate risk, the patient may be stabilized in a trauma
center before transfer to a burn center.
• Burned children in hospitals without qualified personnel for
the care of children
• Burn injury in patients who will require special social,
emotional, or rehabilitative intervention
18. Treatment
• FLUID Resuscitation parkland formula…4ml/%/kg
• Oxygen supplementation
• Blood transfusion
• Immediate burn care and cooling — Any hot or burned clothing, jewelry,
and obvious debris should immediately be removed to prevent further injury
and to enable accurate assessment of the extent of burns
Burned areas should be cooled immediately using cool water or saline
soaked gauze
Pain and anxiety management
Chemoprophylaxis ….tetanus and topical antibiotics
Wound management
.
