Burn, degrees and management

1. NUR FADZLINA ZABRI
082013100006

2. Definition
• Burn is a type of coagulative necrosis caused
by heat, transferred from the source to the
body
• Types :
1. Thermal : flame and scald
2. Electrical
3. Chemical
4. Radiation
• Frostbite is also a coagulative necrosis but it
is caused by extreme degrees of cold

4. electrical BURNS

6. CHEMICAL
BURNS

7. Injury to the
airway and
lung
Inflammation
and circulatory
changes
Other life
threatening
events
Pathophysiology of burns

8. Injury to the airway and lung
Physical burn injury to the
airway above larynx
– Hot gases bur the nose,
mouth, tongue, palate
– Lining of these structures
started to burn and swell
– Obstruct the airway

9. Metabolic poisoning
Carbon monoxide
binds to Hb
Blocks oxygen
transport
Hydrogen cyanide
Interfere mitochondrial
respiration
Metabolic acidosis

10. Inhalational injury
Minute particles not filtered by airways
Stick to moist lining, causing intense reaction in
alveoli
Chemical pneumonitis causing edema within
alveolar sac
Bacterial pneumonitis

11. • Immune system and infection
• Changes to intestine
• Danger to peripheral circulation
Inflammation and circulatory changes
Other life threatening events

12. Pre hospital care
– Stop burning
process
– Check other
injuries
– Cool the burn
wound
– Give oxygen
– Maintain airway
Care of burn patient
Hospital care
– Airway
maintenance
– Breathing
– Circulation
– Disability
– Exposure in a
controlled
environment
– Fluid resuscitation

13. Airway maintenance

14. Assessment of burn wound

16.  First degree – injury localized to the epidermis
 Second degree
 Superficial second degree – injury to the epidermis and
superficial papillary dermis
 Deep second degree – injury through the epidermis and
deep up to reticular dermis
 Third degree – full-thickness injury through the
epidermis and dermis into subcutaneous fat
 Fourth degree – injury through the skin and
subcutaneous fat into underlying muscle and
bone
Grading of burns

18. Heals in 3-4
days by peeling
of epidermis
Forms blister.Heals in
3-9 weeks with
scarring, sensitive on
pressure
All elements are
destroyed no
potential to heal

21. IV fluid with IV narcotics analgesic, antibiotics
– Children : 10% per cent
– Adult : 15% per cent
– Fluid use – ringer lactate’s/Hartmann’s solution,
fresh frozen plasma, hypertonic saline
Treatment of burn shock

22. • Monitoring :
– Urine output should be 0.5-1.0ml/kg body weight
– If less , infusion rate should be increased by 50 per
cent
– Signs of hypoperfusion : bolus of 10ml/kg body
weight
– Acid-base balance
– Hematocrit level

23. Treatment of burn wound
Escharatomy
– Incising the whole length of full thickness
– Large amount of blood may loss

24. Full-thickness burns and obvious deep dermal
wounds
– Dressing with nanocrystalline silver

25. Superficial partial thickness wounds and mixed
depth wounds
– Vaseline impregnated gauze or fenestrated
silicone sheet
– Prevent swabs adhere to the wound, reduces the
stiffness of dry eschar
– Early debridement and grafting

26. Additional treatment
• Analgesics
• Energy balance and nutrition
• Monitoring and control of infecrion
• Nursing care
• Physiotherapy
• Psychological

27. Surgery for the acute burn wound
• Any deep partial thickness and full thickness
burn requires surgery

28. Delayed reconstruction and scar management
– Common for large full-thickness burns

31. Minor burns
• Local burn wound care
• Topical agents
• Dressing wound
• Debridement or grafting if wound not heal
• Itching :antihistamines , endopeptides, aloe
vera

32. Non thermal burn injury
Electrical injury
• Results from source of electrical power that makes
contact with patient’s body
• Treatment : ABC,IV access, ECG, urine output
monitoring
• Intravenous fluid administration should be increased to
ensure urine output of 100ml/hr in adult
• If pigment is not clear with increased fluid, 25g mannitol
given and 12.5g mannitol should be added in
subsequent liters of fluid to maintain diuresis

34. Chemical injury
– Results from alkali, acid or petroleum products
– Burn is influenced by duration of contact,
concentration and amount
– Burn site should be immediately flushed with copious
amount of water for at least 20-30 minutes
– Alkali burns require longer irrigation
– If dry powder present, brush it away before irrigation

35. References
• Bailey and Love
• Internet