BURNS.pdf

BURNS
3/30/202
0
BY A. MUSONDA. Dip. CM,BcSC.MBChB under study. 1

THE SKIN
• The skin is the largest organ of the body
• While not very active metabolically, the skin serves
multiple functions essential to the survival of the
organism
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FUNCTIONS OF SKIN
• Thermal regulation and prevention of fluid loss by
evaporation
• Mechanical barrier against infection
• Contains sensory receptors that provide information
about environment
• cosmetics
• Locomotion
• Major burns compromise these functions
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SKIN LAYERS
• Epidermis: This is the outermost layer composed of
cornified epithelial cells
• Dermis: This is the middle layer composed of
primarily connective tissue, hair follicles and sweat
glands
• Hypodermis: This is a layer of adipose and
connective tissue between the skin and underlying
tissues
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INFANTS AND CHILDREN
• Most scald burns to children, especially small
children aged 6 months to 2 years, are caused by hot
foods or liquids spilled in the kitchen or other areas
where food is prepared and served
• Children aged 4 years and younger and children with
disabilities are at the greatest risk of burn-related
death and injury, especially scald and contact burns
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• The leading cause of residential fire-related death
and injury among children aged 9 years and younger
is due to carelessness
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HISTORY
• consider the type of burn (thermal, chemical,
radiation,electrical)
• Add to the description: contact (with source name),
scald (with fluid or gas type), heat, and flame
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• The most common type of burns are thermal burns
• Soft tissue is burned when it is exposed to
temperatures above 46°C
• The extent of damage depends on surface
temperature and contact duration
• A thermal burn causes coagulation of soft tissue
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As soft tissue temperature increases:
• Capillary permeability increases
• Fluid loss occurs
• Plasma viscosity increases with resultant
microthrombi formation
• Fluid loss can lead to hypovolemia and shock,
depending on the amount of loss and response to
resuscitation
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96
• Burns cause an increased metabolic rate and energy
metabolism
• How the individual responds to the increased energy
demands will dictate recovery
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Definition of Burns
Injury to tissues caused by contact with Flames,
Friction, Radiation, Electrical, Chemical and Heat.
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CLASSIFICATION
• Burn depth is described as first, second, or third degree
• SUPERFICIAL BURNS(1st degree)
• First-degree burns involve only the epidermis
 Tissue blanches with pressure.
 Tissue is erythematous and often painful.
 Tissue damage is minimal.
 NO BLISTERS
 Painful(pin prick is positive)
 Heals with no scars usually
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PARTIAL-THICKNESS BURNS
• Second-degree burns are also referred to as partial-
thickness burns
• Epidermis and portions of the dermis are involved
• Accesory structures (eg, sweat glands, hair follicles)
are often involved
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PARTIAL-THICKNESS BURNS
a. Superficial partial thickness
• Involves epidermis and the papillary dermis(uppermost layer
of the dermis)
• Red
• Blistering, moist
• Painful
• Healing complete by 14 days
• Minimal or no permanent scars but can leave discoloration
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b. Deep partial thickness
• Involves epidermis, upper dermis (papillary) and varying
degrees of lower dermis (reticular)
• Pale, molted appearance
• Fixed staining (no blanching)
• May be painful or insensate (depending on depth)
• May take weeks can leave significant scars and contractures
over joints depending on time taken to heal
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FULL-THICKNESS BURNS
• Third-degree burns are also referred to as full-
thickness burns
• These burns are characterized by charring of skin or
a translucent white color, with coagulated vessels
visible below
• The area is insensate, but the patient complains of
pain, which is usually a result of surrounding second-
degree burns
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• As all of the skin tissue and structures are destroyed,
healing is very slow
• Third-degree burns are often associated with
extensive scarring because epithelial cells from the
skin appendages are not present to repopulate the
area
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Full thickness burns-Third Degree
• Both dermis and epidermis burnt.
• No blisters
• Skin appendages damaged.
• Pin prink sensation-negative (Insensitive)
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When you are on call, the pt. comes with burns. What 3 things
would you tell the consultant on phone about the pt.?
• a. The % ESTIMATE of the burns: as this will help in the Mx
of the pt., whether to admit or not and expected complications
• b. What CAUSED the burns - this will help tell the depth of
the burns
• Domestic burns are usually superficial
• Industrial burns are usually deep
• c. What TIME did the pt. get burnt - this will help in fluid
replacement therapy
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BURN EXTENT
 The more body surface area (BSA) involved in a burn, the
greater the morbidity and mortality rates and the
difficulty in management.KNOWING THE TBSA
HELPS IN KNOWING HOW MUCH FLUID TO
GIVE A PATIENT
methods are used to estimate the burn extent
 Palmars rule.An individual's palmar surface represents
1% of the BSA
 Lund and browder (MOST ACCURATE)
 Rule of 7s and 9s
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BURN EXTENT
• A quick method is to use the Rule of Nines and
sevens to estimate the extent of burn injury
• The head represents a greater portion of body mass
in children than it does in adults
• Lund and Browder first described a method for
compensating for the differences, and the Lund and
Browder Chart is used to calculate TBSA in children
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SEVERITY OF BURNS
• On the basis of burn extent and depth, one can
determine the severity of burns
• Any full-thickness or partial-thickness burn involving
critical areas (eg, face, hands, feet, genitals, perineum,
skin over any major joint), as these have significant
risk for functional and cosmetic problems
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Rule of 9 in adults
• Head AND NECK– 9%
• 1 Arm- 9%
• Trunk- 18x2= 36%
• 1 Leg – 18%
• Perineum- 1%
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Rule of 7 in children
• Head and neck – 28%
• 1Arm- 7%
• Trunk – 28%
• Perineum- 2%
• 1Leg- 14%
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SEVERITY OF BURNS
 Circumferential burns of the thorax or extremities
 Significant chemical injury, electrical burns, lightning injury,
coexisting major trauma, or presence of significant
preexisting medical conditions
 Presence of inhalation injury
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AETIOLOGY (causes)
• Flame burns
 Contact with open flame causes direct injury to tissue
 Flame may ignite clothing
 While natural fibers tend to burn, synthetic fibers may melt
or ignite, adding a contact burn component to the injury
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AETIOLOGY
• Contact burns
 Contact burns result from direct contact with a hot object
 Burn injury is confined to the point of contact
 Examples are burns from cigarettes and tools (e.g.,
soldering irons, cooking appliances
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AETIOLOGY
• Scalds
Scalds result from contact with hot liquids
The more viscous the liquid and the longer the
contact with the skin, the greater the damage
Accidental scalds often show a pattern of
splashing, with burns separated by patches of
uninjured skin.
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AETIOLOGY
• Steam burns
Steam burns most often occur in industrial
accidents or result from automobile radiator
accidents
These burns produce extensive injury from the
high heat-carrying capacity of steam and the
dispersion of pressurized steam and liquid
Steam inhalation can actually cause thermal injury
to the distal airways of the lung 3/30/2020

AETIOLOGY
• Gas burns
Inhalation of hot gas normally does not injure
distal airways, as the heat-exchange capacity of the
upper airway is excellent
In this situation, the upper airway is at risk for
thermal injury and subsequent occlusion due to
edema
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AETIOLOGY
• Electrical burns
 Electrical burns produce heat injury by passing through
tissue.
 Ignition of clothing may produce some flame burn, but
most of the injury is deep in the skin
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Admission
Criteria for admission
• -TBSA >10% - for CHILDREN
• -TBSA <5% - in SPECIAL AREAS (Face, Hands,
perineum, joint)
• -TBSA >20% - for ADULTS
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Treatment:
• While minor burns may be treated at home, all other
burns require immediate emergency medical
attention because of the risk of infection,
dehydration, and other potentially serious
complications.
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First-degree burns:
• Run cool water on burned area for 5 - 10 minutes or
cover the area with a cool compress.
• Don't apply oil, butter to the burn.
• Take ibuprofen or acetaminophen to relieve pain and
swelling.
• Any burn to the eye requires immediate emergency
help.
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Second-degree burns:
• Do not break blisters.
• Do not remove clothing that is stuck to the skin.
• Run cool water on burned area for 5 - 10 minutes, or
cover the area with a cool compress then carefully
remove clothing that is not stuck to the skin.
• Elevate burned area above the heart.
• Take ibuprofen or acetaminophen to relieve pain and
swelling.
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• If not near a medical facility, apply bacitracin
ointment or honey on broken blisters to prevent
infection (this is the only situation in which bacitracin
or honey should be applied to burned skin).
• If the burn is near the mouth, nose, or eye, seek
emergency medical help immediately.
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Third-degree burns:
• If the person is on fire, have them stop, drop, and roll.
• Call 991.
• Check airway, breathing, and circulation.
• Do not remove clothing that is stuck to the skin.
• Run cool water continuously on burned area. Do not immerse
large burn areas in water.
• Elevate burned area above the heart.
• Cover the burned area with a sterile bandage or a clean sheet.
Do not apply any ointments.
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• People who are burned seriously will be admitted to a
hospital. There, doctors will concentrate on keeping
the burned area clean and removing any dead tissue
through a process called debridement
• Medications will be used to reduce pain and prevent
infection.
• A tetanus shot will be given if the person has not
had one in 5 or more years.
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• Good nutrition is important as people recover,
because vitamins and minerals have been shown to
promote wound healing and prevent the spread of
infection.
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Hospital management
Initial
• Resuscitation - A, B, C, D, E & fluids
• Catheterize pt.
• Wash burnt surface
Intermediate [directed to the wound (open or closed method)]
• Daily wound cleaning
• Silver sulphadiazine (flamazine)
• Wet soaks
• Sloughectomy/Escharotomy
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Cont of management
Long term
Monitoring;
• o Fluid replacement
• o Urine output (0.5 - 1ml/kg/hr. hence catheterize the pt.)
• o Temperature - spikes may indicate infection.
• o Heart rate - rapid rate may also indicate infection, or severe dehydration
• o Pulse rate
• o Mental status
• o Edema
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Continuation management
Wound healing
• o Color
• o Pus
• o Slough
Nutritional status
• o Weight
• o Skin fold thickness
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How are fluids given..
Parkland formula is used:
• Body wt x TBSA% x (4mls) = X mls
• -1st give half of Xmls in the 1st 8hrs from time of burns event
• -2nd give next half of Xmls in the next 16hrs
• Important!!! The above two formulae are only applicable up to and
including 40% burns. Thus, a pt. with 54% burns will be considered to
have 40% burns, for example. This ensures no fluid overload.
• The fluids used are Crystalloids, N-saline, Ringer’s lactate or
Hartmann’s solution
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Complications of burns
• Hypovolemia
• Hypoxia
• Shock
• Hypothermia
• Hypoglycaemia
• Wound infection
• Anemia plus malnutrition
• Poor healing
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• Renal failure
• Septic arthritis
• Keloids
• Contractures
• Nerve compression
• Psychological effects- cosmetic effect
• Dehydration
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ELECTRICAL BURN
• Make sure that contact with the electrical source is broken
before you touch the casualty
• Flood the injury with cold water (at the entry and exit
points if both are present) for at least ten minutes or until
pain is relieved. If water is not available, any cold,
harmless liquid can be used. Gently remove any jewelry,
watches, belts, or constricting
• clothing from the injured area before it begins to swell.
Do not touch the burn.
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CHEMICAL BURN
• Make sure that the area around the casualty is safe
• Flood the burn with water for at least 20 minutes to
disperse the chemical and stop the burning. If
treating a casualty lying on the ground, ensure that
the contaminated water does not collect underneath
her. Pour water away from yourself to avoid being
splashed
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• Gently remove any contaminated clothing while
flooding the injury
• Arrange to take or send the casualty to the hospital.
Monitor vital signs—level of response, breathing,
and pulse
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HEATSTROKE
• A medical emergency, this condition is caused by a
failure of the “thermostat” in the brain to regulate body
temperature.
• Quickly move the casualty to a cool place.and call 991
• The best way to cool the casualty
• is to spray him with water and then fan him, repeatedly. A
cold, wet sheet may also work, and ice packs in the
armpits and groin may be affective.
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FROSTBITE
• With this condition, the tissues of the
extremities—usually them fingers and toes—freeze
due to low temperatures.
• In severe cases, this freezing can lead to permanent
loss of sensation and,
• eventually, tissue death and gangrene as the blood
vessels and soft tissues become permanently
damaged.
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treatment
• Advise the casualty to put his hands, if affected, in
his armpits. Move the casualty into warmth before
you thaw the affected part further.
• Place the affected parts in tepid water, or lower than
104°F (40°C). Dry gently and apply a light dressing
of dry gauze bandage.
• Raise the affected limb to reduce swelling.
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BURNS TO THE AIRWAY
• Call 991 for emergency help.
• Tell the dispatcher that you suspect burns to the
casualty’s airway. Reassure the casualty. Monitor and
record vital signs—level of response, breathing, and
pulse
• while waiting for help to arrive. Take any steps
possible to improve the casualty’s air supply, such as
loosening clothing around his neck.
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• Offer the casualty ice or small sips of cold water to
reduce swelling and pain.
• Reassure the casualty. Monitor and record vital
signs—level of response, breathing, and pulse
3/30/2020

YOUR MIND IS A POWERFUL
THING.WHEN YOU FILL IT WITH
POSITIVE THOUGHTS, YOUR LIFE
WILL BEGIN TO CHANGE….
3/30/2020

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