1. Burns are injuries to the skin or tissues caused by heat, cold, electricity, chemicals, friction or radiation. They range from minor to life threatening emergencies depending on location and severity. 2. Burn classification includes first through fourth degree burns based on depth of tissue damage. Management involves stopping the burning process, assessing airway/breathing/circulation, giving fluids and antibiotics to prevent infection. 3. Fluid resuscitation is critical for large burns using the Parkland formula to calculate fluid amounts in the first 24 hours to prevent hypovolemic shock. Complications can include infection, fluid loss, hypothermia and breathing issues.

2. SYNOPSIS
• Introduction
• Definition
• Anatomy of skin
• Layer of skin
• Classification of burns
• Pathophysiology
• Hypovolemic shock
• Types of burns
• Carbon monoxide poisoning
• Effect of carbon monoxide
• Sign and symptoms
• Diagnosis
• Assessment of burns
• Management of burns
• Complication

3. INTRODUCTION
• Burns are tissue damage that results from
heat,overexposure to the sun or other radiation, or
chemical or electrical contact. Burns can be minor medical
problems oriented threatening emergencies.
• The treatment of burns depends on the location and
severity of the damage. Sunburns and small scales can
usually be treated at home. Deep or widespread burns need
immediate medical attention.

4. DEFINITION
• Burns is defined as a wound caused by exogenous
agent leading to coagulative necrosis of the tissue.
• A burn is a type of injury to skin or other tissues,
caused by heat,cold,electricity, chemicals, friction,or
radiation.
• Most burns are due to heat from hot,liquids,solids or
fire.

5. Anatomy of skin
• The skin is the largest organ of the body,with a total area
of about 20 square of feet.
• The skin protects us from microbes and the elements,
helps regulate body temperature, and permits the
sensations of touch,heat,and cold.

7. Layers of skin
1. Epidermis- The outermost layer of skin, provides a waterproof barrier and
creates our skin tone.
2. Dermis- Beneath the epidermis, contains tough connective tissue, hair
follicles, and sweat glands.
3. Subcutaneous- The deeper subcutaneous tissue (hypodermis) is made of fat
and connective tissue.

8. Classification of burns
• FIRST DEGREE
• SUPERFICIAL SECOND DEGREE
• DEEP SECOND DEGREE
• THIRD DEGREE
• FOURTH DEGREE

9. • Superficial- First degree- injury localized to the epidermis
• Partial thickness 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 are bone.

10. Superficial burn: 1st degree burn
• Reddened skin
• Pain at burn site
• Involves only epidermis
• Blanch to touch
• Have an in-tact epidermal barrier
• Do not result in scarring
• Example: Sun-burn,minor scald from a kitchen accident

11. • Intense pain
• White to red skin
• Blisters
• Involves epidermis & papillary layer of dermis
• Spares hair follicles, sweat glands etc.
• Erythematous & blanch to touch
• Very painful/sensitive
• No or minimal scarring
• Spontaneously re-epithelialize from retained epidermal structures
7-14 days
Partial- thickness burn: 2nd degree burn

12. Deep second degree burn
• Injury to deeper layers of dermis- reticulated dermis
• Appears pale & mottled
• Do not blanch to touch
• Capillary return sluggish or absent
• Less painful, remain painful to pinkprick
• Takes 14 to 35 days to heal by re- epithelialisation from hair
follicles.

13. Full- thickness burn: 3rd degree burn
• Dry, leathery skin (white,dark brown, or charred)
• Loss of sensation ( little pain)
• All dermal layers/ tissue may be involved
• Always require surgery.
Fourth degree burn
• Involves structures beneath the skin- muscle, bone.

15. PATHOPHYSIOLOGY
• Burns are diffuse soft-tissue injuries created by destructive energy
transfer via radiation, thermal, or electrical energy.
• When a person is burned, this barrier is destroyed, leaving the individual
at high risk for infection, hypothermia, hypovolemia , and shock
• Circumferential Burns of an extremity can lead to compartment
syndrome, resulting in neurovascular compromise and irreversible
damage if not appropriately treated.

16. HYPOVOLEMIC SHOCK
• The shock or hypoperfusion caused by a burn injury and
the tremendous loss of fluids.
• Capillaries leak, resulting in intravascular fluid volume
oozing out of the circulation and into the interstitial
spaces, and cells take in increased amounts of salt and
water.

17. TYPES OF BURN
• THERMAL BURN
• CHEMICAL BURN
• ELECTRICAL BURN
• RADIATION BURN

18. THERMAL BURN
• An injury caused by radiation or direct contact with a heat
source on the skin.

19. THERMAL BURN
A thermal burn caused by
flames touching the skin.
FLAME BURN FLASH BURN
An electrothermal injury
caused by arcing of electric
current.

20. A burn produced by touching
a hot object
CONTACT BURN
A burn produced by hot
liquid.
SCALD BURN
THERMAL BURN

21. CHEMICAL BURN
• It caused by strong acids or alkali substances.
• They continue to cause damage until agents is
inactivated.
• Alkali substances usually cause more severe injury since
they react with the lipids in the skin.

22. ELECTRICAL BURN
• If caused by either Ac or DC current.
• Current follows the path of least resistance and causes injury in
areas other than the contact/entry site.
• They cannot be judged from the external injury alone.
• High voltage >1000 volts, low voltage <1000 volts and lightening.
• Electrical burns are thermal burns from very high heat.

23. RADIATION BURN
• Caused by alpha, beta or gamma radiation.
• They may need to have some type of decontamination done to
stop the injury.

24. CARBON MONOXIDE POISONING
• It is a byproduct of combustion reactions, or the burning of certain
fuels .
• CO can be emitted from gasoline –powered engines , natural gas
heating system
• Oil , propane , wood and other materials which may also relase
carbon monoxide when burned .

25. EFFECTS OF CARBON MONOXIDE
• CO binds more readily to hemoglobin ( Hgb) displacing oxygen and
forming carbohemoglobin.
• Premature relase of O2 prior to reaching distal tissue leads to
hypoxia at the cellular level
• Inflammatory response is initiated due to poor and inadequate
tissue perfusion
• Mycardial depression from CO exposure
• Dysrhythmias , myocardial ischemia, MI .

26. Signs and symptoms
• Dull headache
• Weakness
• Dizziness
• Nausea or vomiting
• Shortness of breath
• Confusion
• Blurred vision
• Loss of consciousness

27. DIAGNOSIS
• Estimation of COHb level
• Pulse oximetry
• Arterial blood gases
• ECG
• Chest X-ray
• Bedside tests

28. ASSESSMENT OF BURN
• The rule of nines is a quick way to estimate the
extent of burns in adults through dividing the
body into multiples of nine and the sum total of
these parts is equal to the total body surface area
injured.
RULE OF NINES

30. MANAGEMENT OF BURN
• Ensure rescuer safety
• Stop the burning process: Stop,drop,and Roll.
• Check for other injuries.
A- Airway control
B- Breathing and ventilation
C- Circulation
D- Disability-neurological status
E- Exposure with environmental control
F- Fluid resuscitation

31. Cont…
• Check followed by a rapid secondary survey.
• Cool the burn wound:
*Analgesia
• Give oxygen.

32. FLUID RESUSCITATION
• Patient with burns covering more than 20% of the TBSA will need
fluid resuscitation.
• Depending on the patients age and other medical conditions.
• An IV line may be inserted in the field to administer fluids and
pain medications as needed.
• A 18-gauge IV catheter should be inserted as early possible in any
patient who has major burns.
• Large-bore IV catheter into a large vein and administer lactate
ringer solution via this line.

33. Cont…
• The amount of fluid the burned patient will need , use the
PARKLAND FORMULA.
• The amount of fluids administered in the first 24 hours after injury
is typically 2-4 ml of lactate ringer solution multiplied by the
patient’s body weight in (Kg) multiplied by the percentage of TBSA
Burned.
2-4ml× body weight (kg)
percentage of body surface burned

34. PARKLAND FORMULA

35. COMPLICATION
• Bacterial infection, which may lead to a bloodstream infection
(sepsis)
• Fluid loss, including low blood volume (hypvolemia)
• Dangerously low body temperature (hypothermia)
• Breathing problems from the intake of hot air or smoke (carbon
monoxide)