slide helps a medical student and physician understand the basics of burns( definition, types, causes, assessment, stages, zones, complications and basic principles of management).

1. BURNS
BY NAWA .M.S

2. OUTLINE
• OVERVIEW OF HISTOLOGY OF SKIN
• DEFINITION
• CAUSES
• CLASSIFICATION
• ASSESSMENT OF BURNS
• COMPLICATIONS
• MANAGEMENT

3. OVERVIEW OF HISTOLOGY OF SKIN

4. DEFINITION:
• Type of coagulative or liquifactive destruction of the
surface layers of the body.
• It is the response of the skin, mucous membrane and
subcutaneous tissue to the thermal and few non
thermal injuries.

5. CAUSES:
• THERMAL CAUSES
• Scald- seconadry to spillage of hot liquids
• Flames- super heated oxidized air
• contact- due to hot and cold solid
• Flash burns- due to hot gases and combustible liquids
• NON THERMAL CAUSES
• Chemical- labs or chemical industries
• electrical
• cold injury-frost/frost bite
• ionizing radiation
• sun burns

6. • BURNS DUE TO CHEMICALS:
• Can be acid or alkaline burn
• question: which is more dangerous? acid or alkaline
• ans: Alkaline
examples of acid: hydrochloric
acid(HCL), sulphuric acid(H2SO4)
examples of alkaline: potassium
hydroxide(KOH), sodium
hydroxide(NAOH)
pathophysiology: acid burns causes
coagulative necrosis which protects
the underlying tissues from acid
exposure
pathophysiology: alkaline burns
cause liquifactive necrosis that
causes saponification of tissues and
hence leads to alkaline exposure
which bleach the tissue.

7. • ELECTRICAL BURNS:
• Can be: low voltage(120v-240v) or high voltage(>1000V)
• Note: parts in which electricity can pass through with low
resistance: blood vessels, subcutaneous tissue, nerves.
• can cause:
• Renal failure: in muscles, electrical burns cause myonecrosis
which leads to release of myoglobin- causes damage to the
kidney via excretion and later on, will cause acute tubular
necrosis.
• Arrythmias and cardiac arrest.

8. CLASSIFICATION:
• FIRST DEGREE/SUPERFICIAL BURNS
• Injury to epidermis only
• epithelial barrier is intact
• heals rapidly by re-epithelialization with no scars in 5-7 days.
• pin prick test is positive(severe pain to prick)
• presentation: redness, pain, no blisters and no scarring
• Complication: increased risk of skin cancer
• SECOND DEGREE/PARTIAL THICKNESS BURNS
• Divided into: superficial partial thickness and deep partial thickness
SUPERFICIAL PARTIAL THICKNESS DEEP PARTIAL THICKNESS
Above level of papillary dermis
presentation: red, blanches to touch, blistering, moist
Involves reticular dermis
presentation: no blistering, pale, mottled appearance,
maybe painful or insensate(depending on depth)
resolves in 1 to 2 weeks(14 days) by epithelialization resolves in 3 to 5 weeks(35 days) by epithelialization and
contracture
minimal or permenant scars but leaves discoloration scar formation

9. THIRD DEGREE/FULL THICKNESSS BURNS
• Ascended the subcutaneous space(both epidermis and dermis
are burnt)
• coagulation of subcutaneous tissue
• presentation: white leathery eschar, painless, no blistering, look
dull or dark, white or cherry red
• no blanching
• Complication: scarring, contracture and amputation
• FOURTH DEGREE
• Deep till the bones
• Complication: Amputation, functional impairment, gangrene and
death.

13. ZONES OF BURNS
• ZONE OF COAGULATION:
• Once a cold/hot surface is in contact with the body- cells undergo coagulative necrosis
and disruption.
• Necrotic area where tissue will not recover
• ZONE OF STASIS:
• Surrounds zone of coagulation
• increased percentage of thromboxane A2 resulting in vasicinstriction
• they is leakage and disruption of blood vessels leading to decreased tissue perfusion.
• tissue can recover or become necrotic
• ZONE OF HYPEREMIA:
• They is vasodilation and increased capillary blood flow
• they is recruitment of white blood cells and other infammatory cells to the zone of
coagulation and stasis.
• healing process begins from this viable tissue.

15. ASSESSMENT OF BURNS
• BY ESTIMATE%: We use=
• Alfred wallace rule of 9(in Adults)/rule of 7(in children)

17. • RULE OF PALM:
• Palm of patient is approximately 1% total body surface
area(TBSA).
• LUND AND BROWDY CHART: MOST ACCURATE

19. COMPLICATIONS/INVESTIGATIONS

20. MANAGEMENT
• INITIAL:
• a.) Remove source or victim from the source
• b.) Cool the burn wound with room temperature water(tap water)
for 10-15 mins to help to decrease the depth of the wound.

21. • C.) Resuscitate- A,B,C,D,E and fluids
• A-airways:
• maintain cervical(c-spine)
• intubate if suspected inhalational injury
• WHEN TO INTUBATE?
• partial pressure of:
• oxygen(PaO2)<60mmhg
• carbondioxide(PaCO2)>50mmhg
• PaO2/PaCO2>200
• upper airway edema
• impending respiratory failure

22. • WHAT IS AN INHALATIONAL INJURY?
• is respiratory injury due to inhalation of toxic gases
• can be: oedema of the vocal cord, cherrins, mucosal ulceration
and sloughing
• treatment: Administer oxygen and bronchodilators

24. • FLUIDS

26. • D.)Catheterize patient to monitor urine output
• E.) Wash burnt surfaces using normal saline or clorhexidine

28. NOTE:

29. REFERENCES
• SURGERY ESSENCE (8TH EDITION) BY DR PRITISH SINGH
• BURNS PRESENTATION BY DR .B. SELVARAJ
• BAILEY AND LOVE’S: SHORT PRACTICE OF SURGERY(27TH
EDITION) BY DR HENRY HAMILTON BAILEY, E’TAL..

30. • YOU ARE TIRED KAH..
• ONLY YOU CAN LICK YOUR ELBOW WITH YOUR TONGUE
THEN YOU CAN REST.
• ENJOY THE MEDICINE.
• THANK YOU