2. Learning Outcomes
List out the Criteria for admission of Burns patient.
Outline the fluid resuscitative methods of burns.
Evaluate the definitive & local management of burns.
Discuss about the effects of Non-thermal burn injury.
4. Immediate [ Pre-hospital Care ]
Remove from source of injury
Clothing to be removed
Cool the burn wound – 10 mts – no
Check for other injury
Ensure rescuer safety
5. Hospital Care
A – Airway / Assessment
B – Breathing & ventilation
C – Circulation
D - Disability
E – Exposure
F – Fluid resuscitation
G – Girth ( Circumference )
H – Hand
I - Inhalation injury
6. Criteria – Admission
Airway burns of any type
Burns in extremes of age
Burns requiring FR & Surgery
Pts. social background is not good
All electric / deep chemical burns
7. Outcome – Major Determinants
Percentage surface area involved
Depth of burns
Presence of an inhalational injury
11. Depth of Burns
Depth Cause Surface/colour Pain sensation
Superficial Sun, flash, minor
Dry, minor blisters,
Scald Moist, reddened
Scald, minor flame
Full thickness Flame, severe
scald or flame
12. Burn causes – Likely depth
Cause of Burn Depth of Burn
Flash Burns Deep Dermal
Flame Burns Mixed deep dermal + Full thickness
Alkali Burns Deep dermal + Full thickness
Acid Burns Weak – Superficial / Strong – Deep dermal
Electric Burns Full thickness
13. Inhalation Injury – Dangers
Inhaled hot gases - supraglottic airway burns & laryngeal
Inhaled steam - subglottic burns and loss of respiratory
Inhaled smoke particles - chemical alveolitis and respiratory
Inhaled poisons, such as carbonmonoxide, can cause
Full-thickness burns to the chest can cause mechanical
blockage to rib movement.
14. Inhalation Injury
RECOGNITION INITIAL MANAGEMENT
A history of being trapped in the presence of
smoke or hot gases.
Burns on the palate or nasal mucosa, or loss of
all the hairs in the nose.
Deep burns around the mouth and neck.
Presents as Hoarseness of voice / Stridor.
Early elective intubation is safest
Delay can make intubation very
difficult due to swelling
Be ready to perform an emergency
cricothyroidotomy if intubation is
15. Fluid Resuscitation
Children > 10%TBSA / Adults > 15%TBSA
IV access - Central vein access
Ringer lactate without dextrose fluid of
Monitor urinary output
16. Fluids used
First 24 hrs = Crystalloids – given / Saline, RL, Hartmann’s fluid
( PASSTHROUGH CAPILLARY WALL EASILY )
After 24 hrs upto 30 – 48 hrs = Colloids Plasma , Dextrans , Haemaccel
(TO COMPENSATE PLASMA LOSS )
Blood transfusion – after 48 hrs
17. Parkland Formula – Commonly used
4ml x % burn x kg = volume [ml] - 24 hrs
Max. % = 50%
First 8 hrs ½ of vol. – Rest in next 16 hrs
Next 24 hrs = ½ of first day fluids
18. Muir & Burclay Formula – Colloids
0.5 x % burn x wt.kg = 1 portion
3 portions = first 12 hrs
2 portions = second 12 hrs
1 portion = third 12 hrs
19. Fluids – Children - DNS
100 ml / kg for 24 hours for the first 10 kg.
50 ml kg / for the next 10 kg.
20 ml kg / for 24 hours for each kilogram over 20 kg body weight.
20. Other General Measures
Monitoring the patient
Catheterization – Monitor urine output
Tetanus toxoid / H2 blockers
NGT – Aspiration & Enteral feeding
Antibiotics – Culture
TPN – If necessary
Intensive nursing care
21. Eschar - Treatment
Charred, denatured, full thickness
deep burns with contracted dermis
Circumferential eschar – Limbs /
Tourniquet effect – compartment
Incising the whole length of full
thickness burns in midaxial line -
Burns patients need extra feeding
A nasogastric tube should be used in all patients with burns
A number of different formulae are available to calculate the
energy requirements of patients
The nutritional balance monitored by measuring weight and
27. Control of Infection
Burns patients are immunocompromised
They are susceptible to infection from many routes
Sterile precautions must be rigorous
Swabs should be taken regularly
A rise in white blood cells count, thrombocytosis and
increased catabolism are warnings of infection.
29. Surgery – Deep burns
Deep dermal burns – tangential shaving & SSG
All but the smallest full-thickness burns need
Topical adrenaline (DILUTED) reduces bleeding
All burnt tissue needs to be excised
Stable cover should be applied at once to
reduce burn load
30. Delayed Scar Management
Transposition flaps and Z-plasties
with or without tissue expansion are
Full-thickness grafts and free flaps –
needed for large or difficult areas
Hypertrophy - treated with pressure
Pharma.treatment of itch is
31. Electrical Burns
LV – injuries cause small, localized, deep burns
Cause cardiac arrest without significant direct
HV – injuries damage by flash / conduction
Myocardium may be directly damaged without
Limbs – fasciotomies or amputation
Look for and treat acidosis and myoglobinuria
32. Chemical Burns
Acid burn occurs in skin, soft tissues and
Alkali burns occur in oral cavity and
Initial treatment is dilution with water
Late neutralisation is done, if required by
0.2% acetic acid in alkali burns.
Na.bicarbonate / calcium gluconate
10% gel, topical ziphrin solution in acid
33. Radiation Burns
Local burns causing ulceration need
excision and vascularised flap cover-
usually with free flaps.
Systemic overdose needs supportive
36. 1.What will be the % if both legs,the groin
and the front chest and abdomen were burned?
37. 2.Which of the following statements
regarding burns treatment is false?
A .The simplest and most commonly used crystalloid is Ringer’s lactate.
B. Oral fluids containing no salt are essential when given as fluid replacement in
C. Human albumin solution is a colloid which reduces protein leak out of cells,
thereby helping to reduce oedema.
D. The Parkland formula is the most widely used formula and calculates the fluid
replacement in the first 24 h.
38. 3. A 25-year-old man is brought to the emergency room after sustaining
burns during a fire in his apartment. He has blistering &erythema of his
face, left upper extremity, and chest with frank charring of his right
upper extremity. He is agitated, hypotensive & tachycardiac. Which one
of the following statements concerning this patient’s initial wound
management is correct?
A .Topical antibiotics should not be used, as they will encourage growth of resistant organisms
B. Early excision of facial and hand burns is especially important
C. Escharotomy should only be performed if neurologic impairment is imminent
D. Excision of areas of third-degree or of deep second-degree burns usually takes place 3–7 days after
E. Split-thickness skin grafts over the eschar of third-degree burns should be performed immediately
in order to prevent fluid loss.
39. 4. Which one of the following statements
regarding the above burn patient is correct?
A . High-dose penicillin should be administered prophylactically
B.Tetanus prophylaxis is not necessary if the patient has been immunized in the
previous 3 years
C.This burn can be estimated at 60% total body surface area using the “rule of nines”
D.The most sensitive indicator of adequacy of fluid resuscitation is heart rate
E.This patient should undergo immediate intubation for airway protection and
40. 3.A women weighing 45 kg, with 35% burns of II
° is brought to the casualty. What will be the
fluid resuscitative methods for next 2 days.