This document provides definitions and descriptions of key terms related to burn wounds. It discusses eschar formation, scabs, pseudo-eschar, and petechiae. It also describes burn depth classifications including superficial, partial, and full thickness burns. Circumferential burns and their risks are outlined. The document explains Jackson's burn wound model and zones of coagulation, stasis, and hyperaemia. It further discusses burn wound conversion, total body surface area calculations, and the Parkland formula for fluid resuscitation.

1. Prepared by
PRIYA MALIK
M.Pharm ( pharmacology)

2. 
 Eschar: Eschar refers to the nonviable layers of skin or tissue indicating
deep partial or full thickness injury. It is black, thick and leathery in
appearance. This word is not synonymous with the word "scab".
 Scab: Dry, crusty residue accumulated on top of a wound, resulting from
coagulation of blood, purulent drainage, serum or a combination of all.
 Pseudo-Eschar: A thick gelatinous yellow or tan film that forms with silver
sulfadiazine cream combining with wound exudate. It can often be
mistaken for eschar, but it can be removed with mechanical debridement.
 Petechiae: Pinpoint, round spots that appear on the skin as a result of
bleeding. The spots can appear red, brown or purple in colour.
Burn wound terminology

3. Eschar formation
over burn
wound on hand
Eschar formation
over burn wound
on elbow
Scab
Pseudo-eschar
formation over
burn wound on hand
Pseudo-eschar
formation over burn
wound bed
Petechiae on
back of hand

5. Superficial
burn wound
Superficial
partial burn wound
Superficial partial
burn wound
Superficial partial
burn wound
Deep partial
burn wound
Deep partial
burn wound

6. Resulting scars
of a deep partial
burn wound
Full thickness
burn wound
Full thickness
burn wound
Full thickness
burn wound
Resulting scars
of a full thickness
burn wound
Subcutaneous burn
wound with
exposed tendon

7. Circumferential burn injury special
considerations
A circumferential burn wound is typically found around an extremity or the
torso and puts the patient at a significant risk for compartment syndrome. This
pattern of burn injury involves deep partial thickness, full thickness, and or
subcutaneous burns.

8. Circumferential burn injury signs and symptoms for
potential compartment syndrome:
• Out of proportion pain with any movement distal to the circumferential
injury.
• Diminished or lack of a pulse distal to the area of circumferential injury.
• Diminished or lack of capillary refill in the fingers and the toes. However,
assessment for compartment syndrome can be limited if the injury
prevents assessment of capillary refill due to extremity damage or
amputation.
• A red flag sign of developing compartment syndrome is a decrease in
temperature of the tissue distal to the area of circumferential injury,
especially on an extremity.
• For patients with circumferential burn injuries around the torso: high
concern for development of compartment syndrome if they experience
difficulty breathing or an increase in difficulty breathing.

9. Blanch Test
The blanch test is similar to the capillary refill test. It is a bedside exam to
assess blood flow to the capillaries of the skin. This can be performed over
intact skin or in a wound bed itself.
To perform the test:
• Gently but firmly compress the tissue to be tested until it turns white.
• Record the time taken for the area to return to the previous colour.
• Refill time should take 3 seconds or less. If the refill time is longer, suspect
capillary damage. If there is no change in colour with applied pressure,
suspect capillary destruction.

10. Jacksons’ Burn Wound Model
Jacksons’ Burn Wound Model is a model used to understand the
pathophysiology of a burn would. This model divides the wound into three
zones.
1. Zone of Coagulation: (outlined in purple below) This is the central area of
the injury and has experienced the greatest amount of tissue damage. It is
often characterised by complete destruction of the capillaries leading to cell
death. This is irreversible as there is no capillary refill.
2. Zone of Stasis or Zone of Ischaemia: (outlined in green below) This area is
adjacent to the zone of coagulation and as the name suggests, it is a zone in
which the there is slowing of circulating blood due to the damage. These
are areas of deep partial thickness burns, or burns of indeterminate depth.
This zone can usually be saved with the correct wound care. Capillaries are
often compromised by oedema due to hypovolemia and/or
vasoconstrictive mediators responding to injury. It is reversible if capillary
flow can be restored.

11. 3. Zone of Hyperaemia: (outlined in blue below) This zone
is located around the edge of the previous zone and is
characterised by superficial and superficial partial thickness
burns and has a robust capillary refill. This is an area of
increased circulation due to vasodilators, such as histamine,
that are released in response to the burn injury. This tissue has
a good recovery rate, as long as there are no complications
such as severe sepsis or prolonged hypo-perfusion. This area
will completely recover without intervention unless
complications occur.
Zone of coagulation outlined in purple; zone of stasis in
green; zone of hyperaemia in blue

12. Burn Wound Conversion
Burn Wound Conversion: True burn wound conversion is a deterioration of the
wound due to events unrelated to the initial burn injury. This refers to the
worsening of tissue damage in a burn wound which previously was expected to
spontaneously heal, but instead it increases in depth to a deeper wound which
may require surgical intervention.
Potential Causes:
• Dessication
• Infection
• Oedema
Example of wound
prior to desiccation
Example of wound
after desiccation
Example of wound
prior to infection

13. Example of wound
after infection has set in
Example of wound
oedema in hand and fingers
Total Body Surface Area
Total body surface area is an important figure when applying the
Parkland Burn Formula. This formula is the most widely used
formula to estimate the fluid resuscitation required by a patient
with a burn wound upon on hospital admission. It is usually
determined within the first 24 hours of admission.

14. • When applying this formula, the first step is to calculate the percentage
of body surface area (BSA) damaged. This is most commonly calculated
using the "Wallace Rule of Nines".When conducting a paediatric
assessment, the Lund-Browder Method is commonly used, as children
have a greater percentage surface area of their head and neck compared
to an adult. The formula recommends 4 millilitres per kilogram of body
weight in adults per percentage burn of total body surface area (%TBSA)
of crystalloid solution over the first 24 hours of care.
• 4 mL/kg/%TBSA (3 mL/kg/%TBSA in children) = total amount of
crystalloid fluid during first 24 hours
• The latest research indicates that while this method is still in use, the
fluid levels should be constantly monitored, while assessing the urine
output, to prevent over-resuscitation or under-resuscitation
Calculation of Percentage Burn of Total
Body Surface Area
• The Rule of Nine
• Lund-Browder Method
• Palmer Method

15. 1. The Rule of Nine

16. 2. Lund and Browder Chart

17. 3. Palmar Surface Method
The "Rule of Palm" or Palmar Surface Method can be used to estimate body
surface area of a burn. This rule indicates that the patient's palm (with the
exclusion of the fingers and wrist) is approximately 1% of the patient's body
surface area. When a quick estimate is required, the percentage body surface
area will be the number of the patient's own palm it would take to cover
their injury. It is important to use the patient's palm and not the provider's
palm.

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