First aid of burns

1. Burns
Prof. Nagwa Elkobbia
Prof. of Anesthesia & Surgical Intensive
Care
Faculty of Medicine, Alexandria
University

2. Definition
 Burn is a coagulative necrosis of the cell
protoplasm due to exposure to abnormal
physical or chemical agent associated with
peripheral vasodilatation leading to rapid
loss of fluid into and from the tissues.

3.  Burns are caused by dry heat and scalds
are caused by wet heat.
 Both burns and scalds damage the body by
removing the layer of skin that protects the
body from infection.
Symptoms
 Extreme pain
 Swelling around site of burn
 Redness and blistering

4.  I) Thermal injuries:
 Scalds
 Flame burns
 Contact burns
 Cold injury (frost bite)
 II) Electrical injuries
 III) Chemical burns

5.  First degree burn
 Second degree
 Superficial
 Deep
 Third degree

6. First Degree Burn
 Affect only the outer layer of the skin.
 red and painful.
 They swell a little.
 They turn white when you press on the skin.

7. Second degree burn:
 Affect both the outer and underlying layer of
skin
 thicker burns, are very painful and typically
produce blisters on the skin.
 The skin is very red or splotchy, and may be
very swollen.

8. Third degree burn
 Extend into deeper tissues.
 They cause white or blackened, charred
skin that may be numb.

9.  Rule of nine

10. Calculating TBSA (extent)
ADULTS: RULE OF NINES
 Head & neck 9 %
 Anterior trunk 18 %
 Posterior trunk 18 %
 Bilateral anterior arm, forearm and hand 9 %
 Bilateral posterior arm, forearm and hand 9 %
 Genital region 1%
 Bilateralanterior leg and foot 18 %
 Bilateral posterior leg and foot 18 %

11. Children: Rule of Nine
 A child under one year has 9 % taken from
the lower extremities and added to the head
region. Each year of life, 1 % is distributed
back to the lower extremities until age 9
when the head region is considered to be the
same as an adult.

13.  Stop further injury
 Extinguish or remove burning clothing
 Cold water lavage or soaks used for only 10 to
15 minutes for pain relief of second degree
burns of 10% or less of TBSA , avoid
hypothermia

14.  If the skin is unbroken, run cool water over
the area of the burn or soak it in a cool
water bath (not ice water).
 Keep the area submerged for at least 5
minutes. A clean, cold, wet towel will also
help reduce pain

15.  Calm and reassure the person.
 After flushing or soaking, cover the burn
with a dry, sterile bandage or clean
dressing.
 Protect the burn from pressure and friction.

16.  Ibuprofen or Acetaminophen
 Moisturizing cream
 Tetanus !!!
 If a second-degree burn covers an area more
than 2 to 3 inches in diameter, or if it is
located on the hands, feet, face, groin,
buttocks, or a major joint, treat the burn as a
major burn

17. Major burns:
 If someone is on fire, tell the person to stop, drop,
and roll.
 Wrap the person in thick material to smother the
flames (a wool or cotton coat, rug, or blanket).
 Douse the person with water.
 Call 123.

18.  Cover the burn area with a dry sterile bandage (if available)
or clean cloth. A sheet will do if the burned area is large.
 If fingers or toes have been burned, separate them with
dry, sterile, nonadhesive dressings.
 Elevate the body part that is burned above the level of the
heart.
 Protect the burn area from pressure and friction.

19.  Make sure the person is breathing.
 Take steps to prevent shock.
 Continue to monitor the person's vital signs
until medical help arrives.

20.  Stop further injuy
 Maintain ventilation
 Administer humidified oxygen by mask
 Examine airway looking for sign of inhalation inj.
 Carbonaceous material in upper airway
 Edema or inflammatory change in upper airway
 Maintain airway

21.  Stop further injury
 Maintain ventilation
 CPR if no pulse or heart action is
detectable

22. Intravenous fluid therapy (in Hospital)
 Required for patients with burns greater than 20%
 Secure a no. 16 or 18 plastic cannula in adequate vein
 Place indwelling urethral catheter and attach to close
drainage system
 Estimate fluid need for the 1st 24 hour (4 ml lactated
ringer ‘s sol. /kg body weight / % of TBSA ( ½ amount in
1st 8 hours then the rest of next 16 hour)
 Plan administration to obtain 30-50 ml urine /hour in pt.
wt greater than 30 kg ( 1 ml urine / hour for pt less than
30 kg)

23.  Maintain peripheral
circulation
 Remove rings and bracelet
 Clinical signs of impaired circulation
include
 Cyanosis
 Impaired capillary refilling
 Progressive neurological
signs, i.e. parethesias and
deep tissue pain

24.  Nasogastric intubation
 Place tube and attach to suction if there is vomiting or
if burns involve more than 25% of TBSA
 Analgesic medication
 Given as needed
 Give only intravenously and in small doses
 Tetanus prophylaxis

25. Do Not
 Do NOT apply ointment, butter, ice,
medications, cream, oil spray, or any
household remedy to a severe burn.
 Do NOT breathe, blow, or cough on the burn.
 Do NOT disturb blistered or dead skin.

26.  Do NOT remove clothing that is stuck to the skin.
 Do NOT give the person anything by mouth, if there is a
severe burn.
 Do NOT immerse a severe burn in cold water. This can
cause shock.
 Do NOT place a pillow under the person's head if there is an
airways burn. This can close the airways.

27.  Electrical burn.
 Low voltage
 High voltage
1st separation from the electrical source
Evaluate cardio-vascular system
Evaluate peripheral circulation
Evaluate internal burn
Associated trauma

28.  Chemical burn
 Alkaline
 Acids
 Copious water lavage ( avoid water lavage for
Na metal H2so4 , HCL)
 Prolonged eyes irrigation
 Remove all contaminated cloth
 Cover with oil

29.  Radiation burns
 bland ointment
 Avoid dryness or irritating substance
 Narcotics as needed for pain
 Splinting of the involved area to reduce pain
with motion

30. Burn to airways
Causes:
 inhaling smoke,
 steam,
 superheated air,
 or toxic fumes, often in a poorly ventilated
space.

31. Symptoms:
 Charred mouth; burned lips
 Burns on the head, face, or neck
 Wheezing
 Change in voice
 Difficulty breathing; coughing
 Singed nose hairs or eyebrows
 Dark, carbon-stained mucus

32. FIRST AID to airway burns
 Call 123
 improve the casualty’s air supply
 recovery position