This document provides an overview of burns, including their anatomy, physiology, incidence, causes, classifications, stages of treatment, complications, and nursing management. It begins with definitions of burns and classifications according to depth and extent. It then discusses the pathophysiology and presents the three phases of burn care - emergent/resuscitative, acute/intermediate, and rehabilitation. Nursing priorities and treatments are outlined for each phase, including wound care, pain management, and psychological support. Surgical procedures and potential complications are also reviewed.

1. BURN
Prepared by-
Deepak Patel
M.Sc. Nursing

2. CONTENT
1. Review of anatomy and physiology
of skin
2. Introduction
3. Incidence
4. Definition
5. Aetiology
6. Classification
7. Jackson’s thermal wound injury
Continue…..

3. CONTENT
8. Pathophysiology
9. Clinical manifestations
10. Diagnostic evaluation
11. Management
12. Complications
13. Prevention
14. summary
15. conclusion

4. 1. REVIEW OF ANATOMY AND
physiology of skin

5. INTRODUCTION TO BURN
• Burns are one of the most
devastating conditions encountered in
the medicine. The injury represents
an assault on all aspects of the
patients from the physical to the
psychological. The visible physical
and invisible psychological scars are
long lasting.

6. DEFINITION OF BURN
• Burn can be defined as any
injury that results from the
direct contact or exposure
to any thermal, chemical,
electrical or radiation
source.

7. INCIDENCE OF BURN
• India records 70 lacs burn injury
annually of which 1.4 lacs people die
and 2.4 suffers from disability.
• 70% of cases are in 15-35 years age
group.
Continue…..

8. INCIDENCE OF BURN
• 4 out of 5 cases are either women or
children.
• 80% cases with women are related to
kitchen related accidents.
• 11th leading cause of death/injury of
children age 1-9 years.
Continue…..

9. INCIDENCE OF BURN
• 250 to 300 acid attacks are reported
in India every year.
• 80% to 90% burns occur at home

10. ETIOLOGY OF BURN
1. Thermal burns
2. Chemical burns
3. Electrical burns
4. Radiation burns
5. Inhalation burns

11. CLASSIFICATION OF
BURN INJURY
1. According to burn
depth
2. According to extent
of burn

12. ACCORDING TO BURN
DEPTH
a) Based on skin layers
involvement
b) Based on degree of
burn

13. Based on skin layers
involvement

14. Based on degree of burn

15. ACCORDING TO EXTENT
OF BURN
a) Rule of nine
b) Lund and Browder
chart
c) Palmer method

16. Rule of nine (adult)

17. Rule of nine (child)

18. Lund and Browder Chart

19. Palmer method

20. JACKSON’S THERMAL
WOUND THEORY
1. The inner zone
2. The middle zone
3. The outer zone
Continue…..

22. PATHOPHYSIOLOGY OF
BURN
1. Cardiovascular alterations
2. Fluid and electrolyte alterations
3. Pulmonary alterations
4. Renal alterations
5. Immunologic alterations
6. Thermoregulatory alterations
7. Gastrointestinal alterations
8. Metabolic alterations

24. DIAGNOSTIC EVALUATION OF
BURN
1. History taking
2. Physical examination (See table)
3. Diagnostic tests-
• Complete blood count
• ABG analysis
• Human chorionic gonadotropin testing
• Serum urea, electrolytes
• Chest X-ray
• CT scan
• Laser Doppler imaging

25. 1. History Taking
1. Time of injury
2. Place of injury (open/closed)
3. unconsciousness during incidence
4. Mechanism of burn injury/agent
5. Duration of exposure to agent
6. Intentional burn injury
7. Last Tetanus shot
8. Any known Allergies

26. 2. Physical Examination
1. Complete head to toe assessment
2. Systematic assessment
3. Burn estimation / severity
assessment

27. Burn severity assessment
MINOR MODERATE MAJOR
• Adult <10%
TBSA
• Young or old
<5% TBSA
• <2% Full
thickness Burn
• Adult 10-20%
TBSA
• Young or old 5-
10% TBSA
• 2-5% Full thickness
burn
• High voltage injury
• Possible inhalation
injury
• Circumferential
burn
• Other health
problems
• Adult >20% TBSA
• Young or old >10%
TBSA
• >5% Full thickness
burn
• Known inhalation
injury
• Significant burn to
face, joints, hands or
feet
• Associated injuries

28. 3. Diagnostic Tests
1. Complete blood count
2. ABG analysis
3. Human chorionic gonadotropin testing
4. Serum biochemistry
5. Chest X-ray
6. CT scan
7. Laser Doppler imaging

29. MANEGEMENT OF BURN
Burn care is typically categorized into
three phases of care;
1. Emergent / resuscitative phase
2. Acute / intermediate phase
3. Rehabilitative phase

30. PHASES OF BURN CARE
PHASE DURATION PRIORITIES
Emergent /
resuscitative phase
• From onset of injury to
completion of fluid
resuscitation.
• First aid
• Prevention of shock
• Prevention of respiratory
distress
• Detection and treatment of
concomitant injuries
Acute / intermediate
phase
• From beginning of
diuresis to near
completion of wound
closure.
• Wound assessment and care
• Wound closure
• Prevention and treatment of
complications, including
infection
• Nutritional support
Rehabilitation
support
• From major wound
closure to return to
individual’s optimal level
of functioning
• Prevention of scars and
contractures
• Physical, occupational and
vocational rehabilitation
• Cosmetic reconstruction
• Psychosocial counselling

31. 1. Emergent / resuscitative
phase
Medical management
1. Assess burn severity
a) Burn depth
b) Burn size
c) Burn location
d) Age
e) General health
f) Mechanism of injury

32. 1. Emergent / resuscitative
phase
Medical management
2. Treat minor burns
3. Major burns
a) Monitor airway and breathing
b) Prevent burn (hypovolemic) shock (see formula)
c) Prevent aspiration
d) Minimizing pain and anxiety
e) Wound care
f) Prevent tetanus
g) Prevent tissue ischemia
h) Transport to burn facility

33. Emergent / resuscitative phase
Calculation of fluids:
1. Consensus formula:
2. Parkland formula:
Ringer’s lactate solution= 2-4 ml X kg body weight X TBSA
½ solution in first 8 hours and rest half in next 16 hours
Volume of Ringer’s lactate= 4 ml X % BSA x weight (kg)
½ solution in first 8 hours and rest half in next 16 hours

34. Nursing management of patient
in Emergent / resuscitative phase
1. Maintaining proper oxygenation and tissues
perfusion
2. Maintaining fluid and electrolyte balance
3. Relieving pain
4. Preventing hypothermia
5. Providing initial wound care
6. Preventing infection
7. Promoting comfort
8. Relieving anxiety and proving psychological
support

35. 2. ACUTE / INTERMEDIATE
PHASE
Medical management
1. Prevent infection
• Asepsis
• Prophylactic antibiotics
• Immunization
• Environmental control

36. 2. ACUTE / INTERMEDIATE
PHASE
Medical management
2. Provide metabolic support
Formula/Author name Formula for daily calorie expenditure estimate
• Curreri (25Kcal / Kg body weight) + (40Kcal X %TBSA
burn)
• Modified Harris-Benict RMR X Activity factor X injury factor
(RMR- Resting metabolic rate)
• U.S. Army Institurte Of
Surgical Research
(Age and gender specific BMR) X (0.89142 +
0.01335 X % TBSA Burn) X (M2 X 24 X Activity
factor)

37. 2. ACUTE / INTERMEDIATE
PHASE
Medical management
3. Minimizing pain
• Patient controlled analgesia devices
• Inhalation analgesic (nitrous oxide)
• Oral analgesics; opioid analgesics, NSAID’s
• Hypnosis, art and play therapy
• Guided imaginary, relaxation techniques
• Distraction therapy, biofeedback
• Music therapy

38. 2. ACUTE / INTERMEDIATE
PHASE
Medical management
4. Provide wound care
a) Wound cleansing
b) Wound debridement
i. Natural debridement
ii. Mechanical debridement
iii. Chemical debridement
iv. Surgical debridement

39. 2. ACUTE / INTERMEDIATE
PHASE
Medical management
c) Topical antimicrobial treatment
• Silver sulfadiazine 1%
• Mafenide acetate 5%
• Silver nitrate 0.5%
• acticoat

40. 2. ACUTE / INTERMEDIATE
PHASE
Medical management
d) Wound dressing
• Moist dressing
• Occlusive dressing for new grafts
• Non-adhesive dressings covers

41. 2. ACUTE / INTERMEDIATE
PHASE
Medical management
5. Maximize function
• Splinting
• Positioning
• Exercise
• Ambulation performance of ADI
• Pressure therapy

42. 2. ACUTE / INTERMEDIATE
PHASE
Medical management
6. Provide psychological support
• Meeting the psychological needs
• Involvement in physical therapy
• Encouragement in wound care
• Ventilation of feeling, emotions, fear
• Promoting self image

43. 2. ACUTE / INTERMEDIATE
PHASE
Surgical management
1. Escharotomy

44. 2. ACUTE / INTERMEDIATE
PHASE
Surgical management
2. Faciotomy or
faciectomy

45. 2. ACUTE / INTERMEDIATE
PHASE
Surgical management
2. Wound grafting
# Biologic dressing / graft
# biosynthetic and synthetic grafts

46. 2. ACUTE / INTERMEDIATE
PHASE
Surgical management
2. Wound grafting
# Biologic dressing / graft types
• Autograft
• Isograft
• Allograft
• Xenograft

48. 2. ACUTE / INTERMEDIATE
PHASE
Surgical management
2. Wound grafting
# Biosynthetic and synthetic graft types
• Biobrane
• Integra
• Calcium alginate
• Non-adhering fine mesh gauze

50. INTEGRA

51. CALCIUM AGINATE

52. NON-ADHERING FINE MESH
GAUZE

53. Nursing management of patient
in acute / intermediate phase
1. Maintaining proper oxygenation and
tissues perfusion
2. Maintaining fluid and electrolyte
balance
3. Relieving pain
4. Preventing hypothermia
5. Providing wound care
6. Preventing infection

54. Nursing management of patient in
acute / intermediate phase
8. Relieving anxiety and proving
psychological support
9. Graft care
10.Nutritional support
11.Improving mobility
12.Promoting comfort

55. 3. REHABILIATION PHASE
Medical management
1. Minimizing functional loss
• Exercise
• Splinting
• positioning

56. 3. REHABILIATION PHASE
Medical management
2. Provide psychological support
• Self image issues
• Physical limitations
• Reintegration into society
• Fear of rejection
• Good communication
• Encourage independence

57. 3. REHABILIATION PHASE
Medical management
3. Abnormal wound healing
• Hypertrophic
• Keloid scars

58. 3. REHABILIATION PHASE
Medical management
4. Prevention and treatment of scars
• Pressure use of topical silicon
• Scar massage
• Steroid injections
• Application of elastic pressure garments
• Cosmetic interventions

59. Nursing management of patient
in Rehabilitation phase
1. Improving mobility
2. Improving self esteem
3. Promoting independence
4. Cosmetic counselling
5. Vocational training
6. Improving body image

60. COMPLICATIONS OF BURN
1. Burn shock
2. Pulmonary complications due to
inhalation burn
3. Acute renal failure
4. Infections and sepsis

61. COMPLICATIONS OF BURN
5. Curling’s ulcers
6. Extensive and disabling scarring
7. Psychological trauma
8. Marjolin’s ulcer
9. Multiple organ failure