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BURNMeenakshi sharma
Pharm.D
Chitkara university
Burn is defined as a
wound caused by an
exogenous agent
leading to coagulated
necrosis of the tissue.
THERMAL BURNS
CHEMICAL BURNS
ELECTRICAL
BURNS
COLD BURNS
RADIATIONS
THERM
AL
BURNS
Scald burn
 Most frequent in home
injuries like hot water ,
liquids and food are most
common cause.
Temperature above than
136˚F causes burn.
Temperature less than 111˚F
tolerated for long periods
CHEMIC
AL
BURN
 Common in industries
and factories but can
occur at homes also.
Caused by concentrated
acids or alkalis.
Acids are more common
than alkali.
ELECTRIC
AL BURNWorse than other types
of burn with entry and
exit wounds.
May stop the heart and
depress the respiratory
system.
May cause thrombosis
and cataracts.
RADIATI
ON
BURNSCause due to radiations
Radioactive explosions.
X-Rays.
Nuclear bomb
explosions.
P’PHYSIOLO
GY
OF BURNS
FLUID SHIFT
Period of inflammatory response.
Vessels adjacent to burn injury dilates –
inc. hydrostatic pressure and inc.
capillary permeability.
Continuous leak of plasma from
intravascular space to interstitial space.
Associated imbalances of fluids,
electrolytes and acid-base occur.
Hemoconcentration
Lasts 24-36 hours.
VIDEO
REPRESENTA
TION OF
BURNS
P’PHYSIOLO
GY
OF BURNS
FLUID REMOBILIZATION
Capillary leak ceases and fluid shifts
back into the circulation.
Restores renal perfusion and fluid
balance.
Increase urine formation and diuresis.
Continued electrolyte imbalances.
Hyponatremia
Hypokalemia
hemodilution
BODY’S
RESPON
SE TO
BURN.
Emergent phase (STAGE 1)
Pain response
Catecholamine response
Tachycardia ,tachypnea ,
mild hypertension , mild
anxiety
BODY’S
RESPON
SE TO
BURN.
FLUID SHIFT PHASE (STAGE
2)
Length 18-24 hours.
Begins after emergent phase
Reaches peak level in 6-8 hours.
Damaged cells initiate
inflammatory response.
Increased blood flow to cells
Shift of fluid from
intravascularto extravascular
space
BODY’S
RESPON
SE TO
BURN.
HYPERMETABOLIC PHASE (
STAGE 3)
Last for days to weeks
Large increase in body’s need for
nutrients as it repairs itself
RESOLUTION PHASE (STAGE
4)
Scar formation
General rehabilitation and
progression to normal function.
CLASSIFICA
TION OF
BURNSFIRST DEGREE
SUPERFICIAL SECOND
DEGREE
DEEP SECOND DEGREE
THIRD DEGREE
FOURTH DEGREE
1ST
DEGREE
BURN
Reddened skin
Pain at burn site
Involves only epidermis
Blanch to touch
Have an intact epidermal
barrier
Do not result in scaring
EG: sunburn , minor accident
Treatment with topical
soothing agents or NSAIDS
2ND
DEGREE
BURNS
Intense skin
White to red skin
Blisters
Involves dermis and papillary layers of
dermis
Spares hair follicles , sweat glands etc.
Erythematous and blanch to touch.
Very painful/sensitive.
No or minimal scarring
Spontaneously re-epithelize from
retained epidermal structures in 7-14
days.
SECOND
DEGREE
BURN
Injury to deeper layers of
dermis-reticular dermis
Appear pale and mottled
Do not blanch to touch
Capillary return sluggish or
absent.
Take 13 to 45 days to heal
Requires excision or skin
grafting.
3RD
DEGREE
BURN
Dry, leathery skin (white ,
dark , brown or charred)
Loss of sensation (little
pain)
All dermal layers/tissues
may be involved.
Always require surgery.
4TH
DEGREE
BURN
Involves structure
beneath the skin-
muscle , bone
ASSESEM
ENT OF
BURNS
RULE OF NINES
Best used for large surface areas
Expedient tool to measure extent
of burn
• RULE OF PALMS
Best used for burns <10 % BSA
MANAGEM
ENTPRE HOSPITAL CARE
Ensure rescuer safety
Stop the burning process :
stop , drop and fall.
Check for other injuries
A standard ABC (AIRWAY ,
BREATHING ,
CIRCULATION) check
followed by a rapid secondary
survey.
MANAGEM
ENT
Cool the burnt wound
Give oxygen
Elevate
Give analgesic
HOSPIT
AL
CARE
A : Airway control
B : Breathing and ventilation
C : Circulation
D : Disability – neurological
status
E : exposure with environmental
control
F : fluid resuscitation
AIRW
AYRECOGNISATION OF THE
POTENTIALLY BURNED AIRWAY
A history of being trapped in the
presence of smoke and 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.
AIRW
AYBurned airway
Early elective intubation is
safest.
Delay can make intubation very
difficult because of swelling.
Be ready to perform an
emergency cricothyroidotomy if
intubation is delayed.
BREATHI
NGInhalation injury
Thermal burn injury to
the lower airway.
Metabolic
pathway:carboxy
hemoglobin
Mechanical block to
breathing: escharotomy
CIRCULATI
ONMaintain iv line with
wide bore cannula
peripherally.
One central line.
Escharotomy of limbs if
circulatory compromise
in circumferential
burns.
FLUIDS
FOR
RESUSCITAT
ION
In children with burns over
10% TBSA and adults with
burns over 15%TBSA , consider
the needs for iv fluid
resuscitation.
If oral fluids are to be used ,
salt must be added.
Fluids needed can be calculated
from a standard formula.
The key is to monitor unit
output.
FLUIDS
FOR
RESUSCITAT
ION
PARKLAND FORMULA
% TBSA ×Weight (KG)×4 = Volume
(ml)
Half this volume is given in first eight
hours.
Second half is given in the
subsequent 16 hours.
Crystalloid : ringer lactate
Hypertonic saline
Human albumin solution
Colloid resuscitation
NUTRITI
ONBurnt patient need
extra feeding
A nasogastric tube
should be used in all
patients with burn over
15% of TBSA
Removing the burn and
achieving healing stops
the catabolic drive.
NUTRITI
ONSUTHERAND FORMULA
Children : 60 kcal/kg +35
%kcal TBSA
Adults : 20 kcal/kg +70
%kcal TBSA
•PROTEIN
20% of energy
1.5 to 2 g/kg protein/day
MONITORING
AND
CONTROL OF
INFECTION
Burn patients are
immunocompromised.
They are susceptible to infections
through many routes.
Sterile precautions should be
taken.
Swabs should be used regularly.
A rise in WBC count
,thrombocytosis, and increase
catabolism are warnings of
infections.
TOPICAL
TREATMEN
T OF DEEP
BURNS
1% silver sulphadiazine
cream.
0.5% silver nitrate
solution.
Mafenide acetate cream.
Serum nitrate, silver
sulphadiazine and cerium
nitrate.
PRINCIPLES
OF
DRESSINGS
FOR BURNS
Full – thickness and deep
dermal burns need
antibacterial dressings to
delay colonization prior to
surgery.
Superficial burns will heal
and require simple dressings.
An optimal healing
environment can make a
difference to outcome in
borderline depth burns.
Burn

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English Drug and Alcohol Commissioners June 2024.pptx
 

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