The document discusses different types of burns including thermal, chemical, electrical, and radiation burns. It describes the pathophysiology of burns including the fluid shift phase and hypermetabolic phase. Burns are classified based on depth from first to fourth degree. Management involves airway control, breathing support, fluid resuscitation, infection monitoring and control, topical treatments, and dressing selection based on burn depth.

1. BURNMeenakshi sharma
Pharm.D
Chitkara university

2. Burn is defined as a
wound caused by an
exogenous agent
leading to coagulated
necrosis of the tissue.

3. THERMAL BURNS
CHEMICAL BURNS
ELECTRICAL
BURNS
COLD BURNS
RADIATIONS

4. 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

5. 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.

6. 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.

7. RADIATI
ON
BURNSCause due to radiations
Radioactive explosions.
X-Rays.
Nuclear bomb
explosions.

8. 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.

9. VIDEO
REPRESENTA
TION OF
BURNS

10. 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

11. BODY’S
RESPON
SE TO
BURN.
Emergent phase (STAGE 1)
Pain response
Catecholamine response
Tachycardia ,tachypnea ,
mild hypertension , mild
anxiety

12. 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

13. 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.

14. CLASSIFICA
TION OF
BURNSFIRST DEGREE
SUPERFICIAL SECOND
DEGREE
DEEP SECOND DEGREE
THIRD DEGREE
FOURTH DEGREE

15. 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

16. 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.

17. 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.

18. 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.

19. 4TH
DEGREE
BURN
Involves structure
beneath the skin-
muscle , bone

20. 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

21. 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.

22. MANAGEM
ENT
Cool the burnt wound
Give oxygen
Elevate
Give analgesic

23. HOSPIT
AL
CARE
A : Airway control
B : Breathing and ventilation
C : Circulation
D : Disability – neurological
status
E : exposure with environmental
control
F : fluid resuscitation

24. 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.

25. 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.

26. BREATHI
NGInhalation injury
Thermal burn injury to
the lower airway.
Metabolic
pathway:carboxy
hemoglobin
Mechanical block to
breathing: escharotomy

27. CIRCULATI
ONMaintain iv line with
wide bore cannula
peripherally.
One central line.
Escharotomy of limbs if
circulatory compromise
in circumferential
burns.

28. 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.

29. 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

30. 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.

31. 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

32. 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.

33. 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.

34. 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.