This presentation provides an overview of burns, including: 1. Definitions, causes, types and classifications of burn injuries. Burns can be caused by heat, cold, electricity, radiation or chemicals and are classified by depth and percentage of total body surface area affected. 2. The pathophysiology and assessment of burn wounds, which involves determining burn depth, total body surface area burned, and monitoring vital signs and laboratory values. 3. The primary survey and management of burns, which includes airway control, fluid resuscitation, wound care, nutrition, infection prophylaxis and wound management. 4. Potential complications of burns like infection, stress ulcers, contractures and psychological impacts. Early excision,

1. Presentation on :
Burns: Assessment & Management
Swornim Gyawali
Intern GMC
2010 batch

2. Outline
• Objective
• Introduction
• Type of Burn injury
• Classification of Burns
• Pathophysiology of Burns
• Assessment of the Burn wound
• Management of Burns
– Primary
– Secondary
• Complications of Burn Injuries

3. Objectives
• At end of this presentation we be able to
know
1. definition and causes of Burn injuries
2. Types and classification of burns
3. pathophysiology of burns
4. Management of a patient who sustained
burn injury
5.Complications of burns

4. Introduction
Definition
• A burn is a coagulative destruction of the
surface layers of the body.
• It occur when some or all of the cells in the
skin or other tissues are destroyed by
 heat
 cold
 electricity
 Radiation
 Lightening
 caustic chemicals

5. Types of Burn Injury
• Thermal
Flame : fire injury
Scald : moist heat/steam
Flash : explosion
Contact : to hot surfaces

6. • Cold exposure (frostbite)
Usually occurs in distal parts of the body
Common sites: Fingers, Toes, Nose and Ears
Severe Vasoconstriction & Decreased Blood flow
 Ischemia
• Chemical burns
 Cause progressive damage
 Acid produces tissue coagulative Necrosis.
 Alkaline burns generate colliquation Necrosis.
 Systemic absorption of some chemicals is life
threatening

7. • Electrical
 mechanisms of injury :
i. Electrical current injury
ii. Electrothermal burns from arcing current
iii. Flame burn caused by ignition of clothes
 Deep destruction of muscles  rhabdomyolysis
myoglobinuria ATN  ARF
• Inhalation Hot smoke
• Radiation sunburn

8. Pathophysiology of Burn
Local Changes
1. Burn causes coagulative necrosis of the epidermis and
underlying tissues
2. depth of injury: temperature & duration of exposure
area of cutaneous injury

9.  Systemic changes

10. Assessment of The Burn Wound
• Burn Depth
 Cutaneous burns are classified according
to the depth of tissue injury:
1. superficial or epidermal (first-degree),
2. partial-thickness (second degree), or
3. full thickness (third degree).
4. Burns extending beneath the subcutaneous
tissues and involving fascia, muscle and/or
bone are considered fourth degree

12. First degree
(Superficial)
• Red, erythematous
• Very sensitive to touch
• Very painful
• Usually moist
• No blisters
Second degree
(partial-
thickness)
• Erythematous or whitish with a fibrinous
exudate
• Wound base is sensitive to touch and Painful
• Commonly have blisters
• Surface may blanch to pressure
Third degree
(Full thickness)
• Surface may be: White, Black, leathery, Pale
or Bright red
• Generally anesthetic or hypoesthetic
• Subdermal vessels do not blanch
• No blisters
• Hair easily pulled from its follicle
Fourth degree • Involves deep tissues including fascia,

14. Assessment of The Burn Wound (cont’d)
• Total percentage of body surface area
(TBSA)
1. Lund-Browder chart

15. • Rule of Nines

18. Management; Primary Survey
Initial Intervention
 Airway maintenance with cervical
spine control
 Breathing and Ventilation
 Circulation with Haemorrhage Control
 Disability: Neurological Status
 Exposure with Environmental Control

19. Diagnostic tests and monitoring
• Arterial blood gas
• Chest x-ray
• Serial peak expiratory flow rates
(PEFR)
• Pulse oximetry
• Capnography
• fiberoptic laryngoscopy and
bronchoscopy

20. Treatment
• Supplemental oxygen and airway
protection
• Close monitoring of fluid resuscitation
• Mechanical ventilation
• Inhaled nitric oxide
• aerosolized heparin and N-
acetylcysteine (NAC)

21. Fluid resuscitation
American Burn Association's practice guidelines,
patient with greater than 15 percent total body
surface area (TBSA) non-superficial burns should
receive formal fluid resuscitation.
Fluid selection
Formulae
1. Parkland : 4ml x wt (Kg) x % TBSA burn
-Ringer’s lactate or Hartman solution
2. Evans :1ml x wt x %TBSA
3. Brooke :1.5ml x wt x %TBSA
4. Modified Brook:2ml x wt x % TBSA

22. Management; secondary Survey (cont’d)
• History
• Thorough physical examination
• Lab studies and monitoring
 CBC
 Electrolytes
 RFT
 Glucose
 Venous blood gas
 Caboxyhemoglobin
 Arterial blood gas
 Chest x-ray
 ECG

23. Management; Secondary Survey (cont’d)
Chemoprophylaxis
Tetanus immunization
Antibiotic
Wound management
 Wound dressing and care
 Escharotomy
 Chest - at the anterior axillary line
 Extremity - can be done at a bedside without
local anesthesia

25. Nutrition
• Hypermetabolism develops as a response
to injury
• If TBSA >40%, lean body weight ↓ by
25% over the first 3 weeks
• Patient with major burn needs high
calorie in the form of: CHO (50%),
protein (20%) , fat (30%) and some
vitamins & minerals

26. Nutritional Requirement Calculations
Curreri formula
• Age 16–59 years: (25)W + (40)TBSA
• Age 60+ years: (20)W + (65)TBSA
Sutherland formula
• Children: 60 kcal /kg + 35 kcal%TBSA
• Adults: 20 kcal /kg + 70 kcal%TBSA
Protein needs
• Greatest nitrogen losses between days 5 and
10
• 20% of kilocalories should be provided by
proteins

27. Burn Complications
1. INFECTION
2. Curling ulcer- stress ulcers
3. Contracture
4. Marjolin’s ulcer, Hypertrophic scar, keloid
Pschological aspect
• PTSD
• Flash backs
• Avoidance behavior
• Sleep disturbance

28. Minimizing complications
1. Hand washing before & after touching
each patient.
2. Aseptic techniques for dressing &
procedures
3. Early nutritional support
4. Early excision of deep burns
5. Use of topical antimicrobials
6. Early excision and grafting

29. Thank you !!!
• Queries ????

30. Refrences
1. SCHWARTZ :Principles of surgery ,9th
edi.2008
2. BAILEY & LOVE : Short practice of
surgery ,25th edi,2008
3. American Burn Association's practice
guidelines, 2012
4. Internet (pictures)
5. Medscape.com