The document provides an overview of burn injuries, including their definition, causes, classification based on depth and severity, and management. It discusses the different types of burns such as thermal, electrical, chemical and radiation burns. It describes the three degrees of burns - first, second and third degree - based on the depth of tissue damage. Methods for assessing burn severity including the Rule of Nines, Rule of Palm and Lund Browder chart are outlined. Key points of initial burn management focusing on airway, breathing, circulation, disability and exposure are highlighted.

1. ْ‫ي‬ ِ‫ح‬َّ‫الر‬ ِ‫ن‬ ٰ‫م‬ْ‫ح‬َّ‫الر‬ ِ‫هللا‬ ِ‫م‬ْ‫س‬ِ‫ب‬ِ‫م‬
BURN INJURIES
Dr H.M ATIF SHEHZAD

2. TOPIC:
INTRODUCTION & TYPES OF BURN
INJURIES

3. Definition:
 Injuries that result
from direct contact
or exposure to any
physical, thermal,
chemical, electrical,
or radiation source
termed as Burn.
 It is Characterized
by damage to the
skin tissue from hot
(scald, flash, flame,
contact) cold,
electrical, chemical,
radiation and
sunlight
INTRODUCTION

4.  Skin is the
largest organ of
the body
 It composed of
three layers
I. Epidermis
II. Dermis
III. Hypodermis
(Fat layer)
INTRODUCTION

5. Epidermis
 Outer layer
 Prevent most of bacteria, viruses, other foreign substance from entering the
body.
 Protect the internal organs, muscles, nerves, and blood vessels against
trauma.
Dermis
 Inner layer
 A thick layer of fibrous and elastic tissue that give the skin its flexible and
strength.
 Contain Blood vessels, nerve, hair follicles, sweat and oil glands
SKIN LAYERS

6. Hypodermis (Fat layer)
 Helps insulate the body from heat and cold
 Provide protective padding and save energy storage area.
SKIN LAYERS

7. TYPES OF BURN INJURIES
I. Friction
II. Thermal
III. Electricity
IV. Radiation
V. Chemicals
VI. Frostbite
VII.Inhalation

8. I. FRICTION BURNS
 Rubbing of the
skin
 Anti-
inflammatory
creams
 Rubbing
 Trauma

9. II. THERMAL BURNS
Common types:
a) Dry (Flame)
b) Wet (Scalding)
Contact
Direct contact with
hot object
(i.e. pan or iron)
Anything that sticks
to skin
(i.e. tar, grease or
foods)

10. a) Flame
 Direct contact
with flame
(dry heat)
 Structural fires
 Clothing catching
on fire

11. b) SCALDING
SCALDING
 Form of thermal
burn resulting from
heated fluids such
as:
Boiling water
Steam
 Most scalds are
considered first or
second degree
burns
 Third degree burns
occurs with
prolonged contact.

12. III. ELECTRICAL BURNS
 Usually follows
accidental contact
with exposed object
conducting electricity
 Electrically
powered devices
 Electrical wiring
 Power
transmission
lines
 Can also result from
Lightning
 Damage depends on
intensity of current

13. III. ELECTRICAL BURNS
 Low-tension injuries(<1000 V)
Low energy burns cause minimal damage to subcutaneous tissues
If Entry & Exit points are fingers then there will be small deep burns.
AC current have the Tetany within muscles, cardiac arrest
due to interference with normal cardiac pacing
 High-tension injuries(>1000V)
Earthed high tension lines can cause Arc over the patient which is
usually a Flash burn.

14. LIGHTNING
Lightning
 HIGH VOLTAGE!!!
 Injury may result
from
 Direct Strike
 Side Flash

15. III. ELECTRICAL BURNS
Severity depends upon:
 What tissue current passes through (Low voltage/ High voltage)
 Width or extent of the current pathway
 AC or DC
 Duration of current contact

16. IV. RADIATION BURNS
Alpha radiation
 Large, travel a short
distance, minimal
penetrating ability.
 Can harm internal
organs if inhaled,
ingested or absorbed.
Beta radiation
 Small, more energy,
more penetrating
ability
 Usually enter through
damaged skin,
ingestion or inhalation.

17. IV. RADIATION BURNS
 UV light
 X-rays
 Radiation therapy
 Radiant energy
Waves or particles of
energy that are
emitted from
radioactive sources

18. V. CHEMICAL BURNS
 Strong acids (sulfuric
acid)
 Strong bases
 Detergents
 Solvents
Sulfuric acid found in toilet
cleaners
Sodium hypochlorite found
in bleach
Halogenated hydrocarbons
found in paint remover

19. V. CHEMICAL BURNS
 Tissue destruction
continue for up to 72
hours after a chemical
injury.
 Usually associated with
industrial exposure
 Degree of tissue damage
determined by
Chemical nature of
the agent
Concentration of the
agent
Duration of skin
contact

20. VI. FROSTBITE
 Cold Injury
(Frostbite)
 Affects fingers, toes,
nose, and ears
 Interventions for
Frostbite Warm
rapidly and
continuously for 15-
20 minutes
 AVOID slow thawing
 Do not debrided
blisters

21.  Numbness, pallor,
severe pain,
swelling, edema
 If Sensory loss than
handle the tissue
carefully!
 Skin appear
mottled blue,
yellowish-white or
waxy

22. VII. INHALATION
 Carbon monoxide
poisoning (CO)
 Inhalation of hot air
or noxious chemical
 Signs include
 Singed nares
 Facial burns
 Charred lips
 Posterior pharynx
edema
 Hoarseness
 Cough
 Wheezing

23. VII. INHALATION
 Darken oral and
nasal
membranes
 Smoke and
inhalation injury
 Inhalation injury
above glottis
 Inhalation injury
below glottis

24. TOPIC:
DEPTH OF BURN INJURIES

25. DEPTH OF BURN INJURIES
 Burns can be
classified into three
types according to
the depth of injury:
1. First degree
(superficial)
2. Second degree
(partial
thickness)
3. Third degree
(full thickness)

26. 1. FIRST DEGREE (SUPERFICIAL)
Only the epidermis
is involved.
The skin is red and
painful. There is
usually no
blistering and skin
will blanch when
touched.
It heals without
scarring.

27. SYMPTOMS
Redness
Mild pain
Dry skin
No blisters
Mild swelling
Involves minimal tissue damage
Minimal fluid lose (can dehydration in young child.)
Not serious unless large areas involve
Example: Sunburn ,UV light
1. FIRST DEGREE (SUPERFICIAL)

28. 2. SECOND DEGREE (partial thickness)
Superficial dermal burns
(SDB)
 Papillary dermis is involved.
 Blisters are seen.
 It heals with minimal
pigmentary changes without
hypertrophic scarring.
Deep dermal burns (DDB)
 Reticular dermis is involved.
 No bullae or blistering.
 Eschar with white or yellow
skin.
 Heals with scarring.

29. SYMPTOMS
 Blisters
 Redness, shiny, wet
 deep redness
 very painful
Example: Contact with hot objects or flame, tar burn
2. SECOND DEGREE (partial thickness)

30. 3. THIRD DEGREE (full thickness)
 Involves the
epidermis and
dermis and extends
to the subcutaneous
layer.
 The skin is dark and
inelastic with
eschar.
 It does not blanch.
 It does not heal
spontaneously
 It requires grafting

31. SYMPTOMS
 Dry skin
 Swelling
 White, black, brown or yellow skin
 Little to no pain
 Requires removal of eschars
 Can result in disruption of nails, hair, sebaceous glands
Example: Electrical or chemical sources, flames
3. THIRD DEGREE (full thickness)

32. TOPIC:
METHODS
1.RULE OF NINES
2.RULE OF PALM
3.LUND BROWDER METHOD

33. 1. RULE OF NINES
 The size of a burn
can be quickly
estimated by using
the "rule of nines.“
 This method
divides the body's
surface area into
percentages.
 Used for:
Second degree
burns
Third degree burns

34. RULE OF NINES FOR BURNS
The front and back of the head and neck equal 9% of the body's surface area.
The front and back of each arm and hand equal 9% of the body's surface
area.
The chest equals 9% and the stomach equals 9% of the body's surface area.
The upper back equals 9% and the lower back equals 9% of the body's
surface area.
The front and back of each leg and foot equal 18% of the body's surface area.
The genital area equals 1% of the body's surface area.

35. HOW IS THE RULE OF NINES USED?
Calculations from the rule of nines in several ways. This
includes:
The amount of fluid replacement
Degree of care a person needs
Burns that are greater than 20 to 25 percent of total body surface
area require significant intravenous (IV) fluids.
We can also use the estimated body surface area burned to
determine how much fluid to administer.

36. There are a few adjustments for the rule of nines in children:
BODY PART PERCENT
Arm (including the hand) 9 percent each
Anterior trunk (front of the body) 18 percent
Head and neck 18 percent
Legs (including the feet) 14 percent each
Posterior trunk (back of the body) 18 percent
RULE OF NINES FOR CHILDREN

37. 2. RULE OF PALM
 The Rule of Palm is
highly accurate and
easy to teach.
 It is used to estimate
the size of a burn.
 The palm of the
person who is
burned (not fingers
or wrist area) is
about 1% of the
body.
 Use the person's
palm to measure the
body surface area
burned.

38. PROCEDURE
The Rule of Palm is used when assessing the extent of burns in first aid.
Look at the victim’s hands, each palm represent about 1% of the total
body surface area.
Now look at the burned areas and calculate how many palm-sized hands
would cover the burns. This will give an approximation of the area.
The reason of using the victim's hands instead of own is due to the
differences in body sizes.
An adult male with large hands would calculate a lower Rule of Palm
number if they were assessing a toddler.
If using the toddler's palms as the measure, see the burn area, it would be
considerably higher.

39. 3. LUND & BROWDER CHART
 The Lund & Browder
Chart is accurate and
has excellent inter-
rater reliability.
 Estimating the extent
of a burn.
 It recognizes the
percentage of TBSA
of various anatomic
parts
 By dividing the body
into very small areas
and providing an
estimate of the
proportion of TBSA

40. 3. LUND & BROWDER CHART
 Initial evaluation is
made on the
patient’s arrival at
the hospital
 Revised on the
second and third
post-burn days
because the
demarcation usually
is not clear.

41. TOPIC:
KEY POINTS OF
MANAGEMENT OF
BURN INJURIES

42. INITIAL ASSESSMENT OF BURN
INITIAL ASSESSMENT INCLUDE:
A:AIRWAY WITH CERVICAL SPINE STABILIZATION
B: BREATHING
C: CIRCULATION
D: DISABILITY
E: EXPOSURE

43. AIRWAY WITH CERVICAL SPINE STABILIZATION
 Secure the airway first
 Assess for signs of inhalation injury and oral scalds or because of severe
burns to the face or oropharynx :
 Hoarseness
 Stridor
 Dysphasia
 Drooling
 History fire in an enclose space or fall.
 Consider intubation for >20%TBSA of burn
 Example: House fire, Car fire, Toxic fumes (Industrial)

44. BREATHING
Assess for airway support.
Assess rate and deep of breathing
History of inhalation injury
Listen: verify breath sounds
Signs of cyanosis (late sign)
If there are signs of breathing problems consider for intubation.

45. CIRCULATION
 Sign of hypovolemic shock
 If shock appear look elsewhere for a cause
 Color of skin
 Depth of burn (degree)
 Capillary refill
 Monitor Blood Pressure, Pulse, and Skin color.

46. DISABILITY / NEUROLOGICAL
 AVPU
 Alert
 Respond to voice stimuli
 Respond to pain stimuli
 Unresponsive
 Pupil
 GCS

47. EXPOSURE
 Stop burning process.
 Expose the patient (remove clothes and jewelry)
 Children with burn easy to lose heat so keep the child in warm
environment and cover with clean dry blankets when no being
examined.
 It is OK to use water to stop the burning process.

48. MANAGEMENT OF BURN INJURIES
KEY POINTS
Immediately cool the effect area with cool /runny water for at least 10
minute for all burns except electricity.
Immerse the site in cold water to reduce pain, edema and to minimize
tissue damage.
Water temperature not be less than 8 Celsius.

49. MANAGEMENT OF BURN INJURIES
KEY POINTS
 Do not use ice, because it may further damage the injured skin.
 If the area of the burn is large, apply clean wraps about the burned area
(or the whole patient) to prevent systemic heat loss and hypothermia.
 Hypothermia is a particular risk in young children.
 Do not touch the wound with your hands or unsterile objects.

50. MANAGEMENT OF BURN INJURIES
KEY POINTS
Do not apply toothpaste, butter, grease or oil. They increase the risk of
infection.
Do not break blisters if develops. If blisters break, clean the area by
running tap water over it.
Keep burned arms and legs above heart level.
Do not stop cooling before 10 minute is up.