This document discusses burn injuries, including: 1) It describes the different types of burns - thermal, chemical, electrical, radiation, and cold injuries. Thermal burns are further divided into flame, scald, and contact burns. 2) It explains the pathophysiology of burns, including the zones of injury and the systemic inflammatory response. Management of burns is also covered, focusing on airway control, fluid resuscitation, wound care, and infection prevention. 3) The severity of burns is classified based on depth and total body surface area affected. Deep partial thickness and full thickness burns require specialized wound care and skin grafting.

1. 16
Those who say: Our Lord! Lo! we
believe. So forgive us our sins
and guard us from the
punishment of Fire

2. Burn Management
Dr. Mahmoud Amin
Consultant Plastic Surgery
K.F.H.H.

3. Skin AnatomySkin Anatomy
Epidermis
Dermis
Hypodermis

4. Skin AnatomySkin Anatomy
Epidermis
• Outermost layer of the skin
• Protective barrier
• Moistened by Sebum to make
it waterproof and pliable

5. Skin AnatomySkin Anatomy
Dermis
• Contains blood vessels,
glands and nerve endings
• Temperature regulation
• Sweat mechanism

6. Functions Of The Skin
• Skin is the largest organ of the body
• Essential for:
- Thermoregulation
- Prevention of fluid loss by evaporation
- Barrier against infection
- Protection against environment provided
by sensory information

7. What is a Burn?What is a Burn?
• An injury to tissue from:
–Exposure to flames or hot liquids
–Contact with hot objects
–Exposure to caustic chemicals or radiation
–Contact with an electrical current

8. Where do most burns occur?
• 0 - 4 years, from kitchen, bathroom.
• Teenagers, suicide (females).
• 5-74 years, outdoors, kitchen.
• > 75 years, kitchen, outdoors.

9. Types of burns

10. When do most burns occur?
Seasonal variations

11. Major causes of burns in the home
• Carelessness dealing with hot fluid specially
TEA ????????
• Hot water from water heaters set at high levels
above 60° C
• Carelessness with cigarettes!!
• Cooking accidents
• Space heaters
• Gasoline
• Chemicals

12. Types of Burn Injury
• Thermal burns: Scald burns ( hot fluids ) ,flame,
flash, contact with hot objects.
• Chemical burns: necrotizing substances (acids,
alkalis).
• Electrical burns: intense heat from an electrical
current
• Smoke & inhalation injury: inhaling hot air or
noxious chemicals
• Cold thermal injury: frostbite.

13. • No one is immune from thermal injury
Thermal flame
Burns

14. Thermal scald
Burns

15. chemical Burns
Chemical
burns
Acids Alkalis
Organic
compounds

16. • Burning will continue as long as the chemical is on the skin
• It is important to remove the person from the burning agent
or vice versa.
• The latter is accomplished by lavaging the affected area with
copious amounts of water.
chemical Burns

17. chemical Burns
Factors That Determine Severity:
•Agent
•Concentration
•Volume
•Duration of contact (delay in treatment)

18. Immediate coagulative
necrosis creating an eschar
though limiting the spread
of burn injury
chemical Burns
acids

19. chemical Burns
Liquefactive necrosis with continued penetration into deeper
tissue resulting in extensive injury
alkalis

20. chemical Burns
• Dry Chemicals ( Lime):
Exothermic reaction with water
– brush away as much of the chemicals as possible
– then wash off with large quantities of water

21. • Liquid Chemicals
– wash off with copious amounts of fluid
• Flush for 20-30 minutes to remove all
chemicals
chemical Burns

22. • Phenol
– Not water soluble
– If available, use alcohol before flushing except in
eyes
– If unavailable, use copious amounts of water
Spcial chemical
Burns

23. • Sodium/Potassium metals
– Reacts violently on contact with H20
– Requires large amounts of water
• Sulfuric Acid
– Generates heat on exposure to H2O (exothermic)
– Wash with soap to neutralize or use copious amounts H2O
• Tar Burns
– Use cold packs
– Do not pull off, can be dissolved later
Spcial chemical
Burns

24. • Hydrofluric Acid
– Most tissue reactive inorganic acid
– Fluoride ion penetrates & binds tissue
• Ceases when it combines with Ca or Mg
• Burns greater than 5%TBSA – can be life threatening
– Copious irrigation with H2O or Zephiran
(benzalkonium chloride)
– Topical calcium gluconate gel or Epsom salts
– If pain persists, inject 10% Ca gluconate into site
Spcial chemical
Burns

25. electrical Burns
Occurs when electricity is converted to heat as it
travels through tissue .
• The severity depends on:
amount of voltage
tissue resistance
current pathways
surface area in contact with the current
length of time the current flow.

26. • Divided into:
– High voltage – greater than 1000 V
– Low voltage – less than 1000 V
• Hands & wrists are common entrance
wounds
• Feet are common exit wounds
electrical Burns

27. • Extremely difficult to evaluate clinically
• Greatest tissue damage occurs under and
adjacent to contact points
• Superficial tissues cool more rapidly than the
deeper tissue
electrical Burns

28. • Cutaneous Burn with no underlying tissue
damage
– No passage of current through patient
• Cutaneous Burn plus deep tissue damage
– Involving fat, fascia, muscle and/or bone
• Muscle damage associated with myoglobin
release
– Urine may be light red to “port wine” colour
– Risk of kidney damage
electrical Burns

29. Management of Electrical Injury:Management of Electrical Injury:
– Examine the urine for pigment
– Maintain urine output 75-100 ml/hr until clear
– Alkalization of urine
– Mannitol 12.5 mg/liter to maintain urine output

30. Management of Electrical Injury:Management of Electrical Injury:
Peripheral CirculationPeripheral Circulation
• Remove all rings, watches and jewelry
• Hourly monitoring of skin color, sensation,
capillary refill and peripheral pulses
• Surgical correction of vascular compromise
• Decompression by escharotomy or
fasciotomy

31. Electrical Burns in the PediatricElectrical Burns in the Pediatric
PatientPatient
• Low voltage accidents is the most common
– Generally household (faulty insulation, frayed
cords, insertion of metal object into wall socket)
– Cutaneous injury, no muscle damage

32. Electrical injury can cause:
• Fractures of long bones and vertebra
• Cardiac arrest or arrhythmias--can be
delayed 24-48 hours after injury
• Severe metabolic acidosis--can develop in
minutes
• Myoglobinuria--acute renal tubular
necrosis.

33. Radiation Burns

34. Radiation Burns
causes
•Ionizing radiation enters a cell
and
changes it
•Unshielded radiation from a
radioactive source
•Dust debris containing small
active particles

35. Radiation Types
• Alpha radiation -Weak source blocked by
paper, skin clothes etc.
• Beta radiation -Greater strength than alpha
can penetrate skin and clothes
• Gamma radiation -Very powerful penetrates
the entire body blocked by lead shielding
• Neutron radiation is very dangerous not
easily blocked by anything

36. Smoke and Inhalation Injury
• Can damage the respiratory
mucosa of the respiratory tract
• soot around nares, or signed nasal
hair

37. Cold Thermal Injury (Frostbite)

38. Classification of Burn Injury
Severity is determined by:
– (WHAT) depth of burn
– (WHAT) extend of burn calculated in percent of
total body surface (TBSA)
– (WHAT) location of burn
– (IS IT ANY) patient risk factors

39. BURN DEPTH
• 11stst
DegreeDegree
- Painful,
- erythematous,
- blanch to touch
- No scarring
• 22ndnd
DegreeDegree
* Painful
*Superficial Partial Thickness (SPTL)
*Deep Dermal(DD)
• 33rdrd
DegreeDegree
i.e. FULL THICKNESS Painless
Erythema
Super.
Dermal
Deep
Dermal
Full
Thickness

40. 1st Degree

41. Superficial Partial Thickness

42. Deep dermal

43. Full thickness

44. Pathophysiology Local response
Zone of coagulation: irreversible tissue loss
due to coagulative necrosis
Zone of stasis: decreased tissue perfusion.
Tissue is viable but can deteriorate to
necrosis if not adequate resuscitation.
Zone hyperaemia: outermost zone with
increased tissue perfusion. Tissue usually
recovers in absence of severe infection or
severe tissue hypo perfusion

45. Pathophysiology Systemic response

46. Pathophysiology Systemic response

47. Extend of Burns Rule of Nines

48. Referral Criteria
• 2nd
or 3rd
Degree Burns >10% TBSA
• Burns to precious areas :Face, neck ,Chest
,Perineum ,Hand and Joint regions
• circumferential burns
• Electrical Burns
• Chemical Burns
• Inhalation Injury

49. Pre-hospital Care
• Remove from affected area! Stop the
burn!
• If thermal burn is large--FOCUS on the
ABC’s
A=airway-check for patency, soot
around nares, or signed nasal hair
B=breathing- check for adequacy of
ventilation
C=circulation-check for presence and
regularity of pulses

50. Other precautions...
• Burn too large--don’t immerse in water due to
extensive heat loss
• Never pack in ice
• Pt. should be wrapped in dry clean material
to decrease contamination of wound and
increase warmth

52. Pertinent History
– How long ago?
– What care has been given?
– What is the cause?
– Burned in closed space?
• Products of combustion present?
• How long exposed?
• Loss of consciousness?
– Past medical history?

53. Care of B U R N S
B -B - breathing
UU - urine output
RR - rule of nines
resuscitation of fluid
N -N - nutrition
SS - shock

54. Management in the emergent phase is...
• Airway management-early nasotracheal or
endotracheal intubation before airway is
actually compromised (usually 1-2 hours after
burn)
• ventilator? ABGs? Escharotomies?

55. Circulatory Status
– Burns do not cause rapid onset of hypovolemic
shock
– If shock is present, look for other injuries
– Circumferential burns may cause decreased
perfusion to extremity

56. Fluid Therapy
• 1 or 2 large bore IV lines
• Consider Fluid Therapy for
– >10% BSA 30
– >15% BSA 20
– >30-50% BSA 10
with accompanying 20
• LR using Parkland Burn Formula
– 4 (2-4) cc/kg/% burn
– 1/2 in first 8 hours
– 1/2 over 2nd 16 hours

57. Assessment of adequacy of fluid replacement
• Urine output is most commonly used
parameter
• Urine osmolarity is the most accurate
parameter
• UOP= 30-50 ml/hr in an adult

58. Wound Care
• Staff should wear disposable hats, gowns,
gloves, masks when wounds are exposed
• keep room warm
• careful hand washing
• any bathing areas disinfected before and
after bathing

59. Wound care continued...
• Treat Burn Wound
– Low priority - After ABC’s and initiation of
IV’s
– Do not rupture blisters
– Cover with sterile dressings

60. Wound care continued...
• Escharotomy / Fasciotomy

61. Wound care continued...
Excision and Application of skin graft

62. Drug Therapy
• Analgesics and Sedatives
• Antacids
• Tetanus immunization
• Antimicrobial agents: Silver sulfadiazine
Nutritional Therapy
• Burn patients need more calories & failure
to provide will lead to delayed wound
healing and malnutrition.

63. Clinical Manifestations
• Burn wound either heals by
primary intention or by grafting.
• Scars may form & contractures.
• Mature healing is reached in 6
months to 2 years
• Avoid direct sunlight for 1 year on
burn
• new skin sensitive to trauma

64. Scar Management
• Massage
• Compression
• Silicone gel sheeting
• Steroid injection
• Surgery (await scar maturity)

65. 50
And the dwellers of the Fire cry out unto the dwellers
of the Garden; Pour on us some water or some of
that where with Allah hath provided you. They say:
Lo! Allah hath forbidden both to disbelievers (in His
guidance).