The document summarizes information about burns and their treatment. It discusses the three layers of skin (epidermis, dermis, hypodermis) and how burns are initially assessed by checking the airway, breathing, circulation, and neurological status. It then outlines the secondary assessment and various treatments for burns including fluid resuscitation formulas, wound care, pain management, skin grafting, nutrition, and physiotherapy.

1. SEMINAR ON BURN
PRESENTED BY;
SHIWANI CHOPRA
NPCC 1ST YEAR.

2. INTRODUCTION
• Skin also contain DNA repair enzymes that help reverse UV damage , such that
people lacking the genes for these enzymes suffers high rates of skin cancer .
• Human skin pigmentation varies among populations in a striking manner.
• The thickness of the skin varies considerably over all parts of the body , between
men and women and the young and the old.
• Skin consist of mainly three layers;
• EPIDERMIS.
• DERMIS.
• HYPODERMIS.

3. contd……
• EPIDERMIS; ‘ epi ’ coming from the greek word “ over ”.
• It is the outermost layer of the skin, act as an waterproof wrap over the body
surface, also serve as a barrier function made up of a stratified squamous
epithelium with basal lamina.
• It is made up of a merkel cells , keratinocytes , with melanocytes and Langerhans
cells also present.
• It is further divided into the following ;
• corneum ; Beginning with the outermost layer .
• Lucidum ; only in palm of hands and bottoms of feet .
• Granulosum .
• Spinosum.
• Basale .
• KERATINIZATION; due to the mitosis division the cell change shape and size
which leads to release of cytoplasm and inseration of keratin and ther reach the
corneum and desuamation is takes place process is known as keratinization.

4. contd……
• DERMIS ; it is the layer of skin beneath the epidermis that consist of
connective tissue and cushions the body from stress and strain.
• Dermis is tightly connected to the epidermis by a basement membrane
.
• It contains the hair follicles, sweat glands , sebaceous glands , apocrine
glands , sebaceous glands , lymphatic vessels .
• The dermis provide nourishment and waste removal from its own cells
as well as from the stratum basale of epidermis.
• HYPODERMIS; it is the deepest section of the skin.
• It refers to the fat tissue below the dermis that insulates the body from
cold temperature and provide shock absorption.
• It also provides shock absorption.

5. • The hypodermis is the thickest in the buttocks , palm of the hands , and soles
of the feet .
• SKIN COLOR;
• there are at least five different pigments that determine the color of the skin
;
• Melanin; brown in color and present in the basal layer of the epidermis.
• Melanoid ; resembles melanin but is diffuse throughout the epidermis.
• Hemoglobin ; found in blood .

26. BURN ASSESSMENT
• Primary assessment; it starts with the airway patency and cervical
spine protection .
• Assess breathing , central and peripheral circulation and cardiac
status; stabilize any deficit , or gross deformity , ; remove the cloth to
assess the extent of burns and concurrent injuries.

27. to be contd…..
• 1. airway ;
• Check the upper airway for obstruction, edema ,
• Place an oral pharyngeal device to protect an unconscious patients
airway.
• If there is any edema in upper airway or obstruction check for theneed
of ET.
• Auscultate the breath sounds and inspect and palapte patient chest
walls .
• Star O at 15 l.
• Monitor the carbondioxide level in carbondioxide patient.

28. to be contd….
• If there is circumferntial burns at the neck or torso may impair
ventilation; to maintain patent airway perform escharotomies to
release constrictive eschar ,needle decompression to relieve a tension
pneumothorax .
• Chest tube placement to drain fluid build up.
• 2. Vital signs; monitoring vital signs and the color of unburned skin to
assess the patients circulatory and cardiac status.
• In circumferntial burns check for the pulses the burn in any extremity.
• HR – 100 to 120 b/m –because of increased circulating
catecholamines and hypermetabolism .
• Inc. in HR indicates hypovolemia from trauma, inadequate
oxygenation, or uncontrolled pain and anxiety.

29. to be cont…..
• Neurologic assessment; it wont altered in early stage of burn…
• If the patient isn’t alert and oriented upon arrival , consider an
associated injury , co posisioning , substance poisoning , hypoxia etc..
• Use the GCS scale to rule out the neurological status.
• Skin exposure; to prevent the depth of injury remove the causative
agent from the skin and flush the burn area with tepid water.
• Remove all of the patient clothing, jewellery , shoes, diapers , and
contact lenses.
• Cover the patient with blankets and use warm fluids, maintain warm
environment.

30. • Transport ; if patient need more care and resources , prepare him or
her to the nearest burn center .
• SECONDARY ASSESSMENT ;
• Immediately after the achievement of the primary assessment .
• Insert iv lines, tubes , catheters ,.
• It includes;
• History ,.
• Head to toe physical examination .
• Calculation of the % of TBSA affected .
• Fluid resuscitation .
• Wound care.

31. • LAB TEST; it must be performed within 24 hrs.
• CBC, RFT , LFT ,.
• ABG ; it is helpful in to detect the carbon dioxide in red blood cells.it
is useful in inhalation injury.
• Other test ;
• ECG ; done in early stage because cardiac arrest can occur.
• Chest x ray ; to detect the position of ET .or atelectasis caused by
large volume fluid resuscitation.
• Serum lactate ; it helps detect acid imbalance and may help in
predicating survival.
• Cyanide level ; if unexplained lactic acidosis occurs ; risk high in
inhalation injury.

32. • Urine myoglobin , serum creatine kinase ; it helps tto detect injuries
to kidney or muscles and help to diagnose rhabdomyolysis ,occur with
electrical or extensive third degree burn .
• Tetanus immunization should be done..
• wound care
• Fluid resuscitation.

46. • FLUID REPLACEMENT THERAPY –
• Fluid replacement therapy is very important in emergent phase of
burn injury. The adequacy of fluid resustication is determined by
monitoring urine output total. Within first 24 hours after injury if
hematocrit and haemoglobin levels decrease or if the urinary output
exceeds 50ml/hour, the rate of IV fluid administration may be
decreased. Formula has been developed to replace the fliud. These

47. • 1. CONSENSUS FORMULA
• Lactate ringer solution: 2-4ml × kg%TBSA burned.
• Half to be given in first 8 hour and remaining half given over next 16 hour.
• 2. EVANS FORMULA
• a) COLLOIDS: 1ml × kg body weight ×% TBSA burned.
• b) ELECTROLYTES(saline): 1ml × body weight × % TBSA burned.
• c) GLUCOSE(5% in water): 2000mlfor insensible loss.
• Day 1: Half to be given in first 8 hour and remaining half given over next 16
hour.
• Day 2: Half of previous day’s colloids and electrolytes all of insensible fluid
replacement.
• Maximum 10,000ml over 24 hour.

48. • ELECTROLYTES(saline): 1ml × body weight × % TBSA burned.
• Day 2: Half of previous day’s colloids and electrolytes all of insensible
fluid replacement.
• GLUCOSE(5% in water): 2000mlfor insensible loss.
• Maximum 10,000ml over 24 hour.

49. • BROOKE ARMY FORMULA
• a) COLLOIDS: 0.5ml × kg body weight × % TBSA burned.
• b) ELECTROLYTES(Lactate Ringer solution): 1.5ml × kg body weight ×
TBSA burned.
• c) GLUCOSE(5% in water): 2000mlfor insensible loss.
• Day 1: Half to be given in first 8 hour and remaining half given over
next 16 hour.
• Day 2: Half of previous day’s colloids and electrolytes all of insensible
fluid replacement.

50. SURGICAL MANAGEMENT
• Reconstructive surgery is the surgery to restore the function of body.
• It is usually termed to improve functions .it is done to improve the
normal appearance.
• SKIN GRAFTING; it involve the transplantation of skin.
• It is a technique in which a section of skin is detached from its blood
supply and transplated as free tissue to the recipient site.

51. TYPES OF SKIN GRAFT
Full thickness
graft
Types of skin graft
Split
thickness
graft

52. SPLIT THICKNESS GRAFTS
• It involves the removal of the top layer of the skin – the epidermis – as
well as a portion of the deeper layer of the skin the dermis.
• It is usually harvested from the front or outer thigh , abdomen ,
buttocks , or back.
• These grafts tends to be fragile and typically have a shiny or smooth
appearance.

53. contd…..
• Full thickness grafts; it involves removing all of the epidermis and
dermis from the donor site.
• Grafts taken from abdomen , groin , forearm , or area above the
clavicle ( collar bone) .
• They tend to be small pieces of skin , closed in a straight line incision
with stiches or staples.
• It is usually used for the small wounds on highly visible parts of the
body , such as face.
• It is well blend in the skin and become more better cosmetic
outcome.

54. PAIN MANAGEMENT
• It must be done on the basis of individual pain experience and
uniqueness related to pain .
• Initial and ongoing pain management is essential to ensure the
patient comfort and relasse the post traumatic stress.
• Regular pain relief such as combo of PCM , and opioids initially .
• Route of administration include ; oral , I/V .

55. WOUND DRESSING
• Removal of previous dressing ; it should not damage the healing burn
wound and should be as atraumatic as possible .
• The use of an adhesive remover , normal saline or water can be used.
• WOUND MANAGEMENT;
• Clean the wound using a soft wipe with water , normal saline , pH
neutral soap and cetrimide .
• Enough pressure should be applied to debride the damage skin and
remove the exudate , loose skin and slough.

56. contd…
• These can be removed with sterile water or normal saline .
• A moistened swab may be benefical , particularly if swabbing dry
areas on the burn injury .
• Debridement of any blisters present allows for wound bed
assessment and appropriate dressing application .
• If the patient has had a bath , pat dry the surrounding skin with clean
towels or gauze .
• Cling wrap could also be utilized to protect the burn if there is an
delay in application of new dressing.

57. • WOUND DEBRIDEMENT – A debris accumulates on the wound surface it can retard a keratinocyte
migration thus delaying the epithelialisation process. Debridement is another fact of burn wound care,
it has two goals:
• • To remove tissue contaminated by bacteria and foreign bodies.
• • To remove devitalized tissue or burn eschar in preparation for grafting and wound healing.
• TYPES OF DEBRIDEMENT – There are three types of debridement ;
• 1. NATURAL DEBRIDEMENT
• 2. MECHANICAL DEBRIDEMENT
• 3. SURGICAL DEBRIDEMENT
• 1. NATURAL DEBRIDEMENT- In natural debridement, the dead tissue separates from the underlying
viable tissue spontaneously.
• 2. MECHANICAL DEBRIDEMENT- It involves the use of surgical scissors, scalpels and forceps to
separate and remove the eschar. This technique is performed by skilled physician, nurses or physical
therapists and is usually done with daily dressings changes and wound cleaning process.
• 3. SURGICAL DEBRIDEMENT- Surgical debridement is an operative procedure involving either
primary excision (surgical removal of tissue) of the full thickness of the skin down to the fascia or
shaving of the burned skin layers gradually down to freely bleeding viable tissue. This may be
performed a few days after the burn or as soon as the patient is haemodynamically stable and edema
has decreased.

58. NUTRITION
• It plays a vital role in burn healing , minimizing complications of care
and meeting the increased metabolic demands associated with
paediatric patients .
• Diet in high protein , energy , aand micronutrients has been shown to
be most beneficial for wound healing .

59. PHYSIOTHERAPY
• Physiotherapy and occupational therapy may be necessary
throughout both inpatient stay and outpatient management for
patients who have suatained a burn injury .
• Strategies to support splinting and positioning regimes include;
• Play therapy , distraction and rewards .
• Ongoing education and positive reinforcement .
• Consistency in care.

61. THANK YOU