Thermal burns can damage the epidermis and dermis layers of skin and are classified as superficial, partial-thickness, or full-thickness based on depth of injury. Initial management of burns focuses on airway protection, fluid resuscitation to prevent shock, analgesia, and wound care. Extent of burns is estimated based on total body surface area involved. Hospital admission is recommended for burns over 10% TBSA in children or 15% in adults due to risk of complications like infection, low blood volume, breathing issues, and joint problems that require close monitoring.

1. BURN
Dr.Mohammed Aqeel
Family Medicine Specialist

2. INTRODUCTION
• A burn is a type of injury to skin, or other tissues, caused by
heat,cold, electricity, chemicals, friction, or radiation.
• Burns are the fourth most common type of trauma
worldwide,following traffic accidents, falls, and interpersonal
violence.
• Burns constitute one of the most common causes of morbidity and
mortality worldwide.
• They can result in significant disfigurement, physical impairment,
work loss,psychological problems, and considerable economic
burden.
• Burns are preventable.
• Burns occur mainly in the home and workplace.

3. Anatomy & Physiology of the Skin
• Largest body organ: 15% of body weight ,It is
not a passive organ.
• Two layers: Epidermis and dermis.
• Epidermis
• Outer cell are dead
• Act as protection and tight seal.
• only the epidermis is capable of true regeneration

4. Functions of skin
• Regulates body temperature.
• Prevents loss of essential body fluids, and penetration of toxic substances.
• Protection of the body from harmful effects of the sun and radiation.
• Excretes toxic substances with sweat.
• Sensory organ for touch, heat, cold, socio-sexual and emotional sensations.
• Vitamin D synthesis
 Outer cells are dead
• Epidermis and Dermis
: Epidermis and Dermis
• 15% of body weight ,It is not a passive organ.

5. PATHOPHYSIOLOGY of Burn

6. PATHOPHYSIOLOGY of Burn

7. PATHOPHYSIOLOGY of Burn

8. PATHOPHYSIOLOGY of Burn

9. PATHOPHYSIOLOGY of Burn

10. Types of Burns
• Thermal (heat) burns
• Chemical burns
• Electrical burns
• Inhalational burns

11. Thermal (heat) burns classification
• Superficial Burn/1st Degree Burn:
• Erythema ,pain at burn site , involves only epidermis, absence
of blisters , heals within 3 to 6 days.
• Example – sunburn.
• Partial-Thickness Burn/ 2nd Degree Burn:
• Entire epidermal layer , part of underlying dermis.
• Mottled and red, painful, swelling and blisters.
• Healing in 10 to 21 days.
• Not enough to interfere with regeneration of the epithelium.

12. Thermal (heat) burns classification
• Full-Thickness Burn/ 3rd Degree Burn:
• Destruction of all epidermal and dermal elements.
• Burn into subcutaneous fat or deeper
• Skin is charred and leathery (woody)
• Generally not painful (nerve endings are dead)
• Fourth-degree :
• Full-thickness, Extending into muscle, tendons or bones
• Black and dry, No pain
• Eschar formation

13. Electrical Burns
• Burns are caused by heat generated by electrical energy as it passes through the body
• Electrical burns result in internal tissue damage.
• Cutaneous burns cause muscle and soft tissue damage that may be extensive,
particularly in high-voltage electric injuries .
• The voltage, type of current, contact site, and duration of contact are important to
identify.
• Alternating current is more dangerous than direct current because it is associated
with cardiopulmonary arrest, ventricular fibrillation, tetanic muscle contraction, and
long bone or vertebral fractures.
• Subcutaneous (Fourth Degree).

14. Chemical burn
• Most acids produce a coagulation necrosis by denaturing proteins,forming
eschar that limits the penetration of the acid.
• Bases typically produce a more severe injury known as liquefaction necrosis.
• Damage continues until the substance is removed or neutralized

15. Inhalational injury
• Its results from the airway inflammatory response to inhalation of the products of
incomplete combustion and is the leading cause of death (up to 77%) in burn patients .
• Dangers of smoke, hot gas or steam inhalation
• Inhaled hot gases can cause supraglottic airway burns and laryngeal oedema
• Inhaled steam can cause subglottic burns and loss of respiratory epithelium
• Inhaled smoke particles can cause chemical pneumonitis and respiratory failure
• Inhaled poisons, such as carbon monoxide, can cause metabolic poisoning
• Full-thickness burns to the chest can cause mechanical blockage to rib
movement

16. • Warning signs of burns to the respiratory system
 Burns around the face and neck
A history of being trapped in a burning room
Change in voice
Strider

19. Estimation of Burned Area

20. Initial management
• History: time, extent and mechanism of burn , age and weight of the patient, brief
medical history.
• Airway assessment: may require ET intubation and mechanical ventilation in case of
acute
inhalational injury, upper airway oedema, chest wall restriction, CO poisoning.
• Breathing: administer 100% humidified oxygen via a non-re breathing mask.
• Circulation: establish two large bore IV cannula and commence fluid resuscitation.
• Assess neurological status.
• Analgesia: IV opiods .
• Formally assess burn area and re-evaluate fluid requirement.
• Monitoring: vital signs, urine output.
• Investigations: ABG, Hb, U & E, FBC, Clotting screen, cross-match blood, ECG,CXR.
• Secondary survey to exclude other injuries.

21. Initial management
• Feeding tube. People with extensive burns or who are undernourished
may need nutritional support. Doctor may .thread a feeding tube
through your to stomach
• Easing blood flow around the wound. If a burn scab (eschar) goes
completely around a limb, it can tighten and cut off the blood
circulation. An eschar that goes completely around the chest can make
it difficult to breathe. Doctor may cut the eschar to relieve this
pressure
• Tetanus shot. Your doctor might recommend a tetanus shot after a
.burn injury

22. When admit patient to hospital
• Suspected airway or inhalation injury
• Any burn likely to required fluid resuscitation
• Any burn likely to required surgery
• Any burn in patient at the extremes of age
• Any suspicion of non accidental injury
• Patients whose psychiatric
• Second-and third-degree burns >10% body surface area (BSA) in patients <10
children or >50 years old
• Second and third-degree burns with serious threat of functional or cosmetic
impairment that involve the face, hands, feet, genitalia, perineum, and major
joints

23. Fluids for resuscitation
• In children with burns over 10% TBSA and adults with
burns over 15% TBSA, consider the need for
intravenous fluid resuscitation
• If oral fluids are to be used, salt must be added
• Fluids needed can be calculated from a standard
formula and start from time of burn
• The key is to monitor urine output

24. Fluid regimen for burn patients
• Proceed with regimen if > 15% burns in adults or > 10% in children.
PARKLAND FORMULA:
• Requirement in first 24 hours ( ml)= BW ×% Burn ×4 ml.
• Fluid given as R/L alone, 50 % within first 8 hr, 25% in second 8 hr, 25 % in last 8
hr.
• Colloids administered only after first 24 hr, 5 % dextrose is required at 1-2
ml/kg/hr after first 24 hr.
Brooke formula:
• 1.5 mL of R/L per kg per % TBSA burn per 24 hours plus 0.5 mL of colloid per kg
per % TBSA burn per 24 hours plus 2,000 mL of 5% dextrose in water per 24 hours
• Half the calculated fluid deficit is administered during the first 8 hours post burn
and the remainder is administered over the next 16 hours.
• Daily maintenance fluid after 24th hour: “ 4-2-1” rule.

25. MEDICAL MANAGEMENT
• There are three phases of burn injury, each requiring various
levels of client care. The three phases are:
• Emergent
• Intermediate
• Rehabilitative

26. EMERGENT PHASE
• This phase begins immediately at the time of injury and ends with the
restoration of capillary permeability.
• The main goal of this phase is to prevent hypovolemic shock and
preserve vital organ functioning.
• Methods used during this time are pre hospital care and emergency
room care

27. INTERMEDIATE PHASE
• It begins about 48–72 hours following the burn injury.
• During this time, the emphasis is placed on restoration of the
patient’s capillary permeability and the phase continues untilthe
wound is totally closed.
• During the intermediate phase, attention is given to removing the
eschar and other cellular debris from the burned area.
Debridement, the process of removing eschar, can be done placing
the client in a tub or shower and gently washing the burned tissue
away with mild soap and water or by the use of enzymes, substances
that digest the burned tissue. Santyl (collagenase) is an important
debriding agent for burn wounds.

28. REHABILITATIVE PHASE
• This stage begins with closure of the burn and ends when the
client has reached the optimal level of functioning.
• In actuality, it begins the day the client enters the hospital and
can continue for a lifetime.
• In the rehabilitative phase, the focus is on helping the client
return to preinjury life.

29. SURGICAL MANAGEMENT OF BURNS
• SKIN GRAFTS
1. Split-thickness grafts
2. Full-thickness grafts
• MICROSURGERY
• FREE FLAP PROCEDURE
• TISSUE EXPANSION

30. Special considerations during resuscitation
• Central venous access is usually required with burns > 20% BSA.
• A high index of suspicion for airway burns should be maintained in all cases
and prophylactic tracheal intubation is often justified, particularly in children
and if inter hospital transfer is required.
• Indication for ICU admission include: potential airway problems, burns
involving > 20 % BSA and the presence of other injuries.
• Volume replacement titrated to achieve a urine output of 0.5-1 ml/kg/hr in
adult and 1.0-1.5 ml/ kg/hr in children.
• bladder pressure monitoring ( to detect intra abdominal hypertension ) for all
patients with major burns of > 30% BSA.

31.  Compromised airway.
 Pulmonary insufficiency.
 Altered mental status.
 Associated injuries.
 Difficult vascular access.
 Rapid blood loss.
 Impaired tissue perfusion.
 Positioning.
• Edema.
• Dysarhythmias.
• Impaired temperature regulation.
• Altered drug responses.
• Renal insufficiency.
• Immunosuppression.
• Infection/ sepsis.
Challenges in Burn anaesthetic management

32. COMPLICATIONS OF BURNS
• Infection
• Low blood volume
• Dangerously low body temperature
• Compartment syndrome
• Breathing problems [Inhalation injury]
• Scarring
• Bone and joint problems
• Shock
• Heat exhaustion and heatstroke