2. ANATOMY OF SKIN
• The skin is the largest organ of the body, with a total area of about 20
square feet.
• The skin protects us from microbes and the elements, helps regulate body
temperature, and permits the sensations of touch, heat, and cold.
• Skin has three layers:
1. The epidermis, the outermost layer of skin, provides a waterproof barrier
and creates our skin tone.
2. The dermis, beneath the epidermis, contains tough connective tissue,
hair follicles, and sweat glands.
3. The deeper subcutaneous tissue (hypodermis) is made of fat and
connective tissue
3.
4. INTRODUCTION
• Burns are tissue damage that results from heat, overexposure to the
sun or other radiation, or chemical or electrical contact.
• Burns can be minor medical problems or life-threatening
emergencies.
• The treatment of burns depends on the location and severity of the
damage.
• Sunburns and small scalds can usually be treated at home.
• Deep or widespread burns need immediate medical attention.
5. • DEFINITION
• Burns:
is defined as a wound caused by exogenous agent leading to coagulative
necrosis of the tissue.
• A burn is a type of injury to skin, or other tissues, caused by heat,
cold, electricity, chemicals, friction, or radiation.
• Most burns are due to heat from hot liquids, solids, or fire.
7. Thermal Burns
• Heat changes the molecular structure of tissue
Causing Denaturion of proteins
• Extent of burn damage depends on
-Temperature of agent.
-Amount of heat.
-Duration of contact.
8. • THE EFFECTS OF THE BURNS ARE INFLUENCED BY THE:
1. Intensity of the energy.
2. Duration of exposure.
3. Type of tissue injured.
9. CLASSIFICATION OF BURNS
First degree.
• injury localized to the epidermis.
Superficial second degree
-injury to the epidermis and superficial papillary dermis
Deep second degree
-injury through the epidermis and deep up to reticular dermis
Third degree-full-thickness
injury through the epidermis and dermis into subcutaneous fat
Fourth degree
-injury through the skin and subcutaneous fat into underlying muscle or bone
10. CLASSIFICATION OF BURNS
SUPERFICIAL BURN 1ST DEGREE BURN
• Reddened skin
• Pain at burn site
• Involves only epidermis
• Blanch to touch
• Have an in-tact epidermal barrier
• Do not result in scarring.
Examples:
Sun-burn, minor scald from a kitchen accident
• Treatment is aimed at comfort with topical soothing agents +/- NSAIDs.
11.
12. PARTIAL-THICKNESS BURN:
2ND DEGREE BURN
• Intense pain
• White to red skin.
• Blisters
• Involves epidermis & papillary layer of dermis
• Spares hair follicles, sweat glands etc.
• Erythematous & blanch to touch
• Very painful/sensitive.
• No or minimal scarring.
• Spontaneously re-epithelialize from
retained epidermal structures in 7-14 days
13. DEEP SECOND DEGREE BURN
• Injury to deeper layers of dermis-reticular dermis.
• Appears pale & mottled
• Do not blanch to touch.
• Capillary return sluggish or absent.
• Less painful, remain painful to pinprick.
• Takes 14 to 35 days to heal by
re-epithelialisation from hair follicles & sweat gland,
keratinocytes often with severe scarring.
• Contractures possible Require excision & skin grafting.
14. 3RD DEGREE )FULL-THICKNESS( BURN:
• Dry, leathery skin(white, dark brown, or charred)
• Loss of sensation(little pain)
• • All dermal layers/tissue maybe involved
• Always require surgery.
Fourth degree burn
• Involves structures beneath the skin- muscle, bone.
15. Recuperative course
Wound appearance
symptoms
Skin Involvement
Depth of burn is
causes
Superficial partial
thickness (similar to
first degree(
Complete recovery
within a week; no
scarring peeling
Reddened; blanches
with perssure; dry
Minimal or no edema
Possible blisters
TinglingHyperesthesia
(supersensitivity Pain
that is soothed by
cooling
Epidermis; possibly a
portion of dermis
SunburnLow-density
flash
Deep partial
thickness(similar to
second degree).
Recovery in 2-4
wksSome scarring &
depigmentation
contractures Infection
may convert it to full
thickness
Blistered, mottled red
base; broken epidermis;
weeping surface edema
Hyperesthesia Sensitive
to cold air
Epidermis, upper
dermis, portion of deep
dermis
ScaldsFlash
flamecontact
Full-thickness (similar to
third degree)
Eschar sloughsgrafting
necessaryScaring & loss
Dry; pale white,
leathery, or charred
Pain freeShock
Hematuria & possibly
Epidermis, entire
dermis, & sometimes
Flame Prolonged
exposure to hot
16. Pathophysiology
• Local Changes:
Thermal injury causes coagulative necrosis of epidermis and underlying
tissue, with depth of injury dependent on temperature to which skin is
exposed, the specific heat of causative agent, duration of exposure.
• The area of cutaneous or superficial injury has been divided into
three zones:
1. Zone of coagulation:Necrotic area of burn where cells are disrupted.
2. Zone of satsis:Its area surrounding zone of coagulation where vessel
leakage & vessel damage present
3. Zone of hyeremiaIt is area where Vasodilation & inflammation is present.
18. Metabolic:
Hypermetabolic state.
Increased oxygen and calorie requirements.
Increase in core body temperature.
Immunologic:
Loss of protective barrier.
Increased risk of infection.
Suppression of humoral and cell-mediated immuneresponses.
19. ASSESSMENT OF BURNS
Rule of Nine
-Best used for large surface areas
-Expedient tool to measure extent of burn
Rule of Palms
-Best used for burns< 10% BSA
