2. Definition
A burn is an injury to the skin or other organic
tissue primarily caused by thermal or other
acute trauma.
Causes: scald(the most common),
flame(deep),flash,contact,chemical,&electrical.
3. Classification
Burn Wounds Classified Based on Depth of
Penetration:
First degree:
• Epidermis only
Skin erythema, pain
Blanches with pressure
No blistering
Symptoms subside over 2-3 days, epithelium
peels at day 4.
6. Second degree
• Superficial: Papillary dermis sparing skin
appendages
Painful
Blanches with pressure
Blistering may be delayed for 12-24 hours after
burn.
Most heal within 3 weeks via stem cells from skin
appendages without hypertrophic
scarring.
8. Second degree(continued)
Deep: Reticular dermis involving loss of skin
appendages
Decreased sensation
No capillary refill
Blistering
Heal in 3-9 weeks, hypertrophic scarring
common, usually treated with excision and
Grafting.
9. Third degree burn
Entire dermis and adnexal structures
Blistering absent
Insensate, leathery consistency,thrombosed veins.
Color varies with mechanism of burn.
If no intervention, it will demarcate and separate over
days to weeks. However, this delays healing and risks
infection.
Circumferential third-degree burns of extremities may
lead to compartment syndrome if muscles become
edematous; likewise circumferential chest wall burns may
inhibit
expansion and breathing.
11. PHYSIOLOGIC RESPONSE TO BURN
INJURY
# Generalized edema is usually seen in patients
with burns greater than 30% total burned
surface area (TBSA).
#Increased capillary permeabilityto protein(last
for 12-18 hours)
#Smaller burns cause localized edema only.
#Microvascular injury can interfere
with the function of various organ systems.
12. Indications of admission
1- Partial-thickness burns greater than 10% of TBSA
2- Third-degree burns
3- Burns involving face, hands, feet, genitalia, perineum, or major
joints
4- Chemical burns
5- Electrical burns
6- Any burn with concomitant trauma in which burn poses greatest risk
to patient
7- Inhalation injury
8- Preexisting medical disorders that could affect mortality
9 Hospitals without qualified personnel or equipment for care of
burned children
10- Patients who will require special social, emotional, or rehabilitative
intervention
13. Resuscitation
NB:Remember your A-B-C-D-Es.
#Burn shock from systemic response typically
occurs with .20% TBSA (.15% in pediatric/
geriatric patients).
# Burn shock requires resuscitation.
PARKLAND FORMULA:
4 ml X Weight (kg) X %TBSA burned.
Half of the total amount in lactated Ringer’s solution given over
the first 8 hours from the time of injury and the second half over
the next 16 hours.
14. Calculation of TBSA
1-Lund and Browder chart
2-rule of nines
3- palm method
NB: first degree burn is not included when
calculating TBSA.
17. Electrical Injuries
# Most sequelae from high-voltage injury (>1000 volts)
# Find contact points
# ECG
# Cardiac monitoring
# Renal function testing
# Tea-colored urine indicates myoglobinuria.
• Maintain urine output at 75-100 ml/hr to minimize
myoglobin precipitation. Bicarbonate or
mannitol may be needed.
#Risk of compartment syndrome in involved extremity
18. Acute-Phase Burn Reconstruction
For deep second and 3rd degree burn
:
Excision
Wound coverage autograft,allograft ,xenograft
Aggressive splinting and therapy
20. Complications
A- Care related
• Pneumonia: Most common cause of death in burn patients
• Sepsis
• Gastrointestinal complications: Ileus and ulceration
• Renal failure: Acute tubular necrosis (ATN) from hypoperfusion
• Shock: Inadequate end-organ perfusion
Signs of sepsis:
1. Hyperventilation
2. Fever or hypothermia
3. Hyperglycemia
4. Obtundation
5. Ileus
6. Hypotension and oliguria
