1. In India, over 1 million people suffer moderate to severe burns every year, with 70% occurring in the productive 15-35 age group and 80% of cases being women and children involved in kitchen accidents. 2. Burns are classified based on depth and healing time - first degree affects the outer skin layer, second degree also involves the dermis, third degree extends deeper, and fourth degree involves muscle and bone. 3. Assessment methods include the Rule of Nines, Lund-Browder chart, and palm rule. Management involves first aid, fluid resuscitation per the Parkland formula, wound care including dressings, surgery, and preventing infection and organ failure.

3. B U R N S
MANGLAM KUMARI

4. Burns
 A burn is an injury to the skin or other organic
tissue primarily caused by heat or due to radiation,
radioactivity, electricity, friction or contact with
chemicals.
(WHO)

5. Related Anatomy - Structure of Skin

6. In India…….
 In India, over 1 000 000 people are moderately or severely burnt every
year1 – WHO 2014
The Union Health Ministry says India records:
- 70 lakh burn injury cases annually of which 1.4 lakh people die of burn
every year.
- Around 70% of all burn injuries occur in most productive age group (15-
35 years).
- Around four out of five burnt cases are women and children.
- As many as 80% of cases admitted are a result of accidents at home
(kitchen-related incidents).

7. CAUSES OF BURNS
 Thermal – Dry Heat, Moist Heat, Smoke and
inhalation
 Electrical
 Chemical
 Radiation
 Cold Burns - Frostbite

11. Classification of Burns
First Degree
Second Degree
Third Degree
Fourth Degree
•Depth – outer layer of the
skin, epidermis
•Sensation – sharp,
uniform pain
•Appearance – red/ pink,
edematous, no blisters
•Healing - +/- 7 days

12. Classification of Burns
First Degree
Second Degree
Third Degree
Fourth Degree
•Depth – epidermis and dermis,
preservation of sebaceous &
sweat glands and hair follicles
•Sensation – painful, sensitive
to air/ temp changes
•Appearance – erythematous,
moist, blisters, serous
exudates
•Healing – 14-21 days
Superficial partial
thickness

13. Classification of Burns
First Degree
Second Degree
Third Degree
Fourth Degree
•Depth – epidermis and
deep dermis
•Sensation – painful
•Appearance – red/ white
(deeper), moist, blisters,
serous exudates
•Healing – over 6 weeks
Deep partial
thickness

14. Classification of Burns
First Degree
Second Degree
Third Degree
Fourth Degree
•Depth – extend into
subcutaneous tissue
•Sensation – painless to
touch and pinprick, can
pain to deep pressure
•Appearance – black/
white, leathery, hard, dry,
hair absent, no blanching
•Healing – granulates,
requires grafting

15. Classification of Burns
First Degree
Second Degree
Third Degree
Fourth Degree
•Depth – extends into
muscle and bone
•Sensation – painless
•Appearance – charred,
skeletonised
•Healing – requires
surgery

17. Depending on the percentage of burns
 Mild (Minor):
 Partial thickness burns < 15% in adult or <10% in children.
 Full thickness burns less than 2%.
 Moderate:
 Second degree of 15-25% burns (10-20% in children).
 Third degree between 2-10% burns.
 Major (severe):
 Second degree burns more than 25% in adults, in children more than 20%.
 All third degree burns of 10% or more.

18. Jackson’s thermal wound theory
 Zone of coagulation
 Centre area of wound,where all tissues are
damaged
 Zone of stasis
 Surrounds the coagulation areasome
tissuesare damaged
 Zone of hyperaemia
 Unburned areasurrounds the stasis but it
is red due to inflammation

19. Pathophysiology

20. CLINICAL MANIFESTATION OF BURNS
 Blisters
 Pain
 Peeling skin.
 Contracture
 Red skin.
 Shock (Symptoms of shock may include pale and clammy skin, weakness,
bluish lips and fingernails, and a drop in alertness.)
 Swelling.
 White or charred skin.
 Multi organ dysfunction

22. ASSESSMENT OF BURNS
Wallace Rule of Nines
Lund and Browder Chart
Palm rule

23. Wallace
Rule of Nine

24. LUND BROWDER
CHART

25. Palm Rule

26. CAUSES OF DEATH IN BURN
 Hypovolemia
 Shock
 Renal failure
 Pulmonary edema and ARDS
 Septicemia
 Multi organ failure

27. MANAGEMENT
 First aid management
 Airway clearance
 Fluid resuscitation
 Wound care
Dressings can be used like
Parrafine gauze
Hydrocolloids
Silver sulfadiazine
 Colloid resuscitation
 Reconstructive surgery

28. PARKLAND FORMULA
Ringers Lactate
4ml/ kg body weight/ percent burn
Half of the
solution for
first 8
hours
Other half of the
solution for
next 16
hours

29. Nursing diagnosis
 Impaired skin integrity
 Risk for infection
 Imbalanced nutrition
 Impaired physical mobility
 Disturbed body image

30. References
1. http://www.who.int/violence_injury_prevention/other_injury/burns/en/
2. http://www.who.int/mediacentre/factsheets/fs365/en/
3. Sinha K. 10 lakh Indians suffer from burns every year. Times of India.
2012 Jun 7. Available from:
http://timesofindia.indiatimes.com/india/10-lakh-Indians-suffer-from-
burns-every-year/articleshow/13880849.cms
4. http://hospitals.unm.edu/burn/classification.html
5. Hettiaratchy S, Dziewulski P. ABC of Burns. British Medical Journal.
Volume 328, june 2004.

31.  Thank you
Thank
you