burns and scaldes

1. BURNS and scaldsN
PRESENTED BY: Mrs yamini
M.Sc
(N),[phd]

2. BURNS
INTRODUCTION
 Burns sustained by children are a common
presentation to emergency departments and often
cause significant distress to both the child and adult
and it is the leading causes of death in children.
Deaths are generally related to flame burns, which
may be complicated by inhalation of smoke and other
toxic gases. Early fatalities are related to respiratory
complications, whereas late deaths are usually
related to infection. The use of early debridement and
skin grafting has led to an increased survival rate in
patients who would have previously died because of
infection.

3. INCIDENCE OF BURNS IN CHILDREN
The exact data about the incidence of burn injury
is not available.
 Children are at higher risk of burn injury than
adults. Approximately one fourth of burns cases
are below 10 years of age, and about 65% of
burnt children are below 5 years of age.
 Over 80% of burn accidents occur in the child’s
own home. Scalds from hot liquids constitute
maximum numbers and others are due to flame
burns, electrical or chemical burns.
 The incidence of burns increased during Diwali,
festivals and in winter seasons. The children of
high risk for burns include single parent,
unsupervised, neglected and less protected child
especially of poor socio-economic group.

5. CHARACTERISTICS OF BURN
TYPE OF INJURY
Scalds
 Scalds are important burn injury caused by hot liquids
(liquid hot food, hot water, tea, coffee, milk) or steam.
It is common in children below 3 years of age.
Electric burns
 It is common in toddlers and adolescents when
playing with electrical outlet, extension cord, touching
high tension wires, etc...

6. Open flame burns
 Open flame burns are common during playing with
lighter or at kitchen near stove or over of gasline. It
may happen from open fire in winter season or from
fireworks during festivals or Diwali. Inhalation burns
mat occur from fireworks.
Chemical burns
 It is also common in children. Out of curiosity they
handle household cleansing chemicals, acids, etc
and get injured.

7. ACCORDING TO DEPTH OF
BURN INJURY
 Superficial burns
 Partial-thickness burns
 Full-thickness
ACCORDING TO EXTENT OF
BURN INJURY
 First- degree burns
 Second- degree burns
 Third- degree burns
 Fourth- degree burns

9. ACCORDING TO EXTENT OF BURN
INJURY
First Degree Burns
 Fisrt degree burns are those that are
limited to the outer layer of the skin,
causing some redness and pain, but no
blistering. A one-second light contact with a
hot iron can cause such a burn.
 It is manifested as pink to red discolored
area with slight edema.
 Pain may present upto 48 hours and
relieved by cooling. Within 5 days
epidermis peels off, pink skin may persist
for a week, no scar develops.

10. Second Degree Burns
 Second degree burns are more
serious, as they are thicker, penetrate
more layers of the skin, and also
involves blistering of the skin. While a
first degree burn is dry, a second
degree burn is moist, and is more
painful.
 It is presented as pink or red
discoloration of the area with blister
formation, weeping and edema.
Superficial skin layers are destroyed.
 Second degree deep dermal burns are
manifested as mottled white and red
area become pale on pressure. The
area may or may not be sensitive to

11. Third Degree Burns
 Third degree burns are those burns in
which all the layers of the skin have
been penetrated. It includes
destruction of epithelial cells even fat,
muscles and bone.
 This is a very severe type of burn and
requires hospitalization. The skin is
charred, feels leathery to the touch,
and the burned area is usually white.
The area may go numb if nerve
endings have been destroyed, so your
child may feel little or no pain.
Fourth Degree Burns
 Fourth degree burns are those that
extend down to muscle and/or bone.

12. ACCORDING TO SEVERITY OF BURN INJURY
 Minor burns
 Moderate burns
 Major burns
Minor burns
 Minor burns are:
 Age 10-50yrs: Partial-thickness burns <15%
TBSA
 Age <10 or >50: Partial thickness burns involving
<10% TBSA
 Full thickness burns <2% TBSA without
associated injuries.
 These burns usually do not require hospitalisation.

13. Moderate burns
 Moderate burns are defined as:
 Age 10-50yrs: Partial thickness burns involving 15-
25% TBSA
 Age <10 or >50: Partial thickness burns involving 10-
20% TBSA
 Full thickness burns involving 2-10% TBSA
 Persons suffering these burns often need to be
hospitalised for burn care.

14. Major burns
 Major burns are defined as:
 Age 10-50yrs: Partial thickness burns
>25% TBSA
 Age <10 or >50: Partial thickness burns
>20% TBSA
 Full thickness burns >10%
 Burns involving the hands, face, feet or
perineum
 Burns that cross major joints
 Circumferential burns to any extremity
 Any burn associated with inhalational
injury
 Electrical burns
 Burns associated with fractures or other
trauma
 Burns in infants and the elderly
 Burns in persons at high-risk of
developing complications

16. ESTIMATION OF EXTENT OF BURNS
SURFACE AREA

17.  Following burn injury several major immunoglobulins,
complement and serum albumin are decreased with
depressed cellular immunity.
 Hypoxia, acidosis and thrombosis of vessels in
the wound area impair host resistance to
pathogenic bacteria.
 These immunological disturbances make the patient
more susceptible to various infections and wound
sepsis.

18. CLINICAL MANIFESTATIONS:
It depends upon the degree of burns;
 The child may present with shock along with varied depth
and extent of body surface area burnt.
 Pallor
 Cyanosis
 Prostration
 Poor muscle tone and failure to recognize familiar people
 Rapid pulse, low BP and subnormal temperature

19. CLINICAL MANIFESTATIONS
Inhalation injury causes;
 Edema of the glottis, vocal cords and upper trachea
leading to upper airway obstruction.
 Dyspnea
 Tachypnea
 Hoarseness
 Stridor
 Chest retractions
 Nasal flaring
 Restlessness, cough and drooling

20. MANAGEMENT OF BURNS
FIRST AID MEASURES
Stop the burning process
The chief aim of rescue in flame burns is to smother the
fire, not fan it
 The injured child should be placed in a horizontal
position and rolled in a blanket, rug or similar article
with care taken not to cover the head and face because
of the danger of inhalation of toxic fumes. Remaining in
the vertical position may cause the hair to ignite or the
inhalation of flames, heat or smoke.
 Major Burns with large amounts of denuded skin should
not be cooled. Heat is rapidly lost from burned areas
and additional cooling leads to a drop in core body

21.  Chemical burns require continuous
flushing with large amounts of water
before transport to a medical facility.
 Burned clothing ie removed to prevent
further damage from smoldering fabric
and hot beads of melted synthetic
materials.
 Jewelry is removed to eliminate the
transfer of heat from the metal and
constriction resulting from edema
formation.

22. Assess the victims condition
 As soon as the flames are extinguished, the patient is
assessed. Airway, breathing, and circulation are the
primary concerns.
 Cardiopulmonary complications may result from exposure
to electric current, inhalation of toxic fumes and smoke,
hypovolemia and shock. Emergency measures are
instituted as appropriate.
Cover the burn
 The burn wound should be covered with a clean cloth to
prevent contamination, decrease pain by eliminating air
contact and prevent hypothermia.

23. Transport the adult to medical aid
 The patient with an extensive burn is not given anything by
mouth to avoid aspiration in the presence of paralytic ileus
and upper airway edema and to prevent water intoxication.
 The patient is transported to the nearest medical facility. If
this cannot be achieved, IV access should be established,
100% oxygen is administered. A report of the initial
assessment and any interventions implemented is given to
the medical facility assuming care of the child.
Provide reassurance
 Providing reassurance and psychological support to both
the family and the child helps immeasurably during the

24. EMERGENCY TREATMENT IN MAJOR BURNS
Fluid replacement therapy
The objectives of fluid therapy are to;
 Compensate for water and sodium lost to traumatized
areas and interstitial spaces
 Reestablish sodium balance
 Restore circulatory volume
 Provide adequate perfusion
 Correct acidosis
 Improve renal function
Fluid replacement is required during the first 24hrs
because of fluid shifts that occur after the injury. It is done
promptly on the basis of TBSA burnt and body weight of
the child.

25. Additional measures
 Airway management is important to keep the clear
airway and to prevent respiratory complications.
Oxygen therapy and ventilator support and
tracheostomy may be need in some patients.
 Tetanus prophylaxis- Tetanus toxoid and tetanus human
immunoglobins to be administered in gross
contamination of the wound.
 Sedatives and analgesics to be given as prescribed to
relieve pain and to reduce anxiety. Morphine sulfate is
the drug of choice for severe burn injuries.
 The administration of systemic antibiotics to control
wound colonization is not indicated, because decreased
circulation to the injured area prevents delivery of the
medications to areas of deepest injury. If prescribed, it
should be given depending upon the culture report. The

26. COMPLICATIONS
Early complications:
 Hypovolemic shock
 Respiratory failure
 Renal failure
 Paralytic ileus
 GI bleeding due to curling’s ulcer
 Wound sepsis
 Thrombophlebitis
 UTI
 Hypostatic pneumonia
 Toxic shock syndrome
 Depression

27. Late complications:
 Anemia
 Malnutrition
 Growth failure
 Marjolin’s ulcer (carcinoma in burn scar)
 Contracture
 Psychological trauma and cosmetic problems

28. PROGNOSIS
 Children differ from adults in their responses
to thermal injury, and the mortality rates in
young children are significantly higher than
those in older children and adults. Mortality is
greatest for children younger than 48 months
of age. Many children who do survive have
long-term functional and cosmetic
impairments.

29. INJURY

30. INJURY
Following all safety measures
 Don’t allow children playing with plastic bags and
electric cords.
 Don’t leave an electric iron switched on close to a
child
 Don’t drink / pass hot tea/ coffee while holding the
infant.
 Don’t keep electric equipments plugged on when
not in use.

31. SCALDS
Scalds
 Scalds are important burn injury caused by hot
liquids (liquid hot food, hot water, tea, coffee,
milk) or steam. It is common in children below 3
years of age.

32.  Start cooling the burn or scald as quickly as
possible. Hold it under cool running water for at
least 10 minutes or until the pain feels better.
 If there is no water available, you could use cold
milk or canned drinks.
 Remove any jewellery or clothing, unless stuck to
the burn, before the area begins to swell

33.  When the burn has cooled, cover the area loosely
with cling film, lengthways.
 Do not wrap the cling film around the burn as the
area needs space to swell.
 If the burn is on a foot or hand you could use a
clean plastic bag.
 Do not use ice, creams or gels. They may cause
damage and increase the risk of infection.
 Do not break any blisters that may appear, as this
may cause infection.
 Monitor the casualty. Seek medical advice.

35. THANK YOU