This document discusses burns, including definitions, classifications by depth, and treatment approaches. It defines burns as injuries caused by exposure to thermal extremes, electricity, chemicals or radiation. Burns are classified based on depth of tissue damage into four degrees: first degree involves only the epidermis; second degree includes both the epidermis and parts of the dermis; third degree extends through the full thickness of the skin; and fourth degree extends into muscle and bone. Treatment depends on the severity and extent of the burn, ranging from first aid for minor burns to emergency care and fluid resuscitation for more severe burns.

1. BurnsBurns
Mª José Forner GrosMª José Forner Gros
Master Degree in Nursing ScienceMaster Degree in Nursing Science
2013/142013/14

2. BurnsBurns
definitiondefinition
classification - depthclassification - depth
- first degree/ superficial thickness- first degree/ superficial thickness
- second degree / partial thickness- second degree / partial thickness
. superficial. superficial
. deep. deep
- third degree / full thickness- third degree / full thickness
- fourth degree / complete burn- fourth degree / complete burn
classification – extend – TBSAclassification – extend – TBSA
treatmenttreatment
minor and severe burns (A & E)minor and severe burns (A & E)

3. DefinitionDefinition
burn: injury that causes destruction of tissue, the skin, from exposition ofburn: injury that causes destruction of tissue, the skin, from exposition of
thermal extremes (either hot or cold) , electricity, chemicals and/orthermal extremes (either hot or cold) , electricity, chemicals and/or
radiationradiation
the primary cause is exposure to temperature extremesthe primary cause is exposure to temperature extremes
-- heat injuries are more frequent than cold injuries
- cold injuries almost exclusively result from frostbite
electrical and chemical burns: 5-10% of burn injuries (result ofelectrical and chemical burns: 5-10% of burn injuries (result of
occupational accidents)occupational accidents)

4. 1st
degree
2nd
degree
3rd
degree
4th
degree
Superficial thickness
Superficial partial thickness
Deep partial thickness
Full thickness
Complete burn
Burn Classification - Depth
Old terminology New terminology

5. www.telegraph.co.ukwww.telegraph.co.uk
www.trialx.comwww.trialx.com
. superficial thickness
. epidermis - only the top layer of the skin is
damaged
. caused by: sun, chemicals, hot water
. symptoms:
- slight swelling
- peeling of the skin
- itching sensation
- no blisters
- skin color: pink to red
- dry
- discomfort
- treatment: outpatient basis
- healing: 5 days*
* depending on your patient's clinical history
11stst
degree burndegree burn

6. 22ndnd
degree burndegree burn
. superficial partial thickness / deep partial thickness
. both layers of the skin are damaged :
epidermis & part of the dermis
symptoms SPT:
- skin color: red & shiny
- pressing: turns to white
- healing: 7 – 21 days*
- future skin: darker or lighter
symptoms DPT:
- skin color: yellow to white
- pressure discomfort
- pressing NO white
- healing: around 3 weeks*
- future skin: scar, risk of
contractures
wet ( blisters break & open)
swelling
edema
pain (severe to extreme)
www.baprass.org.uk
second degree burns have a tendency to induce a more severe inflammatory tissue response : blisterssecond degree burns have a tendency to induce a more severe inflammatory tissue response : blisters
* depending on your* depending on your
patient's clinical historypatient's clinical history

7. - remove jewellery or tight clothing (before skin begins to swell)remove jewellery or tight clothing (before skin begins to swell)
- stop the burning process – flush with cool running waterstop the burning process – flush with cool running water
- put burn ointment or gel / topical antibiotic (Gram – coverage)put burn ointment or gel / topical antibiotic (Gram – coverage)
- no butter, petroleum jelly, home remediesno butter, petroleum jelly, home remedies
- dry sterile non-stick dressing ( loosely )dry sterile non-stick dressing ( loosely )
- pain relief : acetaminophen or NSAIDspain relief : acetaminophen or NSAIDs
- tetanus immunization updatetetanus immunization update
- elevate burnt areaelevate burnt area
- 24 hrs. follow-up (re-evaluation)24 hrs. follow-up (re-evaluation)
- Goal ---- minimizing further damageGoal ---- minimizing further damage
- if Body Surface Area (BSA) burnt 10 %if Body Surface Area (BSA) burnt 10 %
Out patient BasisOut patient Basis
First Aid (minor burns)First Aid (minor burns)
www.mapfre.com

8. 33rdrd
degree burndegree burn
www.medstudentlc.com
full thickness burn
epidermis & all dermis ---subcutaneous tissue
patient's clothes caught on fire
skin:
- dry and leathery
- waxy pearly white
- visible blood vessels , bone
- hair follicles, sweat and sebaceous glands are destroyed
- eschar
no pain ????
scars – surgery – skin grafts

9. 44thth
degree burnsdegree burns
full thickness extending to muscle or bone - hypodermis
severe burn :high voltage electric injury- severe thermal burns
skin: charred, insensate, eschar formation
pain is due to adjacent areas, not in the injury
severe scarring
high risk of contractures
www.medstudentlc.com

10. First aid of major/severe burns (not superficial)First aid of major/severe burns (not superficial)
- no breathing secure airway ABC - RCP process- no breathing secure airway ABC - RCP process
- cover the burn area- cover the burn area
- prevent hypothermia- prevent hypothermia
- remove any jewellery- remove any jewellery
- elevate burnt areas- elevate burnt areas
- call emergency services- call emergency services
remove burnt clothing that is stuckremove burnt clothing that is stuck
immerse large severe burns in cold water – risk of shockimmerse large severe burns in cold water – risk of shock
apply ointmentsapply ointments
iceice
tight or adhesive dressingstight or adhesive dressings
cotton for dressing - fibbers deposition increases risk of infectioncotton for dressing - fibbers deposition increases risk of infection
pop blisterpop blister
no food no water - surgery?no food no water - surgery?
DO NOT:

11. Referral criteria to A&EReferral criteria to A&E
partial thickness 10% TBSApartial thickness 10% TBSA
partial thickness burn to:partial thickness burn to:
face genitaliaface genitalia
feet perineumfeet perineum
hands major jointshands major joints
circumferential burns of limb or chestcircumferential burns of limb or chest
electrical or chemical burnelectrical or chemical burn
patient with co-morbiditiespatient with co-morbidities

12. A & E
Burn Care Goals
• secure airway ABC – respiratory care- intubation? O2?
• assess depth / extend - Total BSA burnt
• administration of fluids “Parkland Formula” - fighting shock
• sub secure risk of infection
• thermoregulation
• adequate pain control
• restore skin integrity – skin grafts
• physical / occupational therapy
• skin wound care (Nursing)

13. Rule of 9´s – TBSARule of 9´s – TBSA
Extend of burns
To calculate how much fluid
we will need to restore
. for adults; different rule for
kids
. add anterior and posterior
sides of the body separately; plus
front and back if necessary
.do not include 1st
degree
burns when calculating
.can be revised after edema
resolves, when edema goes
down
TBSA total body surface area

14. Fluids Therapy

15. Innovation: calculating fluid requeriments
www.jambinnovations.com

16. Medical AppMedical App
www.jambinnovations.com

17. ““Thirty to forty years ago, many burn patientsThirty to forty years ago, many burn patients
didn't live. Advances in treatment have created adidn't live. Advances in treatment have created a
whole new patient population that not only lives,whole new patient population that not only lives,
but has an improving quality of life “but has an improving quality of life “
Charles Durfor, PhDCharles Durfor, PhD
Mª José Forner GrosMª José Forner Gros
2013/142013/14