Burns is very Common illness and knowing how to manage them is critical to their survival.

1. Peculiar OLURONKE
BURNS

2. OUTLINE
 INTRODUCTION
 CAUSES
 EPIDEMIOLOGY
 PATHOPHYSIOLOGY
 CATEGORIES OF BURN DEPTH
 ESTIMATION OF BURN SURFACE AREA
 MANAGEMENT
 COMPLICATIONS
 CONCLUSION

3. INTRODUCTION
 A burn is a coagulative necrosis of the
skin and sometimes the deeper tissues.
 Burn injury is a type of injury to the skin caused
by heat, cold, electricity, radiations, chemicals
or other factors .
 Results in various typical clinical presentations
and physiological and pathological sequelae.

4. CAUSES OF BURNS
 THERMAL : Moist heat(resulting in scald), flame/dry
heat.
 CHEMICAL : Strong acids (sulphuric acid,
hydrochloric acid formic acid), srtong alkali like
sodium hydroxide.
 RADIATION : Ultraviolet rays, ionising radiations.
 ELECTRICAL : Electrical wires & outlets, lightening.

5. EPIDEMIOLOGY
 The highest incidence occurs during the first few years of life and in persons aged 20-
29 years with approximately 180,000 deaths annually worldwide.
 Scalds accounting for approximately 75% of burns in children under age 5 years.
 At later ages, a large number of heat sources (eg,hot surface, liquid scald, grease
scald, radiation, chemical) cause burn injury.
 Approximately 1.2 million people in the USA require medical care for burn
injuries each year, with 51,000 requiring hospitalization. Approximately 30-
40% of these patients are younger than 15 years.
 Fires are a major cause of mortality in children, accounting for up to 34% of
fatal injuries in those younger than 16 yr.
 Scald burns account for 85% of total injuries and are most prevalent in
children younger than 4 yr.
 Steam inhalation used as a home remedy to treat respiratory infections is
another potential cause of burns.
 Flame burns account for 13%; the remaining are electrical and chemical
burns.
 Approximately 18% of burns are the result of child abuse (usually scalds),
making it important to assess the pattern and site of injury and their
consistency with the patient

6. PATHOPHYSIOLOGY
 Heat causes coagulation necrosis of skin and
subcutaneous tissues
 This causes release of inflammatory markers, histamine,
bradykinin, IL-1,IL-6,TNF alpha,
 There is altered vascular and capillary permeability
 Loss of fluid into the interstitial spaces
 Severe hypovolemia
 Decreased cardiac output and renal blood flow
 End organ and multiple organ hypoperfusion
 Multiple organ dysfunction due to hypovolemic shock
 Increased Reactive oxygen species destroying, proteins
and lipids throughout the body
 Hypermetabolism, immunosuppression, increased
bacterial multiplication causing sepsis and SIRS, Multiple
organ failure and death

7. PATHOPHYSIOLOGY

8. CATEGORIES OF BURN DEPTH

9. CATEGORIES OF BURN DEPTH

10. Degree of BURNS

11. ESTIMATION OF BURNT SURFACE
AREA
 RULE OF 9'S
 RULE OF PALM (for small burns & for children up
to 4 yrs)
 RULE OF 5'S (for U5's)
 USE OF CHART : LUND & BROWDER CHART
(modified for different age groups)

12. Rule of 9‘s and Rule of Palm

13. Rule of 5‘s
Head & Neck – 15%
Upper limb – 10% each
Ant & Pos Trunk – 20% each
Lower limb – 15% each

14. ESTIMATION OF BURNT SURFACE
AREA

15. ESTIMATION OF BURNT SURFACE
AREA
 Severity of burn is estimated by the BSA
 Major- Supf of 15% in adults
- Supf of 10% in children
-Deep of 7.5% in adults
-Deep of 5% in children
35%BSA=50% mortality
50%BSA=90% mortality
 Any thing less is minor & can be treated on an
outpatient basis

16. MANAGEMENT: First AID
 Remove victim from source of burn OR source of burn
from victim.
 Extinguish flame by rolling on ground or covering with
a heavy piece of clothing.
 For chemical injury, remove remaining chemical,
followed by copious irrigation with water.
 Cover burned area with clean, dry sheeting.
 Start resuscitation (esp. for victims of inhalational
injury or high-voltage electric burns)
 Administer analgesic (if available)

17. First AID
 Take a quick history to include:
 Cause of burn.
 Duration of injury.
 Setting of burn (enclosed area?).
 Interventions so far.
 Assess for possible acute complications
(dehydration, shock, anemia)
 Then decide whether to manage as outpatient or
in-patient.

18. OUTPATIENT VS INPATIENT
MANAGEMENT
 Based majorly (among other factors) on :
 1- Degree of burn
 2- Extent of burn

19. OUTPATIENT MGT OF MINOR
BURNS
 1st- and 2nd-degree burns of <10% of TSA
 (except admission is indicated for other reasons)
 Blisters should be left intact & dressed daily with
bacitracin or silver sulfadiazine cream.
 Very small wounds may be treated with bacitracin
ointment & left open.
 Debridement of devitalised skin may be done when
blisters rupture.
 Deep 2nd-degree burns take longer to heal, and may
benefit from enzymatic debridement (collagenase
ointment applied daily) to aid removal of dead tissue.

20. INPATIENT MGT

21. INPATIENT MGT (investigations)
 Full Blood Count and differentials
 Electrolyte, Urea and Creatinine levels
 Blood culture
 X-ray of injury site.

22. INPATIENT MGT

23. INPATIENT MGT (Resuscitation)
 Ensure & maintain adequate airway (O2 supplementation
& endotracheal intubation if indicated)
 FLUID RESUSCITATION
 -> Burns >15% should not receive oral fluid initially
because abdominal distention may occur.
 -> IV fluid requirement calculated based on BSA:
 Parkland formula : 4ml of RLS/kg/% BSA OR
 Shriner children hospital - gavelston formula : 5L/m2 of
BSA + 2L/m2 of TSA
 Give 1/2 over 8hrs; remaining over 16hrs.

24. INPATIENT MGT (Resuscitation)
 Next day : 3/4 over 24hrs.
 Maintenance subsequently given.
 Blood transfusion for BSA >20% (20ml/kg whole
blood).
 Urine output monitored.

25. INPATIENT MGT (prevention of
infections)
 TT booster dose.
 Housing in a bacteria-controlled nursing unit
 Antibiotics prophylaxis (penicillin or erythromycin)
 eg. : carbenicillin 200-400 mg/kg/day
 DRESSING:
 with topical antimicrobials: 0.5% Ag nitrate solution, Ag
sulfadiazine cream, mafenide acetate cream.
 Early excision & grafting of deep burns.

26. INPATIENT MGT (control of pain and
psychologic adjustment )
 Pain and anxiety contribute to early metabolic stress
which in turn increases energy expenditure.
 Adequate analgesia (esp. during surgical precedures
and change of dressing)
 Psychological support
 Short course of anxiolytics may be useful

27. INPATIENT MGT (nutritional
support)
 Burns victim have increased energy requirements as
a result of heat loss, pain, anxiety & hypermetabolic
response characterized by both protein and fat
catabolism.
 Sepsis also increases metabolic rate.
 So, control of pain, anxiety, early covering & caloric
supplementation may help reduce energy
expenditure, maintain weight & prevent malnutrition.

28. INPATIENT MGT (nutritional
support)
 Feeding should be commenced as soon as possible
to deliver caloric need and keep the GIT active.
 Both enteral and parenteral routes can be used.
 1.8Kcal/m2/d maintenance + 2.2Kcal/m2 BSA/d of
high carbohydrate high protein diet.
 Discontinue parenteral as soon as practical.

29. INPATIENT MGT (rehabilitation)
 To start as early as possible.
 To include passive or active movement of joints.
 Early ambulation.
 Psychological rehabilitation to aid return to normal
life.

30. COMPLICATIONS
 EARLY :
 Dehydration, hypovolemia, shock, AKI.
 Anaemia.
 Sepsis.
 Curling's ulcer.
 Thrombosis (from increased viscocity).

31. COMPLICATIONS
 LONG-TERM :
 Hypertrophic scar, keloids.
 Contracture.
 Marjolin's ulcer.
 Psychological complications.

32. CONCLUSION
 Burn injuries are easily preventable, and when
they do occur proper management is required to
increase survival chance and limit short and long-
term physical and psychological complications.
Thank you

33. REFERENCES
 Nelson Textbook of Paediatrics, 20th edition
 Medscape
 Other material sources