This document discusses different types of burns including thermal, chemical, electrical and radiation burns. It describes the depth of burns and classifications including first, second and third degree burns. It discusses pathophysiology including Jackson's burn zones and fluid resuscitation using the Parkland formula. It provides guidelines on monitoring, wound care, surgical procedures and first aid for burns.

1. BURNS
TAEI Training of Trainers
Dr. M. SANTHOSH KUMAR MS,MCH(URO),DNB(URO)
ASSISTANT PROFESSOR
DEPARTMENT OF PLASTIC SURGERY
KAPVMC- MGMGH
TIRUCHIRAPALLI

2. Thermal Burns

3. Chemical Burns

4. Electrical Burns

5. Radiation Burns

6. Layers of Skin

7. Depth of Burn

8. Classification
Depth
First degree: injury localised to epidermis. Painful,
red, blanches to touch. Heals spontaneously. E.g.
sunburn.
Second degree superficial: injury to the epidermis
and superficial dermis. Red painful, blistering,
blanches to touch. Usually heals from intact skin
appendages with some skin discoloration.
Second degree deep: injury through the epidermis
deep into dermis. Pale mottled, does not blanch to
touch, painful to pin prick. Heals with scarring

9. Classification
Third degree : full thickness injury into
subcutaneous fat. Hard leathery eschar, painless
black, white or red. No visible skin appendages.
Skin grafting necessary.
Fourth degree : injury to underlying muscle and
bone

10. I degree Burn

11. II degree Burn

12. III degree Burn

13. Pathophysiology

14. Oedema

15. Jackson's burn zones
1. Zone of coagulation
Irreversible tissue loss due to coagulative
necrosis.
2. Zone of stasis
Decreased tissue perfusion. Tissue is viable but
can deteriorate to necrosis if not adequate
resuscitation.
3. Zone hyperaemia
Outermost zone with increased tissue perfusion.
Tissue usually recovers in absence of severe
infection or severe tissue hypo perfusion.

16. Jackson’s Zones

17. Resuscitation - Effects

18. Admission Criteria
• Partial thickness burns more than 20% of TBSA
• Full-thickness burns more than 2 % of TBSA
• Face, hands, feet, genitalia, perineum, or joints
involved
• Electrical burns
• Chemical burns
• Inhalation burns
• Burns in conjunction with preexisting medical
conditions
• Risk of morbidity or mortality

19. Wallace Rule of Nines for Adults
• Head & Neck = 9%
• Each upper extremity (Arms) = 9%
• Each lower extremity (Legs) = 18%
• Anterior trunk= 18%
• Posterior trunk = 18%
• Genitalia (perineum) = 1%

20. Rule of Nines Chart

21. The Lund and Browder chart

22. Rule of Palm
 Patient’s palm equals
1% of his body surface
area
 Best used for burns <
10% BSA

23. Fluid resuscitation
First 24 hours
• Modified Parkland Formula : 3ml /kg body wt /
% for first 24 hours
• Give one-half of the fluid calculated in the first
8 hours postburn (i.e. from the time of burn)
• Give the balance in next 16 hours postburn

24. Fluid Administered
• For Adults : Ringer Lactate only
• For Children : Ringer Lactate as calculated by formula
• In addition 5% Dextrose
• 100ml /kg till 10 kg
• 50ml /kg for 11-15 kg
• 30 ml /kg for above 15 kg body weight
• The Dextrose fluid calculated is divided into 3 equal
doses for administration every 8 hours.This is given
because Children have poor Glycogen storage in
their Liver and hence prone for Hypoglycemia.

25. Monitoring
• Urinary output is the most sensitive
noninvasive assessment parameter for cardiac
output and tissue perfusion
• Foley Catheter insertion
• Ideal rate of Urine output
Adults : 0.5 to 1.0 ml /kg / hr
Children : 1.0 to 1.5 ml /kg / hr
Infants : 1.5 to 2.0 ml /kg / hr
• Palpable peripheral pulses
• Clear sensorium

26. Monitoring
• Tissue Perfusion – Pulse Oximeter
• Basic investigations :
Serum electrolyte levels
Hemoglobin and hematocrit levels
Blood Glucose
Blood Urea & Serum Creatinine

27. • Tetanus Toxoid
• Pain management
• Prophylactic antibiotics
• Wound Culture

28. 24 to 48 hrs
• The amount of fluid administration is based on the
hydration measured mainly by urine output
• Usually ½ of first day requirements.
• Adults : Normal saline/ Ringer Lactate 5% Dextrose
added if there is no hyperglycemia.
• Children : Normal saline/ Isolyte P / 5% Dextrose
are administered

29. • Colloids are administered in the form of Fresh
Frozen Plasma (FFP) – 2units /day.
• The exact quantity and nature of fluids
administered are based on Patient clinical
condition, Jugular venous pressure and
Investigation reports.
• Goal: Prevent shock by maintaining adequate
circulating blood volume and maintaining vital
organ perfusion

30. 48 to72 hrs
• Infection control :
Wound Cultures repeated every 3 days and
appropriate antibiotics are administered.
• To Continue Wound care : Topical Antibiotics
and Dressings
• Wound closure
• Nutritional support
• Pain management
• Physiotherapy

31. Topical Antimicrobials
• Mafenide acetate for Ear
• Bacitracin for Face
• Silver sulfadiazine for Trunk & Extremities
• Mupirocin
• Chlorhexidine
• Acriflavin
• Acticoat

32. Surgical Procedures
• Debridement
• Tangential Excision
• Escharotomy
• Fasciotomy
• Escharectomy
• Split Skin Grafting
• Flap cover
• Amputation

33. Collagen

35. Skin Graft Mesher

36. Chemical Burns
• Acid Burns – Coagulation Necrosis Form a thick,
insoluble mass where they contact tissue Limits
burn damage.
• Alkali Burns – Liquefaction Necrosis Destroy cell
membrane deeper tissue penetration.

37. Chemical Burns - Acid

38. Electrical Burns

39. Electrical Flash Burns

40. Burns ICU - Cubicles

41. FIRST AID
Pour Water immediately

42. Use clean cloth

43. Cover with clean cloth

44. Thank you
Annal Gandhi memorial Government Hospital , trichy