This document provides information on burns, including: - Burn epidemiology statistics showing they are the second leading cause of trauma deaths. - An overview of skin anatomy and the different layers (epidermis, dermis, subcutaneous tissue) affected by burns of varying depths. - Descriptions of superficial, partial thickness, and full thickness burns based on the skin layers involved and appearance. - Methods for estimating burn extent, including the Rule of Nines and Rule of Palm. - Considerations for management of burns including stopping the burning process, assessing airway/breathing/circulation, treatment of the burn wound, and indicators for advanced life support.

1. MAHARAJ VINAYAK GLOBAL UNIVERSITY
Jaipur Nursing College
Subject: Medical Surgical Nursing
Topic: Burns
Presented By
Mr. Kailash Chandra Saini
Assistant Professor
1

2. 2
BURNS
…more than just
another soft tissue
injury

3. 3
Burn Epidemiology
2,500,000/year
100,000 hospitalized
12,000 deaths
Second leading cause of trauma
deaths after motor vehicle accidents.

4. 4
Skin Form & Function
 Largest body organ
 More than just a passive covering
 Functions:
Sensation
Protection
Temperature regulation
Fluid retention

5. 5
Skin Anatomy
 Skin Layers
Epidermis
Dermis
Subcutaneous
tissue

6. 6
Epidermis
 Outer layer
 Top (stratum corneum) consists of dead,
hardened cells
 Lower epidermal layers form stratum
corneum and contain protective pigments

7. 7
Dermis
 Elastic connective tissue
 Contains specialized structures
Nerve endings
Blood vessels
Sweat glands
Sebaceous (oil) glands
Hair follicles

8. 8
Subcutaneous/Muscle
 Fat (protective layer)
 Muscle for support, movement,
coordination
 Depth of burn?

9. 9
Major Concerns
Loss of fluids
Inability to maintain body
temperature
Infection

10. 10
Superficial Burns
 Superficial (First degree)
 Involves only epidermis
 Red
 Painful
 Tender
 Blanches under pressure
 Possible swelling, no blisters
 Heal in ~7 days

11. 11
Partial Thickness Burns
 Partial Thickness
(Second degree)
 Extends through
epidermis into dermis
 Salmon pink
 Moist, shiny
 Painful
 Blisters may be present
 Heal in ~7 to 21 days

12. 12
Partial Thickness Burns
 Burns that blister are
second degree.
 But all second degree
burns don’t blister.

13. 13
Full Thickness Burns
 Full Thickness (Third degree)
 Through epidermis, dermis
into underlying structures
 Thick, dry
 Pearly gray or charred
black
 May bleed from vessel
damage
 Painless
 Require grafting

14. 14
Burn Depth
 Often cannot be accurately
determined in acute stage
 Infection may convert to higher
degree
 When in doubt, over-estimate

15. 15
Burn Depth

16. 16
Burn Depth

17. 17
Burn Depth

18. 18
Burn Depth

19. 19
Burn Extent
BSA Estimation

20. 20
Burn Extent: Rule of Nines

21. 21
Burn Extent: Rule of Thumb
 “Rule of Palm”
Patient’s palm
equals 1% of his
body surface area

22. 22
Burn Severity
Depth
Extent
Location
Cause
Patient Age
Associated Factors

23. 23
Critical Burns
 Full-thickness burns involving hands, feet,
face, upper airway, genitalia, or
circumferential burns of other areas
 Full-thickness burns covering more than
10% of total body surface area
 Partial-thickness burns covering more than
30% of total body surface area
 Burns associated with respiratory injury

24. 24
Critical Burns, continued
 Burns complicated by fractures
 Burns on patients younger than 5 years old or
older than 55 years old that would be classified
as moderate on young adults

25. 25
Moderate Burns
 Full-thickness burns involving 2% to 10% of total
body surface area excluding hands, feet, face,
upper airway, or genitalia
 Partial-thickness burns covering 15% to 30% of
total body surface area
 Superficial burns covering more than 50% of
total body surface area

26. 26
Minor Burns
 Full-thickness burns involving less than 2% of
the total body surface area
 Partial-thickness burns covering less than 15%
of the total body surface area
 Superficial burns covering less than 50% of the
total body surface area

27. 27
Associated Factors
 Patient Age
< 5 years old
> 55 years old
 Burn Location
Circumferential burns of chest, extremities

28. 28
MANAGEMENT

29. 29
Initial Assessment
 Scene Safety
 BSI
 Determine MOI/Severity
 Number of Patients
 Additional Resources

30. 30
Stop Burning Process!
 Remove patient from source of
injury
 Remove clothing unless stuck
to burn
 Cut around clothing stuck to
burn, leave in place

31. 31
Assess Airway/Breathing
 Start oxygen if:
Moderate or critical burn
Decreased level of consciousness
Signs of respiratory involvement
Burn occurred in closed space
History of CO or smoke exposure
 Assist ventilations as needed

32. 32
Assess Circulation
 Check for shock signs /symptoms
Early shock seldom results from effects of
burn itself.
Early shock = Another injury until proven
otherwise

33. 33
Obtain History
 How long ago?
 What has been done?
 What caused burn?
 Burned in closed space?
 Loss of consciousness?
 Allergies/medications?
 Past medical history?

34. 34
Rapid Physical Exam
 Check for other injuries
 Rapidly estimate burned,
unburned areas
 Remove constricting bands

35. 35
Treat Burn Wound
 DO NOT apply ointments or creams
 Superficial Burn:
Cool, moist dressings
Protect from exposure to air
 Partial/Full Thickness Degree Burns:
Cover with dry dressing (commercial burn
sheets are acceptable)

36. 36
Pediatric Considerations
 Thin skin, increased severity
 Large surface to volume ratio
 Poor immune response
 Small airways, limited respiratory reserve
capacity
 Consider possibility of abuse

37. 37
Burns in Infants and Children
 Critical Burns:
 Full-thickness burns covering > 20% of BSA
 Burns involving hands, feet, face, upper airway,
genitalia
 Moderate Burns:
 Partial-thickness burns 10%-20% of BSA
 Minor Burns:
 Partial-thickness burns < 10% of BSA

38. 38
Geriatric Considerations
 Thin skin, poorly circulation
 Underlying disease processes
Pulmonary
Peripheral vascular
 Decreased cardiac reserve
 Decreased immune response
 % Mortality=BSA burned (Age + %)

39. 39
Inhalation Injuries
…Beware the unseen injury!

40. 40
Concerns:
 Hypoxia
 Carbon monoxide toxicity
 Upper airway burn
 Lower airway burn

41. 41
Carbon Monoxide Poisoning
 Product of incomplete combustion
 Colorless, odorless, tasteless
 Binds to hemoglobin 200x stronger than
oxygen
 Headache, nausea, vomiting, “roaring” in
ears
 Exposure makes SpO2 useless!

42. 42
Upper Airway Burn
 True Thermal Burn
 Danger Signs
Neck, face burns
Singing of nasal hairs, eyebrows
Tachypnea, hoarseness, drooling
Red, dry oral/nasal mucosa

43. 43
Lower Airway Burns
 Chemical Injury
 Danger Signs:
Loss of consciousness
Burned in a closed space
Tachypnea (+/-)
Cough
Rales, wheezes, rhonchi
Carbonaceous sputum

44. 44
Chemical Burns

45. 45
Concerns:
 Damage to skin
 Absorption of chemical; systemic
toxic effects
 EMS personnel exposure
 Hazmat incident?

46. 46
Management
 Remove chemical from skin
 Liquids
Flush with water
 Dry chemicals
Brush away
Flush what remains with water

47. 47
Chemical Burns
 Occur whenever a
toxic substance
contacts the body
 Eyes are most
vulnerable.
 Fumes can cause
burns.
 To prevent
exposure, wear
appropriate gloves
and eye protection.

48. 48
Care for Chemical Burns
 Remove the
chemical from the
patient.
 If it is a powder
chemical, brush
off first.
 Remove all
contaminated
clothing.

49. 49
Care for Chemical Burns, cont'd
 Flush burned area
with large amounts of
water for about 15 to
20 minutes.
 Transport quickly.

50. 50
Specific Chemical Burns
 Phenol
Not water soluble
Flush with alcohol
 Sodium/Potassium/Magnesium
Explode on water contact
Cover with oil

51. 51
Specific Chemical Burns
 Tar
Use cold packs to solidify tar
Do NOT try to remove
Tar can be dissolved with organic
solvents later

52. 52
Chemical Burns to the Eye
 Hold open eyelid
while flooding eye
with cold water.
 Continue flushing
en route to
hospital.
 Do not use other
chemicals

53. 53
Electrical Burns
Current kills, not
voltage!

54. 54
Considerations:
 Intensity of current
 Duration of contact
 Kind of current (AC or DC)
 Width of current path
 Types of tissues exposed (resistance)

55. 55
Electrical Burns
 Non-conductive injuries:
Arc burns
Ignition of clothing
 Conductive injuries:
“Tip of Iceberg”
Entrance/exit wounds may be small
Massive tissue damage between entrance/exit

56. 56
Electrical Entrance/Exit Wounds

57. 57
Other Complications
 Cardiac arrest/arrhythmias
 Respiratory arrest
 Spinal fractures
 Long bone fractures
 Internal organ damage

58. 58
Electrical Burn Management
 Make sure power is
off before touching
patient.
 Check ABCS
 Two wounds to
bandage.
 Transport patient
and be prepared to
administer CPR.

59. 59
ALS Indicators
 Possible airway involvement including singed
facial hair, soot in mouth/nose, or hoarseness
 Burns with injuries: shock, fractures, or
respiratory problems
 Partial or full thickness burns to the face
 Partial or full thickness burns > 20% BSA
 Severe pain (ALS pain control)

60. Thank You
Maharaj Vinayak Global University, Jaipur