This document discusses burns and scalds, including their causes, pathophysiology, assessment, treatment, and complications. The major points covered are: - Burns are caused by dry heat (fire, electricity) or wet heat (scalds from hot liquids) and result in coagulative necrosis of tissue. - Pathophysiology includes increased vascular permeability, fluid shifts from blood vessels to tissues, and potential for shock with large burns over 15% of body surface area. - Assessment involves determining burn depth (superficial vs. partial vs. full thickness) and percentage of total body surface area burned, often using the Rule of Nine. - Treatment principles are airway, breathing, circulation support along with

1. Dr. Dinesh. M.G
Professor of Surgery
J.J.M.M.C.
Davangere

2. Burns & Scalds
 Burn is a wound in which there is coagulative necrosis of
the tissue.
 Majority of burns is caused by heat
 A scald is a burn caused by moist heat
Aetiology
 Dry heat caused by fire from kerosene, petrol, coal etc,
 Wet heat caused by hot liquids
 Boiling water, tea , coffee, hot cooking oil etc
 Electrical burns
 Chemical burns(acid or alkali)
 Irradiation (radio dermatitis)

3. Burns & Scalds
Pathophysiology of burns
 The damage is mainly to skin and respiratory tract is
affected by inhalation of hot & poisonous gases
 Burns produce inflammatory reaction
 Leads to increased vascular permeability
 Water, solutes & proteins move from the intra- to the extra
vascular space
 Fluid last thus is directly proportional to the area of burn
 Shock is produced by burns involving >15% of body
surface
 Reduced functioning of immune system

4. Burns & Scalds
Pre-hospital care of burn patient
 Remove the patient from the burning agent
 Pour water to extinguish fire as well as to cool the burnt
area to minimize the damage
 Switch off the electricity
 Wash thoroughly with water in chemical burns
 Wrap the patient in clean dry sheet and shift to hospital

5. Burns & Scalds
Hospital care
The principles are same as any acute trauma case
 A. Airway: Endotracheal intubation or tracheostomy
 B. Breathing: Humidified oxygen, bronchodilators,
artificial ventilation
 C. Circulation:Venesection, intravenous fluid resuscitation
 D. Disability-Neurological status
 E. Exposure with environmental control

6. Burns & Scalds
Major determinants of the outcome of a burn
 Percentage surface area involved
 Depth of burns
 Presence of an inhalational injury

7. Burns & Scalds
Assessment of burn wound
 Percentage area of burns
 Wallace rule of 9
 Hand method: size of patient’s
hand is taken as 1%
 Fluid calculation
 Parkland formula
 4ml/kg/%burn of Ringer
lactate in first 24 hours.
 Half is given in first 8hrs,
 1/4th is given in second 8 hrs
 1/4th is given in the next 8 hrs

8. Depth of burns
 I0 burn
 Burn of epidermis only
 e.g. sun burns
 II0 burn
 Burn involving epidermis and
part of dermis
 e.g. Flash burns and scalds
 III0 burn
 Burn of epidermis and full
thickness of dermis
 e.g. Flame, chemical and
electrical burns

9. Depth of burns-clinical appearance
 I0 burn
 Burn of epidermis only
 e.g. sun burns
 Painful erythema
 Tender to touch
 Blanches to pressure
 Healing
 Occurs in 3-5 days
without scarring from
regeneration of remaining
pilosebaceous elements of
epidermis

10. Depth of burns-clinical appearance
 II0 burn
 Painful blisters
 Cutaneous oedema
 Red, shiny and wet after
blisters rupture
 Healing
 Occurs in 7-14 days with
minimal scarring
 By regeneration of
epidermal cells from
remaining pilosebaceous
elements

11. Depth of burns-clinical appearance
 III0 burn
 Painless
 Dry, charred, grayish black in
colour
 No cutaneous oedema
 Healing
 Small burn area can heal by
scarring in 3-5 weeks
 Larger area requires skin
grafting

12. Burns & Scalds
Early treatment
 Oxygen therapy
 Antibiotics
 Tetanus prophylaxis
 Analgesia
 Catheterisation
 Antiulcer drugs
 Nasogastric intubation
 Monitoring : Input-output chart, TPR chart

13. Burns & Scalds
Local treatment
 Dressing
 Closed method
 Open method
Surgical treatment
 Escharotomy
 Debridement and excision
 Early tangential excision and
skin grafting
 Delayed skin grafting
 Nutrition
Escharotomy
Delayed split thickness skin grafting

14. Burns & Scalds
Complications of burns
 Smoke inhalation syndrome
 Hypovolemic shock
 Septic shock
 Neurogenic shock
 Renal failure
 Electrolyte imbalance
 Curling’s ulcer
 Malnutrition
 Contractures
 Marjolin’s ulcer

15. Burns & Scalds
How do you calculate fluid requirement of patient weighing 50
kgs with burns of both the upper limbs and front of chest?
 Assessment of burn area
 9% for one upper limb+ 9% for
other upper limb+
9% for front of chest
 Total of 27% of burnt surface
area
 Intravenous fluid
requirement(Parkland formula)
 4ml / kg / %body surface area
burnt
 4ml x 50 x 27= 5400 ml in first
24 hours
 Half of this i.e. 2700ml of
Ringer’s lactate is given in first
8 hours
 Second half i.e 2700ml of
Ringer’s lactate is given in next
16 hours
Rule of 9

16. Thank you