2. DEFINITION
Refers to coagulative necrosis of the
tissues caused by heat transferred from
the source to the body.
NB: frostbite is coagulative necrosis
caused by extreme degrees of cold
3. ETIOLOGICAL CLASSIFICATION OF BURNS
• Thermal burns: Flame and Scald burns
• Electrical Burns
• Chemical Burns
• Radiation Burns
• Inhalation Burns
• Friction Burns
• FRICET
4. ANATOMICAL CLASSIFICATION
1. First degree burns – erythema – redness –
sunburn – painful – n0 blister formation
[vesicle/bulla] – epidermis only
2. Second degree burns – blister formation – very
painful – damage to basement membrane –
epidermis & superficial dermis
3. Third degree burns – dermis – painless – aka =
full thickness burns
4. Fourth degree burns – subcutaneous tissue –
muscle & bone
A mixture is of the above is a common finding
5. DEPENDING ON THICKNESS OF SKIN INVOLVED
I. Partial thickness burns: It is either first
or second degree burn which is red and
painful, often with Blisters
II. Full thickness burns: It is third degree
burns which is charred, insensitive, deep
involving all layers of the skin.
7. PATHOPHYSIOLOGY
Heat causes coagulation necrosis of skin and subcutaneous
tissue.
Release of vasoactive peptides
Altered capillary permeability
Loss of fluid
Severe hypovolemia
Decreased cardiac output
1. Decreased renal blood -Oliguria (Renal failure)
2. Altered pulmonary resistance causing pulmonary oedema
Infection
Systemic Inflammatory Response Syndrome (SIRS)
Multi Organ Dysfunction Syndrome (MODS).
8. PHASE 1 = RAPID RESPONSE SYSTEM = NERVOUS SYSTEM
• “Fight or flee”
• Governed by hypothalamus = autonomic
nervous system [sympathetic component]
• Release of adrenaline and noradrenaline
• Pupils dilate
• Heart rate rises
• Brain alert
• Airways dilate
9. PHASE 2 = LOCAL RESPONSE
• Initial response is vasoconstriction by the
catecholamine augmented by endothelin =
most potent vasoconstrictor known
• Soon this is replaced by vasodilatation and
increased vascular permeability at injury site
• Principal vasodilators include nitric oxide,
prostacyclin, histamine, serotonin
• This allows for the extravasation of inflammatory
cells to come in to kill the invaders and clean up
the mess
10. PHASE 3 = ENDOCRINE RESPONSE
• Remember the bigger the insult or injury the bigger the
response
• Therefore limited injury will have no systemic response
• The goal of all these responses is preserve intravascular
volume
• Any insult threatening intravascular integrity
HYPOTHALAMUS-PITUITARY-ADRENAL AXIS
• Low Bp is picked up by the baroreceptors =>
hypothalamus=>corticotrophin releasing hormone=>
adrenacorticotropin hormone=> cortisol & aldosterone=>
raises sensitivity of catecholamine & sodium reabsorption
11. RENIN-ANGIOTENSIN-ALDOSTERONE AXIS
• Baroreceptors in the juxtaglomerular
apparatus=> renin=> angiotensinogen=>
angiotensin-1=> angiotensin converting
enzyme=>angiotensin-2=> vasoconstrictor
& stimulate aldosterone release by the
adrenal cortex
12. CRITERIA FOR ADMISSION TO A BURNS
CENTER
1. Burns >20% bsa in adults
2. Burns >10% bsa in children & elderly >50
3. Electrical burns
4. Chemical burns [extensive]
5. Suspected child abuse burns
6. Inhalation burns
7. Special areas – face, hands, genitalia , major joints
8. Concomitant trauma – trauma center first
9. Co-morbidities – cardiopulmonary, dm, epilepsy
10. >5% deep burns
14. RULE OF PALM
• “RULE OF THE PALM” = PATIENT’S PALM IS APPROXIMATELY 1%
OF THE BSA IN BOTH ADULTS AND CHILDREN
15. INVESTIGATIONS
• FBC.
• U+E.
• If inhalation suspected: chest X-ray,
arterial blood gases, CO
• estimation.
• Blood group and crossmatch.
• ECG/cardiac enzymes with electrical
burns.
16. IN SUMMARY
1. ABCDE
2. Pain control
3. Tetanus prophylaxis
4. Secondary survey + % bsa + depth
5. Foley catheter
6. Fluid resuscitation => oral or intravenous
7. Proton pump inhibitors
8. Topical antibiotics
9. Daily wound care
10. Keep the room warm
17. OTHER ESGENERAL MEASUR
• High protein diet
• Blood transfusion
• Physiotherapy
• The use of a cradle
• Always keep the patient warm
18. FLUID RESUSCITATION
1. PARKLAND FORMULA:-
1. 4ml x KG x % BURN AREA = MLS
2. Half is administered in first 8 hours
3. The next half is administered in the following 16 hours
• This formula or any formula is not cast in stone and should be
modified to achieve the desired urine output
• Literature says don’t go beyond 8.4 liters. Maximum percentage for
fluid should be less than 50%
• But in practice (30-40%)
E.g. 22years old student at Zera sustains 20% burns, he weight is 70
calculate his fluid requirement using parkland formula
19. 2. MUIR AND BARCLAY
• =(%BSA x Kg) /2
Fluids are given over 36 hrs. as following
