Burns are injuries to the skin or deeper tissues caused by heat, electricity, chemicals, or radiation. They are classified based on thickness and percentage of total body surface area affected. First degree burns affect the outer layer of skin, second degree burns also involve some deeper skin layers, and third degree burns extend into deeper tissues. Burn assessment methods include the Rule of Nine and Lund and Browder chart. Burn management involves stopping the burning process, assessing the severity, providing fluid resuscitation like the Parkland formula, treating infections, and rehabilitation. Complications can include scarring, contractures, and specific issues for electrical or chemical burns.

1. Burns
Presented by:
Group 12

2. Outline
• Definition
• Causes of burn
• Classification of burns
• Clinical features
• Assessment of Burn
• Management

3. DEFINITION
• Damage to the skin or deeper tissues caused
by sun, hot liquids, fire, electricity or
chemicals.
• A wound caused by exogenous agent leading
to coagulative necrosis.

4. CAUSES OF BURNS
• Thermal Burns
oDry heat
oContact burn
oFlame burn
oMoist heat-scald burn
oSmoke and inhalation injury

5. CAUSES OF BURNS
• Chemical burns – acids & alkali
• Electrical burns – high and low voltage
• Cold burns – frostbite
• Radiation
• Sun burns

6. CLASSIFICAION
Burns can be classified either
 Based on thickness of skin involved
 Based on percentage of burn

7. Based on thickness of skin involved
First-degree (superficial) burns: affect only the outer layer
of skin, the epidermis.
Second-degree (partial thickness) burns: involve the
epidermis and part of the lower layer of skin, the dermis.
Third-degree (full thickness) burns: affects the epidermis
and dermis and may go as far as the subcutaneous tissue.
Fourth-degree burns. Affects both layers of the skin and
deeper tissue, possibly involving muscle and bone.

8. Based on percentage of burn
Mild: partial thickness burn <15% in adults and less
than 10% in children. Also full thickness burn <2%.
Moderate: 2nd degree burn 15-25% in adults or 10-20%
in children and 2-10% 3rd degree burns.
Major: 2nd degree burns >25% in adults and >20% in
children. Burns involving eyes, ears, hands, perineum.
All inhalation and electrical burns.

10. Clinical Features of burns
First degree burns
• Reddened skin
• Pain at burn site
• Involves only epidermis
• Blanch to touch
• Examples: sunburns, minor scald from kitchen
accident

11. Clinical features
Superficial second degree burns
• Intense pain/sensitive
• White to red skin
• Blisters
• Involves epidermis and papillary layer of dermis
• Spares hair follicles, sweat glands etc.
• Erythematous and blanch to touch
• No or minimal scaring
• Spontaneous re-epitheliazation from retained epidermal structures in 7-14days

12. Clinical features
Deep second degree burns
• Injury to deeper layers of dermis i.e. reticular dermis.
• Appears pale and mottled
• Do not blanch to touch
• Capillary return sluggish or absent
• Less painful, remain painful to pinprick
• Takes 14 to 35 days to heal by re-epitheliazation from hair follicles and sweat
gland, keratinocytes often with severe scarring
• Contractures possible

13. Clinical features
Third degree burns
• Dry, leathery skin (white, dark brown, or charred)
• Loss of sensation
• All dermal layers/tissue may be involved

14. Clinical features
Fourth degree burns
• Involves structures beneath the skin – muscle, bone
• There is no feeling in the area since the nerve endings are
destroyed.

15. Assessment of burns
Wallace Rule of Nine

16. Assessment of burns
Lund and Browder’s Method
• Each and every part of the body is individually assessed for
involvement of burns.
• Assigns percentages of BSA for various anatomic parts
Palm method
• The size of the palm (approximately 1% of BSA) can be used
to assess the extent of burn injury in patient with scattered
burns

17. Factors considered in Assessments
• Depth and size of burn
• Part of body burn
• Age of client(extreme ages)
• Client’s medical history

18. BURN MANAGEMENT
Stop the burning process.
Cool the area with tap water with continuous
irrigation for 20 minutes
Indications for admission in burns:
Moderate and severe burns.
Airway burns of any type.
Burns in extremes of age.
All electrical or deep chemical burns.

19. Definitive treatment
Maintain airway, breathing, circulation (ABC)
Sedation and analgesia
Assess % burn, degree and type of burn and accordingly
fluid management.
Chemoprophylaxis: tetanus toxoid antibiotics and local
antiseptic
Ryle’s tube insertion initially for aspiration and later for
feeding

20. Fluid Resuscitation
Formula to calculate fluid replacement;
• Parkland Regimen
• 𝑻𝒐𝒕𝒂𝒍 𝑭𝒍𝒖𝒊𝒅 𝑹𝒆𝒑𝒍𝒂𝒄𝒎𝒆𝒏𝒕 𝒊𝒏 𝟐𝟒 𝒉𝒐𝒖𝒓𝒔 =
𝟒𝒎𝒍 𝒑𝒆𝒓 % 𝒐𝒇 𝒃𝒖𝒓𝒏 𝒑𝒆𝒓 𝑲𝒈 𝒃𝒐𝒅𝒚 𝒘𝒆𝒊𝒈𝒉𝒕.
• Half of the volume is given in the first 8 hours,
the rest is given in the next 16 hours.

21. Fluid Resuscitation
Muir and Barclay Regimen
For colloid after 12-24 hours.
𝑶𝒏𝒆 𝑹𝒂𝒕𝒊𝒐𝒏 = % 𝒃𝒖𝒓𝒏 × 𝒃𝒐𝒅𝒚 𝒘𝒆𝒊𝒈𝒉𝒕 𝒊𝒏(
𝑲𝒈
𝟐
).
3 Rations given in 1st 12 hours
2 Rations given in next 12 hours
1 Ration is given in the next 12 hours

22. Fluid Resuscitation
• Galveston Regimen (Pediatric)
•
𝟓𝟎𝟎𝟎𝒎𝒍
𝒎𝟐 𝒃𝒖𝒓𝒏 𝒂𝒓𝒆𝒂 +
𝟏𝟓𝟎𝟎𝒎𝒍
𝒎𝟐 𝑻𝒐𝒕𝒂𝒍 𝑩𝑺𝑨

23. Fluids used for Resuscitation
• *Ringer lactate is the fluid of choice*
• Blood id transfused after 48 hours
• In first 24 hours only crystalloids should be given
• After 24 hours colloids like plasma, gelatin, dextran,
hetastarch are used at rate of 0.35-0.5 ml/kg/% of burn
• Urine output should be 30-50 ml/ hr
• Hourly TPR charting

26. Complications of burns
• Eschar: It is a charred, denatured, full thickness deep, burn with
contracted dermis.
• Eschartomy:
• Incise along medial and/or lateral surfaces.
• Avoid bony prominences.
• Avoid tendons.

27. Complications of burns
• Electrical burns

28. Complications of burns
• Contractures
• Disorganized over formation of compact
collagen (three times than normal) causes
hypertrophic scar finally leading to
contracture.

29. Complications of burns
• Chemical burns

30. Thank You
Hope you learned something new.