The thermal injury

Done BY :
Dr.

Sara Al-Ghanem | Medical intern from
KFU
1

I-definition & incidence

II- types ( etiology )

4-management of burn

5-complicatios

III- classifications
According
2

A burn is defined as a traumatic injury to the
skin or other organic tissue primarily
caused by thermal or other acute exposures.
Burns occur when some or all of the cells in
the skin or other tissues are destroyed by
heat, cold, electricity, radiation, or caustic
chemicals.
3

Burns are the fourth most common type of trauma worldwide,
following traffic accidents, falls, and interpersonal violence.
Approximately 90 percent of burns occur in low to middle income
countries.
Most burn injuries occur in a domestic setting, with cooking as
the most common activity.
Pediatric burns occur more commonly in the home (84% )
and while children are unsupervised (80%) .
Adults are equally likely to sustain a burn in the home, outdoors
or at work.
Burns to adult females occur mostly at home, while burns to adult
males occur mostly in outdoor or work locations.
The elderly are most likely to sustain a burn in the bathroom,
4
followed by the kitchen .

Thermal

Cold exposure (frostbite)

Chemical burns

Electrical current

Inhalation

Radiation burns
5

IV- classifications
According to:

Burn depth & clinical presentation of
each type
Size or extent
Severity grading
6

involve only the epidermal
layer of skin
No blister, painful
dry, red, and blanch with
pressure.
healed in six days without
scarring.
commonly seen with
sunburns.
8

Partial-thickness
I- superficial:

Superficial –
blisters
painful, red, and weeping, and
blanch with pressure.
heal in 7 to 21 days.
 scarring is unusual.
 pigment changes may occur.

9

I- deep:
extend into the deeper dermis
damage hair follicles and glandular tissue.
painful to pressure only
almost always blister (easily unroofed), are wet or waxy dry, and
have variable mottled colorization from patchy cheesy white to red .
They do not blanch with pressure.
Healing in three to nine weeks.
invariably cause hypertrophic scarring.
If they involve a joint, joint dysfunction is expected even with
aggressive physical therapy.
 A deep partial-thickness burn that fails to heal in three weeks is
functionally and cosmetically equivalent to a full thickness burn 10

extend through and destroy
all layers of the dermis and
often injure the underlying
subcutaneous tissue.
Burn eschar, the dead and
denatured dermis, is usually
intact..

12

eschar can compromise the viability of a limb or torso if
circumferential.
 Full thickness burns are usually anesthetic or hypoesthetic.
Skin appearance can vary from waxy white to leathery gray to
charred and black.
skin is dry and inelastic and does not blanch with pressure
 Hairs can easily be pulled from hair follicles.
Vesicles and blisters do not develop.
Without surgery, these wounds heal by wound contracture with
epithelialization around the wound edges.
 Scarring is severe with contractures
 complete spontaneous healing is not possible.
13

extend through the skin into underlying tissues
such as fascia, muscle, and/or bone
potentially life-threatening injuries
Never heal , unless surgically treated

14

• The two commonly used methods of assessing TBSA in adults are
the Lund-Browder chart and "Rule of Nines,”
• whereas in children, the Lund-Browder chart is the recommended
method because it takes into account the relative percentage of
body surface area affected by growth.
• When the burn is irregular and/or patchy, the palm method may
be useful

15

Role of 9  Adult

head & neck = 9% TBSA
upper limb = 9 % TBSA
trunk = 18% TBSA
back = 18% TBSA
genitalia = 1% TBSA
lower limb= 18 % TBSA

16

Lund-Browder
chart
SARA AL-GHANEM

17

Small or patchy burns can be approximated
by using the surface area of the patient's
palm.
The palm of the patient's hand, excluding
the fingers, is approximately 0.5 percent of
total body surface area and the entire palmar
surface including fingers is 1 percent in
children and adults

The major determinants of severity of any burn injury are :
-Burn factors:
- Type of the burn
- the percentage of total body surface area
- the presence of an inhalational injury,
- depth & site of the burn
- presence of infection
- associated injuries
-complications
-Patient's factors :
age , sex , mentality , socio-economic status, concomitant diseases

The principles of managing an acute burn injury
are the same as in any acute trauma case:
A Airway control.
B Breathing and ventilation.
C Circulation.
D Disability – neurological status.
E Exposure with environmental control.
F Fluid resuscitation
SARA AL-GHANEM

25

Initial management of the burned
airway (A)
• Early elective intubation is safest
• Delay can make intubation very difficult because of
 swelling
• Be ready to perform an emergency cricothyroidotomy
if intubation is delayed
• Recognition of the potentially burned airway
• A history of being trapped in the presence of smoke or
hot gases
• Burns on the palate or nasal mucosa, or loss of all the
hairs in the nose
• Deep burns around the mouth and neck
SARA AL-GHANEM

26

Breathing : management of
inhalational injury (B) :
• The clinical features are :
a progressive increase in respiratory effort and
rate, rising pulse, anxiety and confusion and
decreasing oxygen saturation.

• Treatment starts as soon as this injury is suspected
and the airway is secure. Physiotherapy, nebulisers
and warm humidified oxygen are given .
27

In children with burns over 10% TBSA and adults with burns over 15%
TBSA, consider the need for intravenous fluid resuscitation
The key is to monitor urine output

Fluids needed can be calculated from a standard
formula
28

Full-thickness and deep dermal burns need antibacterial
dressings to delay colonization prior to surgery

Superficial burns will heal and need simple dressings

An optimal healing environment can make a difference
to outcome in borderline depth burns
31

• The four most common dressings for fullthickness and contaminated wounds are :
• 1% silver sulphadiazine cream
• 0.5% silver nitrate solution
• Mafenide acetate cream
• Serum nitrate, silver sulphadiazine and cerium
nitrate
32

1-Analgesia

2-Energy balance and nutrition

3-Monitoring and
control of infection
33

Infection control in burns patients:
• Burns patients are immunocompromised
• They are susceptible to infection from many
routes
• Sterile precautions must be rigorous
• Swabs should be taken regularly
• A rise in white blood cell count, thrombocytosis
and increased catabolism are warnings of
infection
• If there are signs of infection, then further
cultures need to be taken and antibiotics started
34

6-Psychological

4-Nursing care

5-Physiotherapy

35

7-Surgical treatment
• Deep dermal burns need tangential shaving and split-skin grafting
• All full-thickness burns need surgery
• The anaesthetist needs to be ready for significant blood loss
• Topical adrenaline reduces bleeding
• All burnt tissue needs to be excised
• Stable cover, permanent or temporary, should be applied  at once
to reduce burn load
36

Escharotomy

incising the whole
length of full-thickness
burns

37

general complications of burns
1-inhalation injury & airway damage
2-CO poisoning
3-all types of shocks
4-renal failure (acute tubular necrosis)
5-supra-renal failure 6-GI ulcers ( curling
ulcers )
7-multi-organ failure
39

-Wound infections . -Wound escher( is a very tough
layer in the 3rd degree burn covering the row area &
necrotic tissue) >> causing deformities & movement
restriction
-Malignant ulcers
-Loss of functions
-Dupuytren contracture (wrist joint movement
restriction)
-Hypertrophic scar (keloid)
40

-disfigurement
-Family breaking & divorce
-Low self-esteem
-Long absence from the work
-unemployment -pressure

41

The thermal injury

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