BURNS MANAGEMENT

1. BURNS MANAGEMENT
TAEI Training of Trainers
Dr. M. MEDHUN KUMAR ,M.Ch
Assistant Professor
Department of Plastic surgery
Chengalpattu Medical College and Hospital

2. Thermal Burns

3. Chemical Burns

4. Electrical Burns

5. Radiation Burns

6. Layers of Skin

7. Depth of Burn

8. Classification
Depth
First degree: Injury localised to epidermis. Painful,
red, blanches to touch. Heals spontaneously. E.g.
sunburn.
Second degree superficial: injury to the epidermis and
superficial dermis. Red painful, blistering, blanches
to touch. Usually heals from intact skin appendages
with some skin discoloration.
Second degree deep: injury through the epidermis
deep into dermis. Pale mottled, does not blanch to
touch, painful to pin prick. Heals with scarring

9. Classification
Third degree : full thickness injury into
subcutaneous fat. Hard leathery eschar, painless
black, white or red. No visible skin appendages.
Skin grafting necessary.
Fourth degree : injury to underlying muscle and
bone

10. I degree Burn

11. II degree Burn

12. III degree Burn

13. Jackson's burn zones
1. Zone of coagulation
Irreversible tissue loss due to coagulative necrosis.
2. Zone of stasis
Decreased tissue perfusion. Tissue is viable but
can deteriorate to necrosis if not adequate
resuscitation.
3. Zone hyperaemia
Outermost zone with increased tissue perfusion.
Tissue usually recovers in absence of severe
infection or severe tissue hypo perfusion.

14. Jackson’s Zones

15. Resuscitation - Effects

16. Pathophysiology

17. Oedema

18. Wallace Rule of Nines for Adults
• Head & Neck = 9%
• Each upper extremity (Arms) = 9%
• Each lower extremity (Legs) = 18%
• Anterior trunk= 18%
• Posterior trunk = 18%
• Genitalia (perineum) = 1%

19. Rule of Nines Chart

20. The Lund and Browder chart

21. Rule of Palm
 Patient’s palm equals
1% of his body surface
area
 Best used for burns <
10% BSA

22. Fluid resuscitation
First 24 hours
• Modified Parkland Formula : 3ml /kg body wt /
% for first 24 hours
• Give one-half of the fluid calculated in the first
8 hours postburn (i.e. from the time of burn)
• Give the balance in next 16 hours postburn

23. Admission Criteria
• Partial thickness burns more than 20% of TBSA
• Full-thickness burns more than 2 % of TBSA
• Face, hands, feet, genitalia, perineum, or joints
involved
• Electrical burns
• Chemical burns
• Inhalation burns
• Burns in conjunction with preexisting medical
conditions
• Risk of morbidity or mortality

24. Fluid Administered
• For Adults : Ringer Lactate only
• For Children : Ringer Lactate as calculated by
formula
• In addition 5% Dextrose
• 100ml /kg till 10 kg
• 50ml /kg for 11-15 kg
• 30 ml /kg for above 15 kg body weight
• The Dextrose fluid calculated is divided into 3 equal
doses for administration every 8 hours.This is given
because Children have poor Glycogen storage in
their Liver and hence prone for Hypoglycemia.

25. Monitoring
• Urinary output is the most sensitive
noninvasive assessment parameter for cardiac
output and tissue perfusion
• Foley Catheter insertion
• Ideal rate of Urine output
Adults : 0.5 to 1.0 ml /kg / hr
Children : 1.0 to 1.5 ml /kg / hr
Infants : 1.5 to 2.0 ml /kg / hr
• Palpable peripheral pulses
• Clear sensorium

26. Monitoring
• Tissue Perfusion – Pulse Oximeter
• Basic investigations :
Serum electrolyte levels
Hemoglobin and hematocrit levels
Blood Glucose
Blood Urea & Serum Creatinine

27. • Tetanus Toxoid
• Pain management
• Prophylactic antibiotics
• Wound Culture

28. 24 to 48 hrs
• The amount of fluid administration is based on the
hydration measured mainly by urine output
• Usually ½ of first day requirements.
• Adults : Normal saline/ Ringer Lactate 5%
Dextrose added if there is no hyperglycemia.
• Children : Normal saline/ Isolyte P / 5% Dextrose
are administered

29. • Colloids are administered in the form of Fresh
Frozen Plasma (FFP) – 2units /day.
• The exact quantity and nature of fluids administered
are based on Patient clinical condition, Jugular
venous pressure and Investigation reports.
• Goal: Prevent shock by maintaining adequate
circulating blood volume and maintaining vital
organ perfusion

30. 48 to72 hrs
Infection control :
Wound Cultures repeated every 3 days and
appropriate antibiotics are administered.
To Continue Wound care :
• Topical Antibiotics and Dressings
• Wound closure
• Nutritional support
• Pain management
• Physiotherapy

31. Topical Antimicrobials
• Mafenide acetate for Ear
• Bacitracin for Face
• Silver sulfadiazine for Trunk & Extremities
• Mupirocin
• Acriflavin
• Acticoat

32. Surgical Procedures
• Debridement
• Tangential Excision
• Escharotomy
• Fasciotomy
• Escharectomy
• Split Skin Grafting
• Flap cover
• Amputation

33. Collagen

35. Skin Graft Mesher

36. Chemical Burns
• Acid Burns – Coagulation Necrosis Form a
thick, insoluble mass where they contact tissue
Limits burn damage.
• Alkali Burns – Liquefaction Necrosis Destroy
cell membrane deeper tissue penetration.

37. Chemical Burns - Acid

38. Electrical Burns

39. Electrical Flash Burns

40. RADIATION INJURIES
• Pathophysiology process set in motion by
radiation can either be prevented or
attenuated.
• Once damage occurred, only healing process
can be accelerated

41. Burns ICU - Cubicles

42. FIRST AID
Pour Water immediately

43. Use clean cloth

44. Cover with clean cloth

45. Thank you
Chengalpattu Medical College and Hospital, Chengalpattu