1. http://www.who.

int/violence_injury_prevention/other_injury/burns/en/

Burns

A burn is an injury to the skin or other organic tissue primarily caused by heat or due to
radiation, radioactivity, electricity, friction or contact with chemicals. Skin injuries due to
ultraviolet radiation, radioactivity, electricity or chemicals, as well as respiratory damage
resulting from smoke inhalation, are also considered to be burns.

Globally, burns are a serious public health problem. An estimated 265 000 deaths occur each
year from fires alone, with more deaths from scalds, electrical burns, and other forms of
burns, for which global data are not available.

Over 96% of fatal fire-related burns occur in low- and middle-income countries. In addition to
those who die, millions more are left with lifelong disabilities and disfigurements, often with
resulting stigma and rejection.

The suffering caused by burns is even more tragic as burns are so eminently preventable.
High-income countries have made considerable progress in lowering rates of burn deaths,
through combination of proven prevention strategies and through improvements in the care of
burn victims. Most of these advances in prevention and care have been incompletely applied
in low- and middle-income countries. Increased efforts to do so would likely lead to
significant reductions in rates of burn-related death and disability.

Harmonizing global burn data collection

WHO and partners are pilot testing a new burn data collection instrument.

 More information
Related links

 Burn prevention: success stories, lessons learned

 A WHO plan for burn prevention and care [pdf 1.8Mb]
 WHO fact sheet on burns
Partners

 International Society for Burn Injuries

 2. https://www.webmd.com/first-aid/tc/burns-topic-overview#1

Burns and Electric Shock - Topic Overview

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ARTICLES ONBURNS AND ELECTRIC SHOCK

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 Credits
Most burns are minor injuries that occur at home or work. It is common to get a minor burn from hot
water, a curling iron, or touching a hot stove. Home treatment is usually all that is needed for healing
and to prevent other problems, such as infection.
There are many types of burns.

 Heat burns (thermal burns) are caused by fire, steam, hot objects, or hot liquids. Scald burns
from hot liquids are the most common burns to children and older adults.
 Cold temperature burns are caused by skin exposure to wet, windy, or cold conditions.
 Electrical burns are caused by contact with electrical sources or by lightning.
 Chemical burns are caused by contact with household or industrial chemicals in a liquid,
solid, or gas form. Natural foods such as chili peppers, which contain a substance irritating to
the skin, can cause a burning sensation.
 Radiation burns are caused by the sun, tanning booths, sunlamps, X-rays, or radiation
therapy for cancer treatment.
 Friction burns are caused by contact with any hard surface such as roads ("road rash"),
carpets, or gym floor surfaces. They are usually both a scrape (abrasion) and a heat burn.
Athletes who fall on floors, courts, or tracks may get friction burns to the skin. Motorcycle or
bicycle riders who have road accidents while not wearing protective clothing also may get
friction burns. For information on treatment for friction burns, see the topic Scrapes.

3. https://www.joyelawfirm.com/personal-injury-lawyer/burn-injury/classification/

CLASSIFICATION OF BURNS
 Burn injuries are generally classified according to their severity and depth. Traditionally, burns
were classified by the apparent severity of the burn injury. The four traditional classifications of
burns according to severity are:

 First-degree burns — A first-degree burn affects only the outer layer of skin, known as the
epidermis. Skin that has suffered a first-degree burn is typically red and dry, but lacks blister
formation. A first-degree burn is usually very painful, but usually heals within three to five days
without significant long-term consequences. A mild case of sunburn is an example of a first-
degree burn where the injured epithelium peels away from the healthy skin during the healing
process.
 Second-degree burns — A second-degree burn can be partial or full thickness and will include
the epidermis and part of the dermis, the layer of skin below the surface. In a partial-thickness
second-degree burn, some of the dermis is affected, while a full-thickness second-degree burn
will destroy all of the dermis. The burn area is typically pink or red and appears wet and/or
blistered. It will be very painful, though sensation may be diminished. The wound may blanch
when touched. A second-degree burn usually takes a minimum of two to three weeks to heal.
Excision and skin grafting may be required.
 Third-degree burns — In a third-degree burn, not only are the epidermis and dermis destroyed,
but the underlying muscles, tendons and bones may also be damaged. The burn area may be
white or black and will appear charred, dry or leathery. A third-degree burn causes severe
damage to nerve endings and permanent tissue damage and scarring. Treatment for a third-
degree burn can require several weeks or longer. The victim often requires intravenous (IV)
fluids containing electrolytes as well as antibiotics by IV or by mouth to prevent infection. Skin
grafting will likely be necessary, as will functional and/or cosmetic surgery.
 Fourth-degree burns — The damage is the most severe in a fourth-degree burn. All layers of
skin are completely destroyed in a fourth-degree burn, and muscle, fat, bone and tendons are
often affected. Extensive skin grafting and even amputation are common with these injuries, and
the victim is usually left with functional impairment.

4. https://www.emedicinehealth.com/burn_percentage_in_adults_rule_of_nines/article_em.
htm

Burn Percentage in Adults: Rule of Nines

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The rule of nines assesses the percentage of burn and is used to help guide treatment decisions
including fluid resuscitation and becomes part of the guidelines to determine transfer to a burn
unit.
You can estimate the body surface area on an adult that has been burned by using multiples of 9.

An adult who has been burned, the percent of the body involved can be calculated as follows:

As an example, if both legs (18% x 2 = 36%), the groin (1%) and the front chest and abdomen
were burned, this would involve 55% of the body.

Consumer e-Tools are not intended to provide professional advice or recommend particular
products. Physicians and healthcare professionals should exercise their own clinical judgment
when assessing the results of our tools or calculators. Consumers should consult a doctor for
advice when assessing the results.

5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC449823/

Assessment of burn area

Assessment of burn area tends to be done badly, even by those who are expert at it. There are
three commonly used methods of estimating burn area, and each has a role in different scenarios.
When calculating burn area, erythema should not be included. This may take a few hours to fade,
so some overestimation is inevitable if the burn is estimated acutely.acutely.

Figure 1
Wallace rule of nines
Palmar surface—The surface area of a patient's palm (including fingers) is roughly 0.8% of total
body surface area. Palmar surface are can be used to estimate relatively small burns (< 15% of
total surface area) or very large burns (> 85%, when unburnt skin is counted). For medium sized
burns, it is inaccurate.
Wallace rule of nines—This is a good, quick way of estimating medium to large burns in adults.
The body is divided into areas of 9%, and the total burn area can be calculated. It is not accurate
in children.
Lund and Browder chart—This chart, if used correctly, is the most accurate method. It
compensates for the variation in body shape with age and therefore can give an accurate
assessment of burns area in children.
It is important that all of the burn is exposed and assessed. During assessment, the environment
should be kept warm, and small segments of skin exposed sequentially to reduce heat loss.
Pigmented skin can be difficult to assess, and in such cases it may be necessary to remove all the
loose epidermal layers to calculate burn size.
Go to:

Resuscitation regimens
Fluid losses from the injury must be replaced to maintain homoeostasis. There is no ideal
resuscitation regimen, and many are in use. All the fluid formulas are only guidelines, and their
success relies on adjusting the amount of resuscitation fluid against monitored physiological
parameters. The main aim of resuscitation is to maintain tissue perfusion to the zone of stasis and
so prevent the burn deepening. This is not easy, as too little fluid will cause hypoperfusion
whereas too much will lead to oedema that will cause tissue hypoxia.
The greatest amount of fluid loss in burn patients is in the first 24 hours after injury. For the first
eight to 12 hours, there is a general shift of fluid from the intravascular to interstitial fluid
compartments. This means that any fluid given during this time will rapidly leave the
intravascular compartment. Colloids have no advantage over crystalloids in maintaining
circulatory volume. Fast fluid boluses probably have little benefit, as a rapid rise in intravascular
hydrostatic pressure will just drive more fluid out of the circulation. However, much protein is
lost through the burn wound, so there is a need to replace this oncotic loss. Some resuscitation
regimens introduce colloid after the first eight hours, when the loss of fluid from the
intravascular space is decreasing.decreasing.

Figure 2
Lund and Browder chart
Burns covering more than 15% of total body surface area in adults and more than 10% in
children warrant formal resuscitation. Again these are guidelines, and experienced staff can
exercise some discretion either way. The most commonly used resuscitation formula is the
Parkland formula, a pure crystalloid formula. It has the advantage of being easy to calculate and
the rate is titrated against urine output. This calculates the amount of fluid required in the first 24
hours. Children require maintenance fluid in addition to this. The starting point for resuscitation
is the time of injury, not the time of admission. Any fluid already given should be deducted from
the calculated requirement.
At the end of 24 hours, colloid infusion is begun at a rate of 0.5 ml×(total burn surface area
(%))×(body weight (kg)), and maintenance crystalloid (usually dextrose-saline) is continued at a
rate of 1.5 ml×(burn area)×(body weight). The end point to aim for is a urine output of 0.5-1.0
ml/kg/hour in adults and 1.0-1.5 ml/kg/hour in children.children.

Table 1
Parkland formula for burns resuscitation
High tension electrical injuries require substantially more fluid (up to 9 ml×(burn area)×(body
weight) in the first 24 hours) and a higher urine output (1.5-2 ml/kg/hour). Inhalational injuries
also require more fluid.fluid.

Table 2
Worked examples of burns resuscitation
In Britain Hartman's solution (sodium chloride 0.6%, sodium lactate 0.25%, potassium chloride
0.04%, calcium chloride 0.027%) is the most commonly used crystalloid. Colloid use is
controversial: some units introduce colloid after eight hours, as the capillary leak begins to shut
down, whereas others wait until 24 hours. Fresh frozen plasma is often used in children, and
albumin or synthetic high molecular weight starches are used in adults.
The above regimens are merely guidelines to the probable amount of fluid required. This should
be continuously adjusted according to urine output and other physiological parameters (pulse,
blood pressure, and respiratory rate). Investigations at intervals of four to six hours are
mandatory for monitoring a patient's resuscitation status. These include packed cell volume,
plasma sodium, base excess, and lactate.
Burns units use different resuscitation formulas, and it is best to contact the local unit for advice.
6.https://www.researchgate.net/publication/281114464_DIFFERENTIATION_OF_ANTE
MORTEM_POSTMORTEM_BURNS_BY_HISTOPATHOLOGICAL_EXAMINATION