BURN

Burns: definition, classification, causes, prevention, pathological

changes, complications, clinical features and management.

• Thermal injury

- Scald—spillage of hot liquids

- Flame burns

- Flash burns due to exposure of natural gas, alcohol, combustible liquids

– Contact burns—contact with hot metals/objects/materials

• Electrical injury
• Chemical burns—acid/alkali

• Cold injury—frost bite

• Ionizing radiation

• Sun burns

1-

• Thermal injury

2-

• Electrical injury
3 - Chemical burns

4 - frost bite

5-

• Ionizing radiation
Classification of Burns
SYSTEMIC COMPLICATIONS

Multi system organ dysfunction — Multiple organ dysfunction syndrome (MODS) is a progressive
disorder that commonly occurs in acutely ill patients, regardless of etiology of the injury or illness.
MODS exists in a continuum with the systemic inflammatory response syndrome (SIRS) which affects
most patients with a severe burn, with or without an infection. The risk of MODS increases with burn
wounds >20 percent total body surface area (TBSA), increasing age, male gender, sepsis,
hypoperfusion, and under-resuscitation . Approximately 50 percent of patients who succumbed to
the burn injury had been diagnosed with MODS [6]. Most patients with MODS have an inability to
attenuate the inflammatory response to injury.
Clinical features and management
The burns patient has the same priorities as all other trauma patients.

• Assess: - Airway - Breathing: beware of inhalation and rapid airway compromise - Circulation: fluid
replacement - Disability: compartment syndrome - Exposure: percentage area of burn.

• Essential management points: - Stop the burning - ABCDE - Determine the percentage area of burn
(Rule of 9’s) - Good IV access and early fluid replacement.

• The severity of the burn is determined by: - Burned surface area - Depth of burn - Other
considerations.

• Morbidity and mortality rises with increasing burned surface area. It also rises with increasing age
so that even small burns may be fatal in elderly people.

Burn Management iinn AAdduullttss

• The “Rule of 9’s” is commonly used to estimate the burned surface area in adults.

• The body is divided into anatomical regions that represent 9% (or multiples of 9%) of the total
body surface (Figure 7). The outstretched palm and fingers approximates to 1% of the body surface
area.

• If the burned area is small, assess how many times your hand covers the area.

• Morbidity and mortality rises with increasing burned surface area. It also rises with increasing age
so that even small burns may be fatal in elderly people.

Burn Management in Children

• The ‘Rule of 9’s’ method is too imprecise for estimating the burned surface area in children
because the infant or young child’s head and lower extremities represent different proportions of
surface area than in an adult

• Burns greater than 15% in an adult, greater than 10% in a child, or any burn occurring in the very
young or elderly are serious.

Clinical features of Burn patients

Symptoms

Skin anatomyOpen pop-up dialog box

Third-degree burnOpen pop-up dialog box

Radiation burnOpen pop-up dialog box

Burn symptoms vary depending on how deep the skin damage is. It can take a day or two for the
signs and symptoms of a severe burn to develop.

• 1st-degree burn. This minor burn affects only the outer layer of the skin (epidermis). It may
cause redness and pain.

• 2nd-degree burn. This type of burn affects both the epidermis and the second layer of skin
(dermis). It may cause swelling and red, white or splotchy skin. Blisters may develop, and
pain can be severe. Deep second-degree burns can cause scarring.

• 3rd-degree burn. This burn reaches to the fat layer beneath the skin. Burned areas may be
black, brown or white. The skin may look leathery. Third-degree burns can destroy nerves,
causing numbness.

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