Republic of the Philippines

CAMARINES SUR POLYTECHNIC COLLEGES

Nabua, Camarines Sur

COLLEGE OF HEALTH SCIENCES

BURNS
● Injuries to body tissue caused by excessive heat (heat greater than 104 degree
fahrenheit (40 degree celsius).
● Commonly occurs in children of all ages after infancy.
● Second greatest cause of unintentional injury in children 1 to 4 years of age and the third
greatest cause in children 5 to 14 years old.
● Burn injuries tend to be more serious in children than in adults, because the same size
burn covers a larger surface of a child’s body.
● Toddlers are often burned by pulling pans of scalding water or grease off the stove and
onto themselves or from bath water that is too hot. Older children are more apt to suffer
burns from flames when they move too close to a campfire, heater, or fire-place.

Assessment
1. When children are brought to a healthcare facility with a burn injury, the first
question must be, “where is the burn and what is its extent and depth?”
● Burns are classified according to the criteria of the American Burn
Association as minor, moderate, severe, based primarily on the depth and
size of the burn.
○ Minor
■ First- and second-degree burns that cover less than 10%
of the body are considered minor and rarely require
hospitalization.
■ No area of the face, feet, hands, or genitalia burned.
○ Moderate
■ Second-degree burns that cover about 10% of the body.
Burns on hands, feet, face or genitals can range from
moderate to severe.
■ Inhalation of smoke has occurred
○ Severe
■ Third-degree burns that cover more than 10% of the body.

Depth of Burn
● When estimating the depth of a burn, use the appearance of the burn and
the sensitivity of the area to pain as criteria.
○ AREA
■ Face and throat burns are particularly hazardous because
there may be accompanying but unseen burns in the
respiratory tract, resulting in edema that could lead to
respiratory tract obstruction.
 Republic of the Philippines
CAMARINES SUR POLYTECHNIC COLLEGES
Nabua, Camarines Sur

COLLEGE OF HEALTH SCIENCES

■ Hand burns are also hazardous because, if the fingers and
thumb are not positioned properly during healing,
adhesions will inhibit full range of motion in the future.
■ Burns of the feet and genitalia carry a high risk for
secondary infection. Genital burns are also hazardous
because edema of the urinary meatus may prevent a child
from voiding.

○ DEPTH
■ First-degree burn involves only the superficial epidermis.
The area appears erythematous. It is painful to touch and
blanches on pressure. Scalds and sunburn are examples
of first-degree burns. Such burns heal by simple
regeneration and take only 1 to 10 days to heal.
■ Second-degree burn involves the entire epidermis. Sweat
glands and hair follicles are left intact. The area appears
very erythematous, blistered, and moist from exudate. It is
extremely painful. Scalds can cause second-degree burns.
Such burns heal by regeneration of tissue but take 2 to 6
weeks to heal.
■ Third-degree burn is a full thickness burn involving both
skin layers, epidermis, and dermis. It may also involve
adipose tissue, fascia, muscle, and bone. The burn area
appears white or back. Flames are a common cause of
third-degree burns. Because the nerves, sweat glands, and
hair follicles have been burned, third-degree burns are not
painful. Such burns cannot heal by regeneration because
the underlying layers of skin have been destroyed. Skin
grafting is usually necessary, and healing takes months.

2. Undress children with burns completely so the entire body can be inspected.
● A first-degree burn is painful, whereas a third-degree burn is not.
Therefore, a child may be crying from a superficial burn that is obvious on
the arm, although the condition needing the most attention is a
third-degree burn on the chest which is covered by a jacket.
3. Ask what caused the burn
● different materials cause different degrees of burn. Hot water, for
example, causes scalding, which is a generally lesser degree of burn than
one caused by flaming clothing.
 Republic of the Philippines
CAMARINES SUR POLYTECHNIC COLLEGES
Nabua, Camarines Sur

COLLEGE OF HEALTH SCIENCES

4. Ask where the fire happened (If applicable only)

● Fire in closed spaces is apt to cause more respiratory involvement than
fires in open areas.
5. Ask whether the child has any secondary health problem
● In their anxiety over the present burn, parents may forget to report
important facts, such as the child has diabetes or is allergic to common
drugs.

Emergency Management of Burns

All burns need immediate care because of the pain involved.
1. Minor Burns
● Although minor burns (typically first-degree burns) are the simplest type of burn,
they involve pain and death of skin cells, so they must be treated seriously.
Immediately apply ice to cool the skin and prevent further burning. Application of
an analgesic-antibiotic ointment and a gauze bandage to prevent infection is
usually the only additional treatment required. The child should have a follow-up
visit in 2 days to have the area inspected for a secondary infection and to have
the dressing changed. Caution parents to keep the dressing dry.
2. Moderate Burns
● Moderate or second-degree burns may have blisters. Do not rupture them,
because doing so invites infection. The burn will be covered with a topical
antibiotic such as silver sulfadiazine and a bulky dressing to prevent damage to
the denuded skin. The child is usually asked to return in 24 hours to assess that
pain control is adequate and there are no signs and symptoms of infection.
Broken blisters may be cut away to remove possible necrotic tissue as the burn
heals.
3. Severe Burns
● The child with a severe burn is critically injured and needs swift, sure care,
including fluid therapy, systemic antibiotic therapy, pain management, and
physical therapy, to survive the injury without a disability caused by scarring,
infection, or contracture.

Therapy for Burns

Second- or third-degree burns may receive open treatment, leaving the burned area exposed to
the air, or a closed treatment, in which the burned area is covered with an antibacterial cream
and many layers of gauze.

● Topical Therapy
○ Applying medication to the skin or mucous membrane to allow the medication to
enter the body.
 Republic of the Philippines
CAMARINES SUR POLYTECHNIC COLLEGES
Nabua, Camarines Sur

COLLEGE OF HEALTH SCIENCES

○ Silver sulfadiazine (Silvadene) is the drug of choice for burn therapy to limit
infection at the burn site for children. It is applied as a paste to the burn, and the
area is then covered with a few layers of mesh gauze.
● Escharotomy
○ An eschar is the tough, leathery scab that forms over moderately or severely
burned areas. An escharotomy is an emergency surgical procedure involving
incising through areas of burnt skin to release the eschar and its constrictive
effects, restore distal circulation, and allow adequate ventilation.
○ Simply means opening the eschar.
● Debridement
○ It is the removal of necrotic tissue from a burned area. It reduces the possibility of
infection, because it reduces the amount of dead tissue present on which
organisms would thrive. Children usually have 20 minutes of hydrotherapy before
debridement to soften and loosen eschar, which then can be gently removed with
forceps and scissors.
● Grafting
○ Homografting (also called as allografting) is the placement of skin (sterilized
and frozen) from cadavers or a donor on the cleaned burn site. These grafts do
not grow but provide a protective covering for the area. In small children,
heterografts (also called xenografts), such as pig skin may be used. Auto
grafting is a process in which a layer of skin of both epidermis and a part of
dermis (called a split- thickness graft) is removed from a distal, unburned
portion of the child’s body and placed at the prepared burn site, where it will grow
and replace the burned skin.
○ The advantage of grafting is that it reduces fluid and electrolyte loss, pain, and
the chance of infection.
○ After the grafting procedure, the area is covered by a bulky dressing so that the
growth of the newly adhering cells will not be disrupted, this should not be
removed or changed.

Summary
● Burns are classified as minor, moderate, and severe and can be divided into three types-
first, second, and third degree - depending on the depth of the burn.
● Treatment depends on the severity of the burn, which can be categorized into superficial
(affecting the skin epidermis); partial thickness (affecting the epidermis and upper layers
of the dermis); deep dermal (that impacts the whole epidermis and dermis); full thickness
(destroying the epidermis and dermis); and 4th degree burns (extending through all
layers of skin into the muscle and bone layers)
● Burns produce systemic body reactions and require long term nursing care.
 Republic of the Philippines
CAMARINES SUR POLYTECHNIC COLLEGES
Nabua, Camarines Sur

COLLEGE OF HEALTH SCIENCES

● As many as 50% of burns could be prevented with improved parent and child education.