BURNS

Incidence and Causes

8,000-10,00 burns per year in the U.S.A.
75-80% occur in homes
Major causes: flames, scalds, heat, chemicals and electricity
Under age 6, major cause is scalding
75% of burns could be avoided

Body surface affected (BSA)

The Rule of Nines

Entire head = 9%
Each arm = 9% (18%)
Chest = 9%
Abdomen = 9%
Upper back = 9%
Lower back = 9%
Front of each leg = 9% (18%)
Back of each leg = 9% (18%)
Groin = 1%
Total 100%
This along with the cause of
the burn helps determine the
severity of the burn

Lund-Browder

Accurate assessment of TBSA

Complications of Major Burns

Pulmonary injury; Stridor (whistling) with breathing

Hypovolaemia; loss of plasma and decreased BP

Hypothermia; with skin gone there is no thermoregulation

Cardiac Arrhythmia; irregular heart beat.

Kidney Failure

Death

When burns are critical

Any burn greater than 25% BSA

Full or deep-partial-thickness burns greater than 10% BSA

Burns complicated by a respiratory or airway injury

Most burns involving the face, hands, feet or genitals

Burns complicated by a fracture or major soft-tissue injury

Electrical or deep-chemical burns

Burns occurring in patients with serious pre-existing medical conditions

Classification of Burns

First degree or superficial burns

involve only the epidermis;
burned area is red; no blisters.

Second degree or partial thickness burns

involve all of epidermis & varying depths of the dermis.
Appearance -blisters, pink, moist, Extremely painful.

Third degree or full thickness burns

involve epidermis & entire dermis, possible deeper tissue such
as muscle and bone.
Appearance- white and dry. May be free of pain. Requires
skin grafting.

Burn types

Thermal - most common (Other than sunburn)

direct flame, scalds and direct contact.

Chemical - contact strong acids or alkalis.

burning process continues as long as the chemical, or agent, is on the body.
need to know the specific chemical because the treatment must be specific

Electrical - type I, II and III.

Type I - contact burn - most common - true electricity injury. burn is most severe at the
entry and exit points.
Type II - flash burn - victim becomes part of an electrical arc.
Type III - flame burn - electricity ignites the victim's clothing.

Sunburn. Radiation burns are by far the most common burns because of being exposed to
an enormous nuclear reactor, the sun.
sunburns are almost always superficial.
Don't underestimate the potential severity of sunburn. Using the Rule of Nines, it is not
uncommon for sunburn to reach the critical stage (burns greater than 25 percent BSA),
Some patients require skin grafting after prolonged sun exposure.

Burn treatment

1.stop the burning

2. evaluate the injury
3. relieve pain
4. prevent shock
5. infection.
Even though the fire is out, the burning can continue.
Remove all burned clothing
flush the skin with cool water.
Flushing is crucial to a chemical burn, particularly alkalis which must be flushed for 1 to 2 hours
Burned skin loses heat more rapidly than intact skin and cool water can cause hypothermia if a
large BSA has been burned.
Pay particular attention to the airway. An airway problem may not be immediately apparent.
If the patient has airway involvement or any respiratory difficulty, advanced rapid treatment is
required.
Superficial burns are easily managed with cool compresses and acetaminophen for the pain.
An extensive superficial burn will demand a slightly stronger analgesic and should be accompanied by an
increase in fluid intake by the patient.
basic systemic pain control along with fluid intake is the best approach.
treatment of partial-thickness burns follows the same approach of cooling the area and covering the burn
with a sterile dressing.
Do not break the blisters; they are actually the best burn dressing available. If the blisters rupture later,
apply Silvadene as an antibiotic ointment and cover with dry, sterile dressing.
Fluid loss can be an early complication and is most common with partial-thickness and deeper burns.
Depending on the extent of BSA involved, a fluid loss can rapidly lead to shock.
If the BSA is greater than 15 percent, fluid replacement is required. This is best managed with I-V fluids

Emergent Care

Burning process stopped with removal of clothing,

jewellery and covering affected area with cool
water
Increase blood volume with IV inserted in intact
skin area
Urinary catheter to monitor fluid output, indicates
dehydration
Intubation to secure an airway
Vitals; BP, HR, BPM, Temp
Determining extent of damage; Rule of Nines or
Lund -Browder

1 week after

3 weeks later

16 weeks later