Unit Nine: 1 Compiled by Yegoraw G. (BSC N)

UNIT NINE
BURN
compiled by Yegoraw G. ( Bsc N) 1
Objectives:-
At the end of this lesson the student will be able to:-
• Define burn injury
• Identify the causes of burn injury
• Describe the different types of burn and degree of burn
• Describe the clinical signs and symptoms of burn injury.
• List the general first aid care for a person with burn
injury.
Definition
• Burn injury:- is one of the most common and most painful
injuries in human being.
• is an injury to the skin and deeper tissues of the body.
 Burns are caused by
• extreme heat (both wet and dry),
• chemicals,
• Electricity and radiation,

Cont…
• They can affect the skin, eyes, lungs, and other
internal organs.
• Practically all burns are preventable if we take a care

of it.
• Burn injury can be classified based on causes, depth

of injury and extent of % TBSA.

 Depth & severity of burn injury depends on:-
• PH of the chemicals
• Concentration of the agent
• Duration of contact with the agent
• Volume of the agent used
• Physical form of the chemical agent
• Involvement of the organs.

Classification of burn based on causes
• Thermal burn:- caused by conduction &
convection. Example; hot liquids, fire or steam
• Electrical burn:- caused by the passage of electrical

current through the body.
• Chemical burn:- occurs when certain chemical

compounds comes in contact with the body.
• Example; sulfuric acid, HCL and Gasoline.

Cont…
• Depending on the depth of the injury classified as:-
1. 1st degree burn (superficial – partial thickness burn)
2. 2nd degree burn (deep partial thickness burn)
3. 3rd Degree burn (full-thickness burn)

Cont…
First degree burns:
Involves only the
outermost layer of skin
(epidermis).
 Redness, Swelling and
Pain
Healing process will take
about 1 week.
Heals without scaring
Cont…
• It is an injury that involves only the epidermis.
• It is caused by a flash of contact with hot

liquids, objects or sun burn or radiation
exposure.
• A superficial burn heals rapidly and

healing is with out scaring.
clinical features:-
 Skin appears pink to red
 Dry skin
 No blister formation
Mild swelling and pain
Rapid healing
Epidermis is included
First Aid Measures
• The objective of first aid for first degree burn is:-
- to relieve pain
- prevent complication and
-to prevent occurrence of shock, usually medical

treatments may not required.
• Apply cold running water or submerge the burned

area in cold water is best.
Cont..
• Apply a dry dressing if it
is necessary
NB: - Severe sun burn
should receive medical
care as soon as possible
 Sunburns are common
form of first-degree
burns.

Cont…
• Second degree
burns:- Involves
epidermis and
underlying layers of
skin (dermis).
• Skin becomes very red,
swollen, and develops
blisters
2. Deep - Partial thickness burns or second
degree burns:-
are more serious because a deeper layer of
skin is affected and because they are easily
infected.
 Relatively it takes longer time than superficial
burn.
Are usually more painful than deeper burns in
which the nerve endings in the skin are
destroyed.
Cont..
• Simply; in DPT there is so destruction of epidermis
and & major parts of dermis;
• Which is characterized by blistering, edema, and
may heals with hypertrophic scar and keloids
formation.
• Thermal flame burns and severe scaled burns ( burn
with hot liquid) could be taken as an example of 2nd
degree burn. compiled by Yegoraw G. ( Bsc N) 15
Clinical features:-
• It involves the epidermis and part of the dermis burns.
 Presentations
• Greater depth than first degree burn/dermis included
• Red or mottled appearance
• Development of blisters
• Considerable swelling over a period of several days and

very painful

Continued..

Continued….
• The skin appears red and wet due to loss of
plasma through the damaged layers of the
skin.
• Presence of blisters
• Intense pain , due to the involvement of the

nerve endings
• Considerable swelling for a longer time

A general principles for burn
• Apply dry sterile gauze or clean cloth as a
protective bandage.
• Do not break blisters or remove tissue
• Immerse the burned part in cold running water but
not ice cold water.

Cont…
• Apply dry sterile gauze

or clean cloth as a
protective bandage.
• Do not break blisters or

remove tissue.

3. Full thickness burn( 3rd degree burn)
• A full-thickness burn involves total destruction of
epidermis and dermis and, in some cases, destruction of
underlying tissue.
• Wound color ranges widely from white to red, brown,
or black.
• The burned area is painless because nerve fibers are
destroyed.
• The wound appears leathery; hair follicles and sweat
glands are destroyed.
Cont..
It involves all the layers of the skin, the
epidermis, the dermis and can extend
beyond the subcutaneous layer in to
muscles, bone or other organs.
It often requires skin grafting and is
highly susceptible for infection.
The skin may be charred black or appear
white & dry.
Cont..
• FTB:- are the most serious burns, involving all of
the layers of the skin.
• In third-degree burns, the skin may appear white,
black, and or leathery-looking and there may be very
little pain, although the areas surrounding the burn
might be extremely painful.

Cont…
 The burn may damage nerve cells so the victim may
not experience pain.
 It is caused by contact with extreme heat sources.
 Example could be
• Hot objects or liquids
• Flames
• Chemicals
• Electricity
Cont..

Cont..

Clinical presentation:-
–The skin appears white and waxy or
–Dark brown or black scar
–There is a deep tissue destruction
–Complete loss of all layers of the skin
–No pain on the areas where there is
complete loss of skin structures as nerve
endings are completely damaged.
Cont…
 If there pain at the surrounding of the burn
area, there is superficial- partial or deep-
partial burn.
 Second-degree burns are the most

painful because more tissue is damaged, but
the nerve endings are still preserved.
Cont..
• These burns heal well and don’t require
medical attention unless they are larger than
two to three inches in diameter.
• If any the four special area are burned, it is

classified as a sever burn & will require
hospitalization.

Classification of Extent of Burn Injury
1. Minor Burn Injury:-
 Second-degree burn of <15% total body surface

area (TBSA) in adults or <10% TBSA in children.
 Third-degree burn of <2% TBSA not involving

special care areas (eyes, ears, face, hands, feet,
perineum, joints).

Cont..
• Excludes all patients with electrical injury,

inhalation injury, or concurrent trauma and all
poor-risk patients (eg, extremes of age, inter
current disease).

2. Moderate, Uncomplicated Burn Injury
• Second-degree burns of 15–25% TBSA in adults or
10–20% in children.
• Third-degree burns of <10% TBSA not involving

special care areas.
• Excludes electrical injury, inhalation injury, or

concurrent trauma and all poor-risk patients (eg,
extremes of age, intercurrent disease).
3. Major Burn Injury
• Second-degree burns >25% TBSA in adults or >20%
in children.
• All third-degree burns >10% TBSA
• All burns involving eyes, ears, face, hands, feet,

perineum, joints.
• All inhalation injury, electrical injury, or concurrent

trauma, and all poor-risk patients.
Fluid and Electrolyte Changes in the
Emergent/Resuscitative Phase:-
• Fluid accumulation phase (shock phase)
• Plasma → interstitial fluid (edema at burn site)
 SOME OF THE CONDITIONS ARE:-
1. Generalized dehydration:- Plasma leaks through
damaged capillaries.
2. Reduction of blood volume:-Secondary to plasma
loss, fall of blood pressure, and diminished cardiac
output.
3. Decreased urinary output:-
Secondary to:-
 Fluid loss
 Decreased renal blood flow
 Sodium and water retention caused by increased

adrenocortical activity
 Hemolysis of red blood cells, causing

hemoglobinuria and myonecrosis or myoglobinuria
4. Potassium +
(K ) excess:-
 Massive cellular trauma causes release of K+ into
extracellular fluid (ordinarily, most K+ is
intracellular).
5. Sodium (Na+) deficit:-

 Large amount of Na+ is lost in trapped edema fluid
and exudate and by shift into cells as K+ is released
from cells (ordinarily most Na+ is extracellular).
6. Metabolic acidosis (base-
bicarbonate deficit)
• Loss of bicarbonate ions accompanies sodium loss.
7. Hem concentration (elevated hematocrit):-
 Liquid blood component is lost into extra vascular

space.

Fluid Requirements:-
• Fluid requirements for the first 24 hours are
calculated by the clinician based on the extent of the
burn injury.
• Resuscitation formulas are approximations only and

are individualized to meet the requirements of each
patient.

Cont….
• The consensus formula(Parkland formula):
• provides for the volume of an isotonic solution to

be administered during the first 24 hours in a range
of 2 to 4 mL/kg per percent of body surface burned.
• half of the calculated total should be given over the

first 8 post burn hours, and the other half should be
given over the next 16 hours.
Cont…
• The rate and volume of the infusion must be
regulated according to the patient's response by
changing the hourly infusion rates.
• Examples:- 70-kg (154-lb) patient with a 50% TBSA
burn:
• Consensus formula: 2 to 4 mL/kg/% TBSA
• 2 × 70 × 50 = 7000 mL/24 hours
• Plan to administer: first 8 hours = 3500 mL, or 437
mL/hour; next 16 hours = 3500 mL, or 219 mL/hour
Cont…
Parkland/Baxter Formula:-
• Lactated Ringer's solution: 4 mL × kg body weight ×
% TBSA burned
• Day 1: Half to be given in first 8 h; half to be given

over next 16 h
• Day 2: Varies. Colloid is added

Cont…
• All third-degree burns require medical treatment.
• Never apply adhesive dressings or any lotions,

ointments, or creams to a first or second degree burn
that you are treating at home unless the skin is
broken.

Cont…
• For any broken blisters, wash carefully with
antibacterial soap and tepid water, apply antibiotic
ointment, and re-bandage.
• For all children, as well as any of the following,

need to be seen by a doctor:
• Third-degree burn, Second-degree burns larger than

an area the size of the palm of your hand.
Cont…
• First-degree burns larger than a five-palm-sized area
• Burns that extend all the way around an arm or leg
• Any “mixed” pattern of varying degrees of burns
• Burns to the genital area, face, hands, or feet

Special point:-
• Never apply grease, oil, ointment, butter, or any
other substance to any burn. Be sure to remove any
clothing or jewelry from the burned area.
• If anything is stuck to the burn, leave it for

medical professionals to remove.
• Immerse the burned area in cool (not ice) water to

stop the heat damage to tissues near the burn.
First aid measures for FTB:-
• Do not immerse an extensive burned area or apply ice
water over it, because cold may intensify the shock
reaction.
• Cover burns with thick, sterile dressings or a freshly
ironed or laundered sheet or other household linen.
• Do not remove adhered particles of charred clothing.

Extent and location of Burn
• The other methods of classifying burn are based on
extents of TBSA.
• Various methods are used to estimate the total body
surface area affected by burns; among them are the
rule of nine , Lund and Browder methods and palm
methods. compiled by Yegoraw G. ( Bsc N) 47

Burn size
• The size of a burn is determined by one of
the following techniques
– The rule of nines
– The Lund and Browder method
– The palm methods.
 Rule of nines is quick assessment tool for

estimating burn size
Cont…
• The basis of this rule is that the body is divided into
anatomical sections each of which represent 9% or
a multiple of 9 % of TBSA.
• The Lund and Browder method modifies the
percentages for body segments according to age and
provides a more accurate estimate of burn size.
• It uses a diagram of body divided into sections with
representative percentage of to TBSA.
Cont…
• The palm method is used with scattered burns, a
method to estimate the percentage of burn is the
palm method.
• The size of the patient’s palm is approximately 1%
of TBSA.
Estimation of body surface area for
Adults
Body regions ( adults) Accounting percent
Head and neck 9%

Anterior trunk 18 %
Posterior trunk 18 %
Arms 9 % (X 2 = 18 %)
Legs 18 % (X 2 = 36 %)
Genital area compiled by Yegoraw G. ( Bsc N) 1% 51
Estimation of body surface area for Infants and children
Body region ( infant ) Accounting percent
Head and neck 18 %

Anterior trunk 18 %
Posterior trunk 18 %
Arm 9 % (X 2 = 18 %)
Leg 13.5 % (X 2 = 27 %)
Genital area compiled by Yegoraw G. ( Bsc N)

1% 52
Cont….
All burns of children, as well as any of the following, need
to be seen by a doctor:
• Third-degree burns, Second-degree burns larger than an

area the size of the palm of your hand,
• First-degree burns larger than a five-palm-sized area
• Burns that extend all the way around an arm or leg
• Any “mixed” pattern of varying degrees of burns
• Burns to the genital area, face, hands, or feet

First Aid for Severe Burns
1. Extinguish the cause of the burn if you are able
to give a care. Make sure none of the
smoldering materials are in contact with the
injured person, but don’t remove any burnt
clothing.
2. Check for ABCs as we learn earlier, clear the

airway if necessary, and begin CPR.
Cont…
3. Cool the burned area with running water as outlined
for treatment of minor burns, being careful not to
overcool the injured person.
4. Wait for help to arrive, or if transporting the person
yourself, cover the burned area with a dry, sterile
bandage or a clean non fibrous cloth such as a sheet,
not a blanket or towel, as fibers may stick to injured
tissues.
5. Don’t apply ointments, creams, or lotions, and
don’t break any blisters.
Treating Minor Burns
NB:- Second-degree burns that are two inches or
larger in diameter and all third-degree burns
require emergency medical assistance.
• Minor burns, or first-degree burns, and small second
degree burns can be treated properly at home with
the following steps:-

Cont…
• All burn patients after 24-48 hrs should start on

oral hyper-alimentation.
• Many formulae are available for protein and caloric

requirement of the patients.

CLASSIFICATION OF BURN based on
SEVERITY
• The severity of a burn injury can be determined with;
– Burn depth
– Burn size ( percentage of TBSA)
– Burn location
– Age
– General health
– Mechanism of injury
Different types of burn based on causes:-
1. Chemical burns
• Chemical burns require immediate care since the
longer the chemical in contact with the body the
greater the potential for injury.
Management of chemical burn
• Protect your self from being involved in the accident
• Wear gloves and eye protection or fluid proof
dressings. compiled by Yegoraw G. ( Bsc N) 61
Cont..
• Dry chemicals: brush before gone to any other
procedure ,then flush with tepid water.
• flush with copious amount of fluid at least for 20

minutes.
• Minimize further body contamination by making

sure that fluid runs away from the injury and not
toward uninjured part.
2. Electric burns
• Electric burns cause severe damage to the whole
body.
• Electric injury will always seek to flow to the
ground, as the energy enters the body it will seek the
path of least resistance to exit the body.

Cont…
• All tissues between the entrance and the exit will
potentially be injured due to the extreme heat
generated by the resistance of the body to the
electricity.
• The heart produces its own electrical energy from

chemical reactions and it may disturb the function of
the heart and result in arrhythmia or cardiac arrest.

Cont…

Management of Electric burns
• Never attempt to remove the patient from the electric
source.
• Try to shut down or off the electric power from its main
source.
• Never touch a patient that is in touch with the electric
source.
• Provide oxygen
• Monitor the victim for cardiac arrest, prepare to
administer CPR.
Cont…
• Assess for the entrance and the exit
• All tissues in between should be assessed for

possible injury
• Refer the victim as soon as possible, though there

may not be any visible signs of severe injury.
• Electric burns have a slow onset and gradual organ

damage.
3. Inhalation injuries
• These indicate the involvement of the respiratory
system. It may be noticed by;
• Facial burns and Singed nasal hair
• Presence of actual burns of the oral mucosa,
Difficulty in swallowing
• A sooty or smoky smell on breath
• Respiratory distress, restriction of chest wall
movement, chest tightness, strider, wheezing,
hoarseness, coughing, cyanosis

General Management of heat Burn
• Remove the patient from the source of the burn
• Stop burning process, remove burnt clothes and
flush with tepid water
• Establish and maintain an open air way
• If breathing is inadequate provide artificial breathing
support or oxygen therapy.

Cont…
• Estimate the involved body surface area, using the
rule of nine
• Determine the depth of the burn, superficial, partial,
or full thickness
• Apply sterile dressings and bandages or burn sheet
• Maintain body temperature
• Do not use oils to stop burning process as oil has a
capacity to hold heat
• Do not use ice water to stop burn process as it may
result in hypothermia.
• Manage other associated injuries
Effect of burn on different systems of the
body
1. Circulatory system
• Burn injury causes extreme fluid loss and it results
over load to the heart
• Burns increase the capillary permeability or the
ability of fluid to exit the vessels.
• Fluid will also leak from the damaged tissues to
areas in between the cells and it causes oedema or
swelling, which will be double in the next 24 hours.
• All these fluid loss will result in shock, hypo
perfussion.
2. Respiratory system
• Swelling on the face or the neck due to burn on the
areas may cause air way closure.
• Inhalation of over heated air may also cause

laryngeal swelling .
• Smoke inhalation may cause toxic gas poisonings.
• Circumferential burn to the chest restricts breathing

movement.
3. Renal system
• The decreased blood flow due to the lost fluid will
result in decreased blood flow to the kidneys; this result
in decreased kidney out put may result in pre-renal
failure.
• The cell distruction resulted from the burn injury will
form many wastes in the blood, the kidneys are
responsible to filter this blood , Filtering such blood
results in blockage of the kidney or may result in
intrinsic renal failure.
4. Nervous system
• Burns may cause nerve damages and will result in
loss of functioning to the injured area, long term
muscle wasting, joint dysfunction because of
scaring.
• Such patients, who are in crisis, need not only

medical care but also psychological help.

5. Gastrointestinal system
• As there is low amount of blood the blood will re-
routed from this system to other parts of the body.
• The long term exposure to such stress result in

development of ulcer called curling ulcer.
• Hence the gastrointestinal system should also be

considered in the treatment of burn by providing
antacids.
Complications of burn
1. Loss of great amount of fluid leads to shock and renal
failure
2. Infection
3. Development of tetanus
4. Contractures and deformities
5. Asphyxia in case of inhalation injury
6. Coexisting injuries, fractures, amputation
7. Development of stress ulcer ( Curling Ulcer)
Cont..

THANK YOU !!!

Quiz 2
1. Write the classification of burn based on causes?
2. How can you determine the extent of total body

surface area of the burned area?
3. how can we differentiate 1st degree burn from 2nd

degree burn?
4. Which assessment tool for estimating burn size is

quickest ?

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UNIT NINE

• Define burn injury

• Identify the causes of burn injury

• Describe the different types of burn and degree of burn

• Describe the clinical signs and symptoms of burn injury.

• is an injury to the skin and deeper tissues of the body.

 Burns are caused by

• extreme heat (both wet and dry),

• Electricity and radiation,

compiled by Yegoraw G. ( Bsc N) 3

• Practically all burns are preventable if we take a care

• Burn injury can be classified based on causes, depth

compiled by Yegoraw G. ( Bsc N) 4

• Concentration of the agent

• Duration of contact with the agent

• Volume of the agent used

• Physical form of the chemical agent

• Involvement of the organs.

compiled by Yegoraw G. ( Bsc N) 5

• Electrical burn:- caused by the passage of electrical

• Chemical burn:- occurs when certain chemical

• Example; sulfuric acid, HCL and Gasoline.

1. 1st degree burn (superficial – partial thickness burn)

2. 2nd degree burn (deep partial thickness burn)

3. 3rd Degree burn (full-thickness burn)

compiled by Yegoraw G. ( Bsc N) 7

• It is caused by a flash of contact with hot

• A superficial burn heals rapidly and

Mild swelling and pain

- prevent complication and

-to prevent occurrence of shock, usually medical

• Apply cold running water or submerge the burned

compiled by Yegoraw G. ( Bsc N) 12

• Greater depth than first degree burn/dermis included

• Red or mottled appearance

• Considerable swelling over a period of several days and

compiled by Yegoraw G. ( Bsc N) 16

compiled by Yegoraw G. ( Bsc N) 17

• Intense pain , due to the involvement of the

• Considerable swelling for a longer time

• Do not break blisters or remove tissue

• Immerse the burned part in cold running water but

not ice cold water.

• Apply dry sterile gauze

• Do not break blisters or

compiled by Yegoraw G. ( Bsc N) 20

the layers of the skin.

• In third-degree burns, the skin may appear white,

black, and or leathery-looking and there may be very

little pain, although the areas surrounding the burn

might be extremely painful.

• Hot objects or liquids

compiled by Yegoraw G. ( Bsc N) 25

compiled by Yegoraw G. ( Bsc N) 26

 Second-degree burns are the most

• If any the four special area are burned, it is

compiled by Yegoraw G. ( Bsc N) 29

 Second-degree burn of <15% total body surface

 Third-degree burn of <2% TBSA not involving

compiled by Yegoraw G. ( Bsc N) 30

• Excludes all patients with electrical injury,

compiled by Yegoraw G. ( Bsc N) 31

• Third-degree burns of <10% TBSA not involving