Burns

Student: Manoliu C.C. Ana

Titu Maiorescu University, Faculty of Medicine, General Nursing, 1st

Year of Study
 Key facts

 An estimated 180 000 deaths every year are caused by burns – the
vast majority occur in low- and middle-income countries.

 Non-fatal burn injuries are a leading cause of morbidity.

 Burns occur mainly in the home and workplace.

 Burns are preventable.

 Summary

The burns are one of the most common causes of accidents and are
extremely serious medical, surgical, psychological and social circumstances,
with a vital and potentially invalid risk.
This trauma is a serious aggression of teguments, and depending on their
depth and extension can produce scarring and permanent sequelae and even
death. They can affect all age groups with different mechanisms and effects.
Prevention of burns and knowledge of first aid measures followed by
specialist treatment in a plastic surgery service are the most important ways
to improve vital prognosis, as well as aesthetic and functional outcomes.
 I. Definition

Burning is an injury to the skin or other organic tissues, mainly caused by heat
or radiation, radioactivity, electricity, friction or direct contact with chemicals.
Skin lesions due to ultraviolet radiation, radioactivity, electricity or chemicals,
as well as airway injuries resulting from smoke inhalation, are also considered
burns.
Burns are a special class of trauma in which the vulnerable agent (physical,
chemical, electrical or ionizing) can cause major damage by destroying the
epidermis and associated tissues, affecting organs and organ systems.
Burning is defined by medical practice, a multidisciplinary disease with a
tendency to continuous aggravation, which requires medical-surgical experience
and optimal quality in post-burn care.
 II. Etiology
A solid, liquid, or gaseous hot-flowing
agent acts on the skin directly or
indirectly by exposing it to a strong,
high-temperature heat source.
The depth of the lesion is most often
due to solid agents, and the extent
extended by the liquid ones.
Caloric flow and viscosity of liquid
agents are an important factor in
calculating the degree of skin damage.
The etiological classification of burns
can be divided into:
- hot liquid burns - 15%
- burns by flame-explosion - 75%
- electrocution burn (domestic or high
voltage) - 5%
- chemical burns - 5%
- burns by contact with hot surfaces - 5%
- burns by irradiation - <1%
 A burn is an injury to the skin or other organic tissue primarily caused by heat or due to:
– radiation
– radioactivity
– electricity
– frostbite
– chemicals
– friction

Thermal (heat) burns occur

when some or all of the cells in
the skin or other tissues are
destroyed by:
– hot liquids (scalds)
– hot solids (contact burns)
– flames (flame burns
 III. Burn size
Burn size determines fluid resuscitation needs
and the majority of decisions for hospital transfer.
Burn injury size is quantified as the percentage of
body surface area involved.
The Rule of Nines
- is a simple and commonly used method to
calculate burn size. It divides the body into
segments that are approximately 9% or multiples
of 9%, with the perineum forming the remaining
1%. Because of the proportionately larger heads
and smaller legs of infants and children, this
method must be modified in pediatric burn injury.
The Palmar Method
- is a second method assumes that the
area of the back of the patient’s hand is
approximately 1% of their total body
surface area. The number of “hands”
that equal the area of the burn can
approximate the percentage of body
surface area burned.
 A third and more precise method
uses the Lund-Browder burn diagram.
This allows an accurate age-adjusted
determination of burn size for a given
depth, allowing for the anatomical
differences of children.
IV. Clasification of burn injury,
according to burn depth
Superficial burns (epidermal,
gr. I)
- sunburn, short-term
exposure to liquids below
50°C, only damage to the
epidermis, red and slightly
edged skin, nausea and local
warmth, spontaneous healing
2-3 days has no definitive
consequences.
Superficial partial burns
(dermal surface, gr. II A)
- it cleanses the epidermis in
its entirety and in part dermis
and skin annexes, produces:
phlebitis, perilesional edema,
pink appearance, intense pain,
local inflammation and
abundant exudate,
spontaneous healing in 7-14
days, without definitive
scarring consequences.
Partial deep burns (Gr.II B)
- they damage the skin and
dermis completely, blister and
white or red wine eschar,
perilesional major edema,
moderate exudate, local
inflammation, intense pain,
hypoallergenic areas, thirst,
oliguria, possible spontaneous
healing in more than 14 days
with scar zones.
Burns in all dermal thickness (total,
subdermal, gr.III).
- it is the complete necrosis of the skin,
affecting in some cases the underlying
structures. All the epithelial elements
in the structure of the skin are
destroyed. Spontaneous re-epithelium
from the deep layers is not possible.
Clinical appearance: broken fingers,
white eschar, important perilesional
edema, reduced exudate volume,
marked impairment of the general
condition (even on small surfaces in
the child) very long or impossible
spontaneous healing, with significant
definitive scarring.
Risk factors for burn depth

Temperature
+
Duration
+ Burn depth
Skin thickness
+
Blood supply
 V. Specific areas of gravity
Specific areas of severity can influence the prognosis of a burned patient, by increasing the possibility of
death, and by substantially reducing recovery from an aesthetic point of view.

The face is an anatomical region that presents an increased risk by the association of airway burns, and by
the formation of massive edema due to a rich vascular network.
The airways can be affected by a burn, by inhaling carbon monoxide which can lead to intoxication or
asphyxia, and by damaging the upper and lower airways as a result of exposure to a thermal agent.
The hands and feet are two anatomical areas that can be easily recovered when the surface is small and
the depth of the burn is limited to the superficial part of the skin.
The perineum represents only 1% of the body surface, according to the "Wallace Rule" (Rule 9), but has
specific features in case of a burn, that involves affecting the kidney, digestive and reproductive system, by
forming edema in the sexual and evacuating organs, such as the urethra and anus.
Circular burns fit perfectly into their classification in specific areas of gravity because they require
hospitalization in a specialized center due to possible complications and surgical maneuvers that must be
applied at the right time.
 VI. Evolution and prognosis
Depends on several cumulative factors, which should never be ignored or
underestimated:

– Age of the patient

– Thermal agent and its temperature
– Duration of action
– Location of the burn
– Degree of depth
– Affected body surface area
– Associated trauma
– Pre-existing chronic pathologies
– The mental state of the patient
– Medical and surgical treatment
 VII. First aid
What to do
• Stop the burning process by removing
clothing and irrigating the burns.
• Extinguish flames by allowing the patient
to roll on the ground, or by applying a
blanket, or by using water or other fire-
extinguishing liquids.
• Use cool running water to reduce the
temperature of the burn.
• In chemical burns, remove or dilute the
chemical agent by irrigating with large
volumes of water.
• Wrap the patient in a clean cloth or sheet
and transport to the nearest appropriate
facility for medical care.
What not to do
•Do not start first aid before ensuring your own safety
(switch off electrical current, wear gloves for
chemicals etc.)
•Do not apply paste, oil, haldi (turmeric) or raw
cotton to the burn.
•Do not apply ice because it deepens the injury.
•Avoid prolonged cooling with water because it will
lead to hypothermia.
•Do not open blisters until topical antimicrobials can
be applied, such as by a health-care provider.
•Do not apply any material directly to the wound as it
might become infected.
•Avoid application of topical medication until the
patient has been placed under appropriate medical
care.
 Bibliography
 “EMERGENCY TREATMENT OF MINOR BURNS AT CHILDREN”, GEORGETA BURLACU, BOGDAN MIHAI OPRITA, SILVANA CERASELA STEFAN,
ELISABETA GABRIELA STANCIU, ANA MANOLIU, BOGDAN GABRIEL URSU, DAN MIRCEA ENESCU - DERMATOVENEROLOGIE – Journal of the
Romanian Society of Dermatology, Volume 63, Year 2018, No. 3, ISSN: 1220-3734
https://www.revistasrd.ro/includes/files/articles/EMERGENCY_TREATMENT_OF_MINOR_BURNS_en_346.pdf
 “Thermal Burns”, “Chemical Burns”, “Electrical and Lightning Injuries” - Tintinalli’s Emergency Medicine, A Comprehensive Study Guide, 9 th
Edition, 2019, ISBN: 978-1-26-001993-3
 Advanced Burn Life Support Course, PROVIDER MANUAL 2018 UPDATE, American Burn Association
http://ameriburn.org/wp-content/uploads/2019/08/2018-abls-providermanual.pdf
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 Catastrofe tehnologice, Manual de medicina de catastrofa, Henri Julien, Raed Arafat, Editura ART 2019, ISBN 978-606-710-653-4
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 Arsurile, Elemente Practice de Diagnostic si Tratament, Henry Brainerd, Sheldon Margen, Milton J.Chatton, Editura Medicala 1967
 Arsurile, Urgentele Medico Chirurgicale, Lucretia Titirca, Editura Medicala 2011, ISBN 973-39-0566-6
 Enescu Dan Mircea, Enescu Mihaela: Arsurile Copilului - Ed. MedicArt, 2003
 Burn Clinical Practice Guideline, Texas EMS Trauma & Acute , 2016
http://tetaf.org/wp-content/uploads/2016/01/Burn-Practice-Guideline.pdf
 Burns, World Health Organization
https://www.who.int/news-room/fact-sheets/detail/burns