BURNS AND SCALDS

OVERVIEW OF STRUCTURE OF
THE SKIN
• One of the largest organs
• Key role in protecting body from injury &
infection
• Role in maintaining constant body temperature
• Layers : epidermis- top most layer with dead
flatenned cells.
• dermis : lower layer with blood vessels ,
nerves, muscles, sweat glands, hair follicles
• Subcutaneous tissue
BURNS:
•Are the injuries that result from dry heat.
•Examples include fire, sun, electric current,
friction , lightening, chemicals
SCALDS:
•Are injuries caused by moist heat
•Examples include boiling water, steam, hot
liquids.
 CAUSES OF BURNS
Chemicals
Heat
Electricity
Friction
Radiation- sunburns
Extreme cold- frost bite
CLASSIFICATON OF BURNS

PARAMETERS USED :
•AREA OF BURN: Expressed as a
percentage. Rule of 9s, palmers method
•DEPTH OF BURN : Expressed in degrees
CLASSIFICATION OF BURNS

• 1st degree

• 2nd degree

• 3rd degree
CLASSIFICATION OF BURNS
 BURNS

• Superficial Burn (1st degree): involves

only the top layer of skin. Skin is red and
dry, and burn is very painful. Usually heal
in 5-6 days without scarring. : sunburns
 BURNS

• Partial-thickness burn (2nd degree):

Involves the top layers of skin. Skin is
red and has blisters that may open and
weep clear fluid. Painful and often swells.
Usually heals in 3-4 weeks. Scarring my
occur.
BURNS

• Full-thickness burn (3rd degree):

Destroys all skin layers and any or all
of the underlying structures- fat,
muscles, bones, and nerves. Burns
look brown or black with the tissues
underneath sometimes appearing
white.
SIGNS AND SYMPTOMS OF BURNS

• Pain
• redness and swelling of the area
• blisters
• grey, charred skin in severe burn.
• signs and symptoms of shock
• Difficulty breathing
AIMS
• To stop the burning and relieve pain
• To maintain an open airway
• To treat associated injuries
• To minimize the risk of infection
• To minimize the risk of shock
• To arrange urgent removal to hospital
• To gather information for the emergency
services
 CLOTHES ON FIRE
• Put out the flames by any means available

• Water readily puts off the flames and

cools the burnt area thus lessening the
damage. – flood the burn with plenty of
cold water.
• Do not allow the person to run around
• Hold a rug or a blanket in front of you
while approaching a person whose clothes
have caught fire.

• Lay him down quickly and wrap the piece

of cloth tightly
HOW TO RESCUE PERSON FROM SITE OF
FIRE

• Speed and clear thinking required.

• Remember that clean air is at ground level

so crawl along the floor to access the
casualty.
• Have a wet handkerchief around your face
as you rescue the victim.

• When there is a fire in a room which the

doors and the windows are closed, DO
NOT open them to let air in as this will
accelerate the fire.
 TREATMENT OF MINOR BURNS AND SCALDS
• Place injured part under slowly running cold
water or immerse in cold water for ten
minutes.
• Remove rings, watches, shoes, and
constricting clothing's before it starts to swell.
• Dress the area with clean , sterile material.
• Give plenty of fluids.
• Do not break blisters
 SERIOUS BURNS AND SCALDS
• Use cold water to cool burns
• Lay the casualty down and make them
comfortable.
• Gently remove any rings, watches,
constricting clothing’s.
• Cover the burnt area with a clean dressing
• If breathing and the heart has stopped :
resuscitate
• Transfer to hospital
• Observe for any difficulty in breathing-
possible inhaled fire
• Treat shock
• Monitor vital signs
BURNS TO THE AIRWAY

• Burns to the face, mouth & throat are very

serious because air passages rapidly
become swollen.
• Suspected if burns occur in a confined
space- possibly inhaled hot air/gases
• 10% addition to TBSA
SIGNS

• Soot around the nose or mouth

• Singeing of nasal hairs
• Redness, swelling or burning of the tongue
• Damaged skin around the mouth
• Hoarseness of the voice
• Breathing difficulty
AIMS
• To maintain an open airway
• To arrange urgent removal to hospital
• Call for help- 999
• Loosen clothing around the neck
• Offer small sips of cold water to reduce swelling
and pain
• Reassure- monitor V/S , level of response, pulse,
breathing
CHEMICAL BURNS
• SIGNS AND SYMPTOMS

• Stinging of the skin

• Skin may appear stained or reddened.

• Blistering and peeling may develop

 TREATMENT
• Flood the area with slowly running water
for ten minutes to prevent further damage
to the burnt tissue
• Remove the contaminated clothing
• Ventilate area to disperse fumes
• Wear protective gloves to prevent contact.
• Continue treatment for severe burns.
• Arrange for removal to hospital
 CHEMICAL BURNS TO THE EYE
• Corrosive chemicals easily enter the eye
and rapidly damage it causing scarring and
blindness.
• hold the affected side of the casualty’s
face under gently running cold water so
that water drains away from the face.
• Lightly dress the eye with a sterile eye pad.
• Transfer to hospital.
ELECTRICAL INJURIES

• Caused by contact with live wire

• Electric shock is produced when an electric
current passes through the human body
which is in contact with the earth. it passes
more quickly if the part is wet
• Electrocution can cause breathing and heart
beat to stop or entry/exit burns
SEVERITY

Severity of injury depends on

•the voltage- low (240v)/ high(440-1000v)
•Type of current- direct / alternating
•Path of the current- hand to hand, foot to
foot or hand to foot
• Injury may be mild or so severe as to cause
immediate death.

• In wet conditions, even a low voltage may

be dangerous.
 SIGNS AND SYMPTOMS
• Fatal paralysis of the heart .
• Sudden arrest of breathing
• Heart may continue to beat while
breathing has stopped.
• Cyanosis on the face.
• Superficial or deep burns – at entry and
exit points.
• Signs of shock
TREATMENT

• CAUTION: YOU CAN ALSO GET

ELECTROCUTED
• Switch off the current or cut off the current by
breaking the wire. do not use a scissor or a
knife.
• Before cutting of the current ensure that you
are standing on a dry piece of wooden board,
rubber soled shoes, rubber gloves
HIGH VOLTAGE
• The casualty may not be in actual contact
with the high tension wires.
• You should keep as far away as possible
from the wires. the casualty should be
dragged with a non conducting material such
as a walking stick, wood plank, dry rope.
• If not breathing no heart beat - CPR
ELECTRIC BURNS

• Occurs when electricity of sufficient high

voltage passes though the body
• Much damage at point of entry but only a
small burn at exit point
• Redness swelling, charring both at entry
and exit point
AIMS OF MANAGEMENT
• To stop the burning and relieve pain

• To maintain an open airway

• To treat associated injuries

• To minimize the risk of infections

• To minimize risk of shock

• To arrange urgent removal to hospital

• To gather information for the emergency

services
• Ensure safety for the casualty and yourself
• Treat shock
• Start resuscitation

• Place in recovery position

• Shift to hospital on a stretcher.

AFTER CARE- HOSPITAL CARE

• Aseptic techniques
• Saline dressing- OPEN AND CLOSED
• Fluid resuscitation: parklands formula - 4:2:1
• Maintain airway
• Antibiotic cream
• Monitor Vital signs
• Provide warmth- HEATERS
• Nutrition as tolerated
• Pain management
• Psychotherapy
• Monitor input and output
• Escharotomy for circumferential
burns
• Bed cradle use especially for open
wounds