Burns injuries

Major Types of Burns

I. Thermal burns
• Most common type
• Flames, scalds by hot water ,
or contact with hot substances
• Frostbite is a type of thermal
injury
II. Chemical burns
• Substances that produce
chemical changes in skin with
or without heat production
III. Electrical injuries
• Lightning injuries
• Direct contact with electrical
current

IV. Radiation Injury

• Ionizing and nonionizing
radiation
• Burns may result from high
level of radiation exposure to a
specific area
Effects of Burns on Body System

I. Circulatory System
• Burn injuries can cause extreme fluid loss and increased stress on
the heart. Burns increase capillary permeability, or the ability of fluid
to leak from the vessels, which decreases the fluid volume inside the
vessels. As fluid leaks from the damaged tissue cells to areas
between the cells, it causes edema “swelling”.
• A condition that can occur with moderate to major burns that cover
sufficient body surface area (BSA) is called burn shock. Burn shock,
which develops only after the first few hours, results from extensive
vascular bed damage that allows both fluid and protein molecules in
the plasma to leak into surrounding tissues
II. Respiratory System
Burns may affect the respiratory system in different ways.
• Swelling of the face or throat may cause airway obstruction
• Inhalation of superheated air may cause the lining of the larynx
to swell (laryngeal edema) and may cause fluid to accumulate in
the lungs.
• Smoke and toxic gas inhalation may cause apneia or DOB
III.Renal System (Kidneys)
• The decrease in blood flow from fluid loss induced by burn will cause
decreased blood flow to the kidneys and a consequent decrease in
urinary output. Also, the burn injury will cause many wastes to form
in the blood because of cell destruction, such as myoglobin from
muscle destruction
IV.Nervous Systems
• Burn injuries can destroy nerve endings in the affected area and
cause loss of function to extremities or other body parts
Classifying Burns By Depth

SUPERFICIAL (FIRST DEGREE)

PARTIAL THICKNESS (SECOND
DEGREE)
FULL THICKNESS (THIRD DEGREE)
I. Superficial Burns “First-degree “

• It involves only the epidermis. Usually, it is caused by a flash (a

sudden occurrence of heat or flame lasting only a few seconds), hot
liquid, or the sun. The skin will appear pink to red and will be dry. In
some cases, there may be slight swelling, but there will be no blisters.
The skin will be soft and tender to the touch.
II. Partial-Thickness Burns” Second-degree”

• It involves epidermis and portions of the dermis. It occurs from

contact with fire (flame or flash), hot liquids or objects, or chemical
substances,
Partial-thickness burns are further classified as superficial partial-
thickness and deep partial-thickness burns
I. Superficial Partial-Thickness Burns
Thin walled blisters result from superficial dermal layer damage.
Skin is pink and moist. (The moisture is caused by small leaks in
the capillary beds caused by the burn.)
Skin is tender to touch
III. Deep Partial-Thickness Burns
Thick-walled blisters often rupture. (The severe blisters occurs
because the dermis is injured at a greater depth, and they tend to
rupture with any body motion or accidental friction because of their
large size.)
Skin is red and blanched white. (Deeper levels of the epidermis and
dermis are injured.)
The patient may feel pressure at the site. (Pain receptors in the
dermis may be damaged and less responsive in some situations)
III. Full-Thickness Burns” Third-degree burn”

 It involves all the layers of the skin. This type of burn results from
contact with extreme heat sources such as hot liquids or solids, flame,
chemicals, or electricity. The skin will become dry, hard, tough, and
leathery and may appear white and waxy to dark brown or black and
charred.
Determining the Severity of Burn Injuries
The most important factors to consider in determining burn severity are
• Depth of burn
• Location of burn
• Patient’s age
• Preexisting medical conditions
• Percentage of body surface area involved
 Based on your knowledge of life span
development, who would you suspect
Critical would have a deeper burn from the same
energy source, an 18-year-old or a 75-
Thinking year-old? Why?
Extent and Severity of Burn Injury
The most traditional method “Rule of
nines”
The rule of nines is a standardized way to
quickly determine the amount of skin
surface, or the body surface area (BSA)
percentage, of a burn.
 The rule of nines or any other type of body
surface area calculation is only applied to
partial-thickness or full-thickness burns. The
rule of nines or other BSA calculations are
not applied to superficial burns.
Emergency Medical Care
1. Remove the patient from the
source of the burn and stop the
burning process. Once the patient
has been removed from the source
of the burn, you can stop the burn
process by using water or saline
but do not keep it immersed. Dry
chemicals should be brushed away
before flushing with adequate
amounts of water. Remove any
smoldering clothing and any
jewelry. If any clothing remains
adhered to the patient, cut around
the area . Do not attempt to
remove the adhered portion.
2. Establish and maintain an airway, and
adequate breathing and oxygenation. Pay
particular attention to evidence of inhalation
injury to the patient’s upper airway.
Maintain an open airway and administer
oxy-gen via NRM at 15 lpm
3. Cover the burned area with a dry sterile
dressing. Consider utilizing burn sheet to
prevent infection
4. Keep the patient warm
 Critical Why should you perform frequent reassessments of
the airway of a patient who has a large burn when
Thinking your initial assessment reveals that the airway is
patent?
Fluid Resuscitation

• Administration of large amounts of IV fluids is needed in first day post burn to

prevent a patient from going into hypovolemic shock. Excessive fluid administration
is harmful. Therefore, although large fluid requirements are needed to treat burn
shock, too much fluid will complicate the patient's management and even worsen
the patient's wounds. The resuscitation of a patient with a burn injury is aimed to
restore the loss of intravascular volume
lactated Ringer's solution, is the best way initially to manage a burn patient.
• There are several formulas that guide fluid resuscitation in the burn patient. The
most notable is the Parkland formula, which delivers 4 ml x body weight in kg x
percentage of area burned. Half of this fluid needs to be administered within the first
8 hours of injury, and the remaining half of the volume from hours 8 to 24.
24-hour fluid total = 4 ml/kg x weight in kg x % TBSA burned
consider an 80-kg (176-pound) man who has sustained third-degree burns to
30 percent of his TBSA and who is managed on scene shortly after the injury.
The fluid resuscitation volume would be calculated as follows
24-hour fluid total = 4 ml/kg x weight in kg x % TBSA burned = 4 ml/kg x 80
kg x 30% TBSA burned = 9,600 ml
Amount of fluid to be given from time of injury to first 8 hours = 9,600 ml/2
= 4,800 ml

The fluid requirement for the next period (16 hours ) is calculated as follows:
Amount of fluid to be given from hours 8 to 24 = 9,600 ml/2 = 4,800 ml
In dressing a burn, follow these guidelines:

Avoid Apply Break or drain

Avoid using any Never apply any type Never break or drain
material that tears or of ointments, lotions, blisters. This may
leaves particles as this or antiseptics to burn cause further
may contaminate the injuries. This may contamination and
burn. cause heat retention potential for fluid loss.
and hospital personnel
would most likely have
to vigorously cleanse
the area of any debris
material.
For Burns of the Eyes

 Do not attempt to open eyelids if

they are burned. Determine if the
burn is thermal or chemical. If
thermal, apply a dry, sterile dressing
to Both eyes to prevent
simultaneous movement of both
eyes .

 Chemical burns should be flushed

strongly with water while en route to
the hospital. Flush the eye from the
medial to the lateral side to avoid
washing the chemical into the
opposite eye.
Chemical Burn

1.Dry chemicals (e.g., dry lime) should be brushed off before

flushing with water
2.Most chemical burns can be flushed with copious amounts of
water . Always ensure that the chemical is one that may be
diluted with water. (Consult a hazardous materials guidebook.)
Some chemicals may produce combustion when they come into
contact with water. Minimize further wound contamination by
making sure fluid runs away from the injury and not toward any
uninjured areas. Remove all clothing and jewelry as in other burn
injuries. Continue to flush while enroute to the hospital.
Emergency Care Protocol

1. Remove the patient from the source of burn and stop the burning process.
2. Establish manual in-line stabilization if spinal injury is suspected.
3. Establish and maintain an open airway; insert a NPA or OPA if the patient is unresponsive
and has no gag or cough reflex.
4. Suction secretions as necessary.
5. If breathing is inadequate, provide positive pressure ventilation with supplemental oxygen at
a minimum rate of 10–12 ventilations/minute for an adult and 12–20 ventilations/minute for
an infant or child
6. If breathing is adequate, administer oxygen by NRM at 15 lpm if inhalation of a toxic gas or
upper airway burn is suspected. If the burn is isolated to an area of the body and does not
involve the face or a possible inhalation injury or toxic exposure, base your oxygen
administration on the SpO2 reading and signs of hypoxia. Administer oxygen to maintain the
SpO2 at 95% or greater
7. Estimate body surface area burn (percent BSA) by using the rule of nines.
8. Determine depth of burn: superficial, partial thick- ness, or full thickness.
9. Apply sterile dressings and bandages or a burn sheet.
10. If the burn is less than 10 percent BSA, dress wet per protocol. Dress all other burns dry.
11. Maintain body temperature.
12. Manage other associated injuries as appropriate.
13. If spinal injury is suspected, immobilize the patient to a backboard.
14. Manage specific burns as follows:
Dry chemical burn:
 Remove affected clothing, brush off dry chemical, then irrigate with large amounts of water.
 Liquid chemical burn:Remove affected clothing; irrigate with large amounts of water if the chemical is one that
does not react to water.
Burns to the hands and feet:
 Remove all rings and jewelry; dress between digits.
Chemical burns to the eyes:
 Flush with large amounts of water and continue to flush en route.
Thermal burns to the eyes:
 Do not attempt to open eyelids; apply dry, sterile dressing to both eyes.
Electrical burns:
Carefully monitor pulse and respiration; inspect for entrance and exit wounds; assess for muscle tender- ness;
apply AED if patient is in cardiac arrest.

15. Transport.
16. Perform a reassessment every 5 minutes if unstable and every 15 minutes if stable.