BURNS

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.

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Some country data
 In India, over 1 000 000 people are moderately or severely
burnt every year.
 Nearly 173 000 Bangladeshi children are moderately or
severely burnt every year.
 In Bangladesh, Colombia, Egypt and Pakistan, 17% of
children with burns have a temporary disability and 18%
have a permanent disability.
 Burns are the second most common injury in rural Nepal,
accounting for 5% of disabilities.
 In 2008, over 410 000 burn injuries occurred in the United
States of America, with approximately 40 000 requiring
hospitalization.
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A burn can be defined as an injury to the skin or other
tissue as a result of heat, radiation, , electricity,
sunlight, friction, chemicals, or radioactivity.

 Burns can either be life-threatening or minor

medical issues.

 The most common burns are those caused by hot

liquid or steam, building fires, and flammable
liquids and gases.

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 Burns are defined by how deep they are and how
large an area they cover.
 A large burn injury is likely to include burned areas
of different depths.
 Deep burns heal more slowly, are more difficult to
treat, and are more prone to complications such as
infections and scarring.
 Very deep burns are the most life-threatening of
all and may require amputation.

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What Causes Burns?
Burns can be caused due to many things,
and some of them are:
 Fire
 Electrical current
 Sunlight or any other sources of UV
radiation, including tanning beds
 Hot metal
 Chemicals (drain cleaners, acids,
gasoline, and paint thinners)
 Radiation
 Hot steam or liquid 20XX 7
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Thermal Burns
This source is divided into two categories, dry
thermal and wet thermal injuries.
 Dry thermal will involve flames, very hot objects,
and radiant heat.
 Wet thermal will involve steam and hot liquids
(Steam has the capacity to carry 4000 times more
heat than dry air). Inhalation of hot smoke or
gases will cause the airways to swell and could
result in a compromised airway.

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Symptoms of Thermal Burns
The symptoms of thermal burns
include:
•Swelling
•Blisters
•Peeling skin
•Pain
•Skin that’s white, charred, or
red
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Chemical Burns
 The source for this category is all
chemicals both wet and dry, alkalis and
hydrocarbons and phenols (industrial
cleaners, solvents, degreasing agents,
petrol).
 Chemical burns are not usually thermic,
but are caused by tissue reaction to
noxious substances, the amount of tissue
damage will depend on the chemical and
exposure time.
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 Full irrigation of all liquid chemical burn sites
must take place prior to cooling, large amounts
of flowing water will be required to wash away
and break down the liquid chemical or
chemicals in question.
It is worth considering using warm water for
irrigation as this will help to protect the core
temperature of the patient.
If possible, remove all saturated clothing,
footwear, watches and jewellery from the
patient 20XX 12
Some of the symptoms of chemical burns:
•Pain
•Redness
•Swelling
•Discoloration of the skin
•Scabs or blisters
•Dry and cracked skin
•Chest pain
•Drooling
•Cough
•Shortness of breath
•Vomiting and nausea
•Blurry vision
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Mechanical Burns
 Mechanical burns are caused when a person’s
skin gets scraped off after coming in contact
with hard objects such as the floor or the
road. The combination of heat, blunt trauma,
and high speed makes mechanical burns
worse.
 As the abrasive surface meets the skin, it
results in blisters, burns, and deep wounds.
These are usually a combination of thermal
burns as well as abrasions.
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 The symptoms of mechanical burns are:
•The area appears red
•Swelling
•Itchy skin

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Electrical Burns
Patients in this category will usually have been in contact with one
of the following two sources of electricity: alternating current (AC)
or direct current (DC).
Electrical injuries can be classified into three groups: true electrical
injury, arc burn and electrical thermal burn.
 True electrical injury occurs when electricity passes through the
body after contact with an electrical conductor. This burn will
present the classic entry and exit wounds, along with deep tissue
destruction.
 With an arc burn, the victim is not in actual contact with
electricity. These injuries are most common with high tension
current. There may be an entry and exit wound. Usually there are
scattered spots of injury where the current made momentary
contact as it jumped to ground.
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  Cardiac complications should always be
considered when called to an electrical burn
injury, on arrival make sure that the power
supply is disconnected at the mains before
approaching the patient having ensured that
the scene is safe.

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 Symptoms of Electrical Burns
•Tingling sensations
•Weakness
•Headaches
•Lightheadedness
•Seizures
•Irregular heart rhythm
•Confusion

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Radiation Burns
 Radiation burns happen when someone is
exposed to the sun’s UV rays for a long period
of time or due to other radiation sources.
 It can also occur due to the radiation therapy
that cancer patients go through.

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Symptoms of Radiation Burns
•Blisters
•Itchy skin
•Skin that is dry and peels
•White skin turning red and brown or black skin
getting darker
•Open sores
•Swelling

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Cold Burns
 Cold burns take place when a person is
exposed to ice for prolonged periods.
 These shouldn’t be confused with frostbite, as
those occur when an individual’s body
witnesses extremely low temperatures for long
periods.

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 Symptoms of Cold burns
The symptoms of cold burns are:
•Blisters
•Tingling
•Pain
•The affected area turning dark, grey, or
red

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Superficial Burns Superficial burns usually
Superficial burns are another name for heal in about a week, and
first-degree burns, and the symptoms the treatment for them may
under this category are as follows: include:
 Swelling •Over-the-counter pain
 Pain
medicines such as ibuprofen
 Redness •Ointments and lotions
 Soreness •Cold compresses
 Dry skin
 Healing 1 to 2 weeks
 Skin peeling
 Itching

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Partial Thickness Burns
 Superficial partial thickness burns involve the epidermis
and dermis, it will often be bright red, blistered and
painful. These burns can take up to 21 days to heal
usually with no scarring.
 Deep partial thickness burns will include all of the epi-
dermis, and deep into the dermis, the site of insult may
be dry or wet, and capillary refill will be reduced,
sensation to pressure remains intact, and the site is less
painful. These burns take a long time to heal and may
result in scarring if not excised and grafted.
 Healing 14-21 days

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Full Thickness Burns
These burns will involve all layers of the skin,
and possibly subcutaneous fat, muscle, and
bone. They may appear as charred, waxy,
mottled, leathery, pale and dry, and will be firm
to the touch. These burns are in a semi-
anaesthetized state and will not be sensitive to
pain and light touch, they will require advanced
medical intervention and hospitalization.

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 This includes understanding how much of your body has been affected by the
burn, and accordingly, they could classify the burn under one of the following
categories:
 Minor
Burns are first and second-degree burns that affect less
than 10% of the victim’s body and don’t always require
hospitalization.
 Moderate
When about 10% of the victim’s body is covered by second-
degree burns, it’s declared moderate.
 Severe
Severe burns are the ones that affect over 1% of the
victim’s body, as is the case with third-degree burns
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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. 20XX 30
 The methods for estimating TBSA are:
1. The Wallace Rule of Nines (Adults Only)
2. The Lund Browder (paediatrics and adults), or
this websites version: Paediatric
Burns Surface Area Assessment,
3. Palmar Method (Hand Surface)

 The Rule of Nines, also known as the Wallace Rule of

Nines, is a tool used by trauma and emergency medicine
providers to assess the total body surface area (TBSA)
involved in burn patients

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  For children and infants, the Lund-Browder chart is used to
assess the burned body surface area.
 Different percentages are used because the ratio of the
combined surface area of the head and neck to the surface
area of the limbs is typically larger in children than that of an
adult.

 The Lund and Browder (LB) chart is currently the most

accurate and widely used chart to calculate total body surface
area affected by a burn injury

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A burn involving half the
chest & 3/4 of the arm is
at approx 16%TBSA
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Terms of Use

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The "rule of palm" is another way to estimate the
size of a burn.
 The palm of the person who is burned (not fingers
or wrist area) is about 1% of the body.
 Use the person's palm to measure the body surface
area burned. It can be hard to estimate the size of
a burn

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Tips:
 With severe burn injuries (>50%TBSA) it maybe easier to
calculate what isn’t burnt then subtract it from 100 to get
%TBSA burns
 Use the Palmar method to calculate %TBSA for smaller
burns. Palmar method uses the size of the patients hand
(palm and fingers) to estimate burn size. Remember to
always use the patients hand, not the clinicians.

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 In the prehospital and emergency department setting, the
%TBSA burns is more important than the depth of burn. %TBSA
burns has indications for severity of injury, fluid resuscitation and
transfer destination. Depth of burn becomes more significant
after arrival at the Burn Service as depth of burn will determine
whether the burn can heal without surgical intervention, and
how the Burn Service will subsequently manage it.
 If %TBSA burn estimation is inaccurate it has the potential to
negatively impact fluid resuscitation by providing too much or
too little fluid. Always titrate fluid resuscitation volumes
according to resuscitation end points. Urine output is a simple
and easy method to assess perfusion

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 Exercises:

1. A 25 year old female patient

has sustained burns to the back of
the right arm, posterior trunk,
front of the left leg, anterior head
and neck, and perineum. Using
the Rule of Nines, calculate the
total body surface area
percentage that is burned?

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2. A 68 year old male patient
has partial thickness burns to
the front and back of the right
and left leg, front of right arm,
and anterior trunk. Using the
Rule of Nines, calculate the total
body surface area percentage
that is burned?*

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3. A 35 year old male
patient has full thickness
burns to the anterior and
posterior head and neck,
front of left leg, and
perineum. Using the
Rule of Nines, calculate
the total body surface
area percentage that is
burned?
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agenda

INTRODUCTION
3

PRIMARY GOALS
4

AREAS OF GROWTH
5

TIMELINE
10

SUMMARY
primary goals
areas of growth
B2B SUPPLY CHAIN ROI E-COMMERCE

Q1 4.5 2.3 1.7 5.0

Q2 3.2 5.1 4.4 3.0

Q3 2.1 1.7 2.5 2.8

Q4 4.5 2.2 1.7 7.0

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 RICHARD BRANSON

“Business opportunities are like buses.

There's always another one coming.”

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meet our team

TAKUMA HAYASHI MIRJAM NILSSON​ FLORA BERGGREN​ RAJESH SANTOSHI

president chief executive chief operations vp marketing
officer officer
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meet our extended team

TAKUMA HAYASHI MIRJAM NILSSON​ FLORA BERGGREN​ RAJESH SANTOSHI

president chief executive officer chief operations officer vp marketing

GRAHAM BARNES ROWAN MURPHY ELIZABETH MOORE ROBINE KLINE

vp product SEO strategist product designer content developer
plan for product launch
PLANNING synergize scalable e-commerce

MARKETING disseminate standardized metrics

DESIGN coordinate e-business applications

STRATEGY foster holistically superior methodologies

LAUNCH deploy strategic networks with compelling e-business needs

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timeline NOV 20XX
disseminate standardized
metrics

SEP 20XX
synergize scalable e-commerce

JAN 20XX
coordinate e-business
applications

MAR 20XX MAY 20XX

foster holistically superior deploy strategic networks with
methodologies compelling e-business needs
areas of focus
B2B MARKET SCENARIOS
 Develop winning strategies to keep
ahead of the competition
 Capitalize on low-hanging fruit to
identify a ballpark value
 Visualize customer
directed convergence​
presentation title
CLOUD-BASED OPPORTUNITIES
 Iterative approaches to corporate
strategy
 Establish a management
framework from the inside
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how we get there
ROI NICHE MARKETS SUPPLY CHAINS
o Envision multimedia- o Pursue scalable o Cultivate one-to-one
based expertise and customer service customer service with
cross-media growth through sustainable robust ideas
strategies strategies
o Maximize timely
o Visualize quality o Engage top-line web deliverables for real-
intellectual capital services with cutting- time schemas
edge deliverables
o Engage worldwide
methodologies with
web-enabled
technologies

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summary
At Contoso, we believe in giving 110%. By
using our next-generation data
architecture, we help organizations
virtually manage agile workflows. We
thrive because of our market knowledge
and great team behind our product. As our
CEO says, "Efficiencies will come from
proactively transforming how we do
business."​

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thank you
mirjam nilsson
mirjam@contoso.com
www.contoso.com