BURNS

Incidence and CausesIncidence and Causes 8,000-10,00 burns per year in the U.S.A. 8,000-10,00 burns per year in the U.S.A. 75-80% occur in homes 75-80% occur in homes Major causes: flames, scalds, heat, chemicals and electricity Major causes: flames, scalds, heat, chemicals and electricity Under age 6, major cause is scalding Under age 6, major cause is scalding 75% of burns could be avoided 75% of burns could be avoided

Emergent CareEmergent Care Burning process stopped with removal of Burning process stopped with removal of

clothing, jewellery and covering affected area clothing, jewellery and covering affected area with cool waterwith cool water

Increase blood volume with IV inserted in intact Increase blood volume with IV inserted in intact skin areaskin area

Urinary catheter to monitor fluid output, Urinary catheter to monitor fluid output, indicates dehydrationindicates dehydration

Intubation to secure an airwayIntubation to secure an airway Vitals; BP, HR, BPM, TempVitals; BP, HR, BPM, Temp Determining extent of damage; Determining extent of damage; Rule of Nines Rule of Nines or or

Lund -BrowderLund -Browder

Body surface affected (BSA) The Rule of NinesThe Rule of Nines Entire head = 9% Entire head = 9% Each arm = 9% (18%) Each arm = 9% (18%) Chest = 9% Chest = 9% Abdomen = 9% Abdomen = 9% Upper back = 9% Upper back = 9% Lower back = 9% Lower back = 9% Front of each leg = 9% (18%) Front of each leg = 9% (18%) Back of each leg = 9% (18%) Back of each leg = 9% (18%) Groin = 1%Groin = 1% Total 100%Total 100%

This along with the cause of This along with the cause of the burn helps determine the the burn helps determine the severity of the burnseverity of the burn

Lund-Browder

Accurate assessment of TBSAAccurate assessment of TBSA

Complications of Major BurnsComplications of Major Burns

Pulmonary injury; Stridor (whistling) with breathingPulmonary injury; Stridor (whistling) with breathing

Hypovolaemia; loss of plasma and decreased BPHypovolaemia; loss of plasma and decreased BP

Hypothermia; with skin gone there is no thermoregulationHypothermia; with skin gone there is no thermoregulation

Cardiac Arrhythmia; irregular heart beat. Cardiac Arrhythmia; irregular heart beat.

Kidney FailureKidney Failure

DeathDeath

When burns are critical

Any burn greater than 25% BSA Any burn greater than 25% BSA

Full or deep-partial-thickness burns greater than 10% BSAFull or deep-partial-thickness burns greater than 10% BSA Burns complicated by a respiratory or airway injury Burns complicated by a respiratory or airway injury

Most burns involving the face, hands, feet or genitals Most burns involving the face, hands, feet or genitals

Burns complicated by a fracture or major soft-tissue injury Burns complicated by a fracture or major soft-tissue injury

Electrical or deep-chemical burns Electrical or deep-chemical burns

Burns occurring in patients with serious pre-existing medical conditionsBurns occurring in patients with serious pre-existing medical conditions

Classification of Burns First degree or superficial burnsFirst degree or superficial burns

involve only the epidermis; involve only the epidermis; burned area is red; no blisters.burned area is red; no blisters.

Second degree or partial thickness burns Second degree or partial thickness burns involve all of epidermis & varying depths of the dermis. involve all of epidermis & varying depths of the dermis. Appearance -blisters, pink, moist, Extremely painful.Appearance -blisters, pink, moist, Extremely painful.

Third degree or full thickness burns Third degree or full thickness burns involve epidermis & entire dermis, possible deeper tissue such involve epidermis & entire dermis, possible deeper tissue such as muscle and bone. as muscle and bone. Appearance- white and dry. May be free of pain. Requires Appearance- white and dry. May be free of pain. Requires

skin grafting. skin grafting.

Burn types Thermal - Thermal - most common (Other than sunburn) most common (Other than sunburn)

direct flame, scalds and direct contact.direct flame, scalds and direct contact.

Chemical -Chemical - contact strong acids or alkalis. contact strong acids or alkalis. burning process continues as long as the chemical, or agent, is on the body. burning process continues as long as the chemical, or agent, is on the body. need to know the specific chemical because the treatment must be specificneed to know the specific chemical because the treatment must be specific

Electrical -Electrical - type I, II and III. type I, II and III. Type I - Type I - contact burn -contact burn - most common - true electricity injury. burn is most severe at the most common - true electricity injury. burn is most severe at the

entry and exit points. entry and exit points. Type II - Type II - flash burn - flash burn - victim becomes part of an electrical arc. victim becomes part of an electrical arc. Type III - Type III - flame flame burn - electricity ignites the victim's clothing. electricity ignites the victim's clothing.

SunburnSunburn. Radiation burns are by far the most common burns because of being exposed to . Radiation burns are by far the most common burns because of being exposed to an enormous nuclear reactor, the sun. an enormous nuclear reactor, the sun.

sunburns are almost always superficial. sunburns are almost always superficial. Don't underestimate the potential severity of sunburn. Using the Rule of Nines, it is not Don't underestimate the potential severity of sunburn. Using the Rule of Nines, it is not

uncommon for sunburn to reach the critical stage (burns greater than 25 percent BSA), uncommon for sunburn to reach the critical stage (burns greater than 25 percent BSA), Some patients require skin grafting after prolonged sun exposure. Some patients require skin grafting after prolonged sun exposure.

Burn treatment 1.stop the burning1.stop the burning 2. evaluate the injury2. evaluate the injury 3. relieve pain 3. relieve pain 4. prevent shock 4. prevent shock 5. infection. 5. infection. Even though the fire is out, the burning can continue.Even though the fire is out, the burning can continue. Remove all burned clothingRemove all burned clothing flush the skin with cool water. flush the skin with cool water.

Flushing is crucial to a chemical burn, particularly alkalis which must be flushed for 1 to 2 hoursFlushing is crucial to a chemical burn, particularly alkalis which must be flushed for 1 to 2 hours Burned skin loses heat more rapidly than intact skin and cool water can cause hypothermia if a Burned skin loses heat more rapidly than intact skin and cool water can cause hypothermia if a

large BSA has been burned.large BSA has been burned. Pay particular attention to the airway. An airway problem may not be immediately apparent. Pay particular attention to the airway. An airway problem may not be immediately apparent.

If the patient has airway involvement or any respiratory difficulty, advanced rapid treatment is If the patient has airway involvement or any respiratory difficulty, advanced rapid treatment is required.required.

Superficial burns are easily managed with cool compresses and acetaminophen for the pain. Superficial burns are easily managed with cool compresses and acetaminophen for the pain. An extensive superficial burn will demand a slightly stronger analgesic and should be accompanied by an An extensive superficial burn will demand a slightly stronger analgesic and should be accompanied by an

increase in fluid intake by the patient. increase in fluid intake by the patient. basic systemic pain control along with fluid intake is the best approach.basic systemic pain control along with fluid intake is the best approach. treatment of partial-thickness burns follows the same approach of cooling the area and covering the burn treatment of partial-thickness burns follows the same approach of cooling the area and covering the burn

with a sterile dressing. with a sterile dressing. Do not break the blisters; they are actually the best burn dressing available. If the blisters rupture later, Do not break the blisters; they are actually the best burn dressing available. If the blisters rupture later,

apply Silvadene as an antibiotic ointment and cover with dry, sterile dressing. apply Silvadene as an antibiotic ointment and cover with dry, sterile dressing. Fluid loss can be an early complication and is most common with partial-thickness and deeper burns.Fluid loss can be an early complication and is most common with partial-thickness and deeper burns. Depending on the extent of BSA involved, a fluid loss can rapidly lead to shock.Depending on the extent of BSA involved, a fluid loss can rapidly lead to shock. If the BSA is greater than 15 percent, fluid replacement is required. This is best managed with I-V fluidsIf the BSA is greater than 15 percent, fluid replacement is required. This is best managed with I-V fluids

1 week after

3 weeks later

16 weeks later