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BURNHardik Maini
Pharm.D
Chitkara university
Burn is defined as a
wound caused by an
exogenous agent
leading to coagulated
necrosis of the tissue.
THERMAL BURNS
CHEMICAL BURNS
ELECTRICAL
BURNS
COLD BURNS
RADIATIONS
THERM
AL
BURNS
Scald burn
 Most frequent in home
injuries like hot water ,
liquids and food are most
common cause.
Temperature above than
136F causes burn.
Temperature less than 111F
tolerated for long periods
CHEMIC
AL
BURN
 Common in industries
and factories but can
occur at homes also.
Caused by concentrated
acids or alkalis.
Acids are more common
than alkali.
ELECTRIC
AL BURNWorse than other types
of burn with entry and
exit wounds.
May stop the heart and
depress the respiratory
system.
May cause thrombosis
and cataracts.
RADIATI
ON
BURNSCause due to radiations
Radioactive explosions.
X-Rays.
Nuclear bomb
explosions.
PPHYSIOLO
GY
OF BURNS
FLUID SHIFT
Period of inflammatory response.
Vessels adjacent to burn injury dilates 
inc. hydrostatic pressure and inc.
capillary permeability.
Continuous leak of plasma from
intravascular space to interstitial space.
Associated imbalances of fluids,
electrolytes and acid-base occur.
Hemoconcentration
Lasts 24-36 hours.
PPHYSIOLO
GY
OF BURNS
FLUID REMOBILIZATION
Capillary leak ceases and fluid shifts
back into the circulation.
Restores renal perfusion and fluid
balance.
Increase urine formation and diuresis.
Continued electrolyte imbalances.
Hyponatremia
Hypokalemia
hemodilution
BODYS
RESPON
SE TO
BURN.
Emergent phase (STAGE 1)
Pain response
Catecholamine response
Tachycardia ,tachypnea ,
mild hypertension , mild
anxiety
BODYS
RESPON
SE TO
BURN.
FLUID SHIFT PHASE (STAGE
2)
Length 18-24 hours.
Begins after emergent phase
Reaches peak level in 6-8 hours.
Damaged cells initiate
inflammatory response.
Increased blood flow to cells
Shift of fluid from
intravascularto extravascular
space
BODYS
RESPON
SE TO
BURN.
HYPERMETABOLIC PHASE (
STAGE 3)
Last for days to weeks
Large increase in bodys need for
nutrients as it repairs itself
RESOLUTION PHASE (STAGE
4)
Scar formation
General rehabilitation and
progression to normal function.
CLASSIFICA
TION OF
BURNSFIRST DEGREE
SUPERFICIAL SECOND
DEGREE
DEEP SECOND DEGREE
THIRD DEGREE
FOURTH DEGREE
1ST
DEGREE
BURN
Reddened skin
Pain at burn site
Involves only epidermis
Blanch to touch
Have an intact epidermal
barrier
Do not result in scaring
EG: sunburn , minor accident
Treatment with topical
soothing agents or NSAIDS
2ND
DEGREE
BURNS
Intense skin
White to red skin
Blisters
Involves dermis and papillary layers of
dermis
Spares hair follicles , sweat glands etc.
Erythematous and blanch to touch.
Very painful/sensitive.
No or minimal scarring
Spontaneously re-epithelize from
retained epidermal structures in 7-14
days.
SECOND
DEGREE
BURN
Injury to deeper layers of
dermis-reticular dermis
Appear pale and mottled
Do not blanch to touch
Capillary return sluggish or
absent.
Take 13 to 45 days to heal
Requires excision or skin
grafting.
3RD
DEGREE
BURN
Dry, leathery skin (white ,
dark , brown or charred)
Loss of sensation (little
pain)
All dermal layers/tissues
may be involved.
Always require surgery.
4TH
DEGREE
BURN
Involves structure
beneath the skin-
muscle , bone
ASSESEM
ENT OF
BURNS
RULE OF NINES
Best used for large surface areas
Expedient tool to measure extent
of burn
 RULE OF PALMS
Best used for burns <10 % BSA
MANAGEM
ENTPRE HOSPITAL CARE
Ensure rescuer safety
Stop the burning process :
stop , drop and fall.
Check for other injuries
A standard ABC (AIRWAY ,
BREATHING ,
CIRCULATION) check
followed by a rapid secondary
survey.
MANAGEM
ENT
Cool the burnt wound
Give oxygen
Elevate
Give analgesic
HOSPIT
AL
CARE
A : Airway control
B : Breathing and ventilation
C : Circulation
D : Disability  neurological
status
E : exposure with environmental
control
F : fluid resuscitation
AIRW
AYRECOGNISATION OF THE
POTENTIALLY BURNED AIRWAY
A history of being trapped in the
presence of smoke and hot gases .
Burns on the palate or nasal
mucosa ,or loss of all the hairs.
In the nose: Deep burns around
the mouth and neck.
AIRW
AYBurned airway
Early elective intubation is
safest.
Delay can make intubation very
difficult because of swelling.
Be ready to perform an
emergency cricothyroidotomy if
intubation is delayed.
BREATHI
NGInhalation injury
Thermal burn injury to
the lower airway.
Metabolic
pathway:carboxy
hemoglobin
Mechanical block to
breathing: escharotomy
CIRCULATI
ONMaintain iv line with
wide bore cannula
peripherally.
One central line.
Escharotomy of limbs if
circulatory compromise
in circumferential
burns.
FLUIDS
FOR
RESUSCITAT
ION
In children with burns over
10% TBSA and adults with
burns over 15%TBSA , consider
the needs for iv fluid
resuscitation.
If oral fluids are to be used ,
salt must be added.
Fluids needed can be calculated
from a standard formula.
The key is to monitor unit
output.
FLUIDS
FOR
RESUSCITAT
ION
PARKLAND FORMULA
% TBSA Weight (KG)4 = Volume
(ml)
Half this volume is given in first eight
hours.
Second half is given in the
subsequent 16 hours.
Crystalloid : ringer lactate
Hypertonic saline
Human albumin solution
Colloid resuscitation
NUTRITI
ONBurnt patient need
extra feeding
A nasogastric tube
should be used in all
patients with burn over
15% of TBSA
Removing the burn and
achieving healing stops
the catabolic drive.
NUTRITI
ONSUTHERAND FORMULA
Children : 60 kcal/kg +35
%kcal TBSA
Adults : 20 kcal/kg +70
%kcal TBSA
PROTEIN
20% of energy
1.5 to 2 g/kg protein/day
MONITORING
AND
CONTROL OF
INFECTION
Burn patients are
immunocompromised.
They are susceptible to infections
through many routes.
Sterile precautions should be
taken.
Swabs should be used regularly.
A rise in WBC count
,thrombocytosis, and increase
catabolism are warnings of
infections.
TOPICAL
TREATMEN
T OF DEEP
BURNS
1% silver sulphadiazine
cream.
0.5% silver nitrate
solution.
Mafenide acetate cream.
Serum nitrate, silver
sulphadiazine and cerium
nitrate.
PRINCIPLES
OF
DRESSINGS
FOR BURNS
Full  thickness and deep
dermal burns need
antibacterial dressings to
delay colonization prior to
surgery.
Superficial burns will heal
and require simple dressings.
An optimal healing
environment can make a
difference to outcome in
borderline depth burns.
Burn

More Related Content

Burn

  • 2. Burn is defined as a wound caused by an exogenous agent leading to coagulated necrosis of the tissue.
  • 4. THERM AL BURNS Scald burn Most frequent in home injuries like hot water , liquids and food are most common cause. Temperature above than 136F causes burn. Temperature less than 111F tolerated for long periods
  • 5. CHEMIC AL BURN Common in industries and factories but can occur at homes also. Caused by concentrated acids or alkalis. Acids are more common than alkali.
  • 6. ELECTRIC AL BURNWorse than other types of burn with entry and exit wounds. May stop the heart and depress the respiratory system. May cause thrombosis and cataracts.
  • 7. RADIATI ON BURNSCause due to radiations Radioactive explosions. X-Rays. Nuclear bomb explosions.
  • 8. PPHYSIOLO GY OF BURNS FLUID SHIFT Period of inflammatory response. Vessels adjacent to burn injury dilates inc. hydrostatic pressure and inc. capillary permeability. Continuous leak of plasma from intravascular space to interstitial space. Associated imbalances of fluids, electrolytes and acid-base occur. Hemoconcentration Lasts 24-36 hours.
  • 9. PPHYSIOLO GY OF BURNS FLUID REMOBILIZATION Capillary leak ceases and fluid shifts back into the circulation. Restores renal perfusion and fluid balance. Increase urine formation and diuresis. Continued electrolyte imbalances. Hyponatremia Hypokalemia hemodilution
  • 10. BODYS RESPON SE TO BURN. Emergent phase (STAGE 1) Pain response Catecholamine response Tachycardia ,tachypnea , mild hypertension , mild anxiety
  • 11. BODYS RESPON SE TO BURN. FLUID SHIFT PHASE (STAGE 2) Length 18-24 hours. Begins after emergent phase Reaches peak level in 6-8 hours. Damaged cells initiate inflammatory response. Increased blood flow to cells Shift of fluid from intravascularto extravascular space
  • 12. BODYS RESPON SE TO BURN. HYPERMETABOLIC PHASE ( STAGE 3) Last for days to weeks Large increase in bodys need for nutrients as it repairs itself RESOLUTION PHASE (STAGE 4) Scar formation General rehabilitation and progression to normal function.
  • 13. CLASSIFICA TION OF BURNSFIRST DEGREE SUPERFICIAL SECOND DEGREE DEEP SECOND DEGREE THIRD DEGREE FOURTH DEGREE
  • 14. 1ST DEGREE BURN Reddened skin Pain at burn site Involves only epidermis Blanch to touch Have an intact epidermal barrier Do not result in scaring EG: sunburn , minor accident Treatment with topical soothing agents or NSAIDS
  • 15. 2ND DEGREE BURNS Intense skin White to red skin Blisters Involves dermis and papillary layers of dermis Spares hair follicles , sweat glands etc. Erythematous and blanch to touch. Very painful/sensitive. No or minimal scarring Spontaneously re-epithelize from retained epidermal structures in 7-14 days.
  • 16. SECOND DEGREE BURN Injury to deeper layers of dermis-reticular dermis Appear pale and mottled Do not blanch to touch Capillary return sluggish or absent. Take 13 to 45 days to heal Requires excision or skin grafting.
  • 17. 3RD DEGREE BURN Dry, leathery skin (white , dark , brown or charred) Loss of sensation (little pain) All dermal layers/tissues may be involved. Always require surgery.
  • 19. ASSESEM ENT OF BURNS RULE OF NINES Best used for large surface areas Expedient tool to measure extent of burn RULE OF PALMS Best used for burns <10 % BSA
  • 20. MANAGEM ENTPRE HOSPITAL CARE Ensure rescuer safety Stop the burning process : stop , drop and fall. Check for other injuries A standard ABC (AIRWAY , BREATHING , CIRCULATION) check followed by a rapid secondary survey.
  • 21. MANAGEM ENT Cool the burnt wound Give oxygen Elevate Give analgesic
  • 22. HOSPIT AL CARE A : Airway control B : Breathing and ventilation C : Circulation D : Disability neurological status E : exposure with environmental control F : fluid resuscitation
  • 23. AIRW AYRECOGNISATION OF THE POTENTIALLY BURNED AIRWAY A history of being trapped in the presence of smoke and hot gases . Burns on the palate or nasal mucosa ,or loss of all the hairs. In the nose: Deep burns around the mouth and neck.
  • 24. AIRW AYBurned airway Early elective intubation is safest. Delay can make intubation very difficult because of swelling. Be ready to perform an emergency cricothyroidotomy if intubation is delayed.
  • 25. BREATHI NGInhalation injury Thermal burn injury to the lower airway. Metabolic pathway:carboxy hemoglobin Mechanical block to breathing: escharotomy
  • 26. CIRCULATI ONMaintain iv line with wide bore cannula peripherally. One central line. Escharotomy of limbs if circulatory compromise in circumferential burns.
  • 27. FLUIDS FOR RESUSCITAT ION In children with burns over 10% TBSA and adults with burns over 15%TBSA , consider the needs for iv fluid resuscitation. If oral fluids are to be used , salt must be added. Fluids needed can be calculated from a standard formula. The key is to monitor unit output.
  • 28. FLUIDS FOR RESUSCITAT ION PARKLAND FORMULA % TBSA Weight (KG)4 = Volume (ml) Half this volume is given in first eight hours. Second half is given in the subsequent 16 hours. Crystalloid : ringer lactate Hypertonic saline Human albumin solution Colloid resuscitation
  • 29. NUTRITI ONBurnt patient need extra feeding A nasogastric tube should be used in all patients with burn over 15% of TBSA Removing the burn and achieving healing stops the catabolic drive.
  • 30. NUTRITI ONSUTHERAND FORMULA Children : 60 kcal/kg +35 %kcal TBSA Adults : 20 kcal/kg +70 %kcal TBSA PROTEIN 20% of energy 1.5 to 2 g/kg protein/day
  • 31. MONITORING AND CONTROL OF INFECTION Burn patients are immunocompromised. They are susceptible to infections through many routes. Sterile precautions should be taken. Swabs should be used regularly. A rise in WBC count ,thrombocytosis, and increase catabolism are warnings of infections.
  • 32. TOPICAL TREATMEN T OF DEEP BURNS 1% silver sulphadiazine cream. 0.5% silver nitrate solution. Mafenide acetate cream. Serum nitrate, silver sulphadiazine and cerium nitrate.
  • 33. PRINCIPLES OF DRESSINGS FOR BURNS Full thickness and deep dermal burns need antibacterial dressings to delay colonization prior to surgery. Superficial burns will heal and require simple dressings. An optimal healing environment can make a difference to outcome in borderline depth burns.