Burns

What are burns?

Injuries that result from direct contact with or exposure to any thermal, chemical, electrical or radiation source are termed burns - Black and Hawks Burns are caused by the transfer of energy from a heat source to the body. The depth of injury depends on the temperature of the burning agent and the duration of contact with it. - Brunner & Suddarth

Causes of Burns
Thermal Burns
Flame, hot liquids, semiliquids, semisolids or hot objects

Chemical Burns
Cleaning agents, industrial chemical

Electrical Burns
Short circuits, electrical shock

Radiation Burns
Sun burn, UV radiation

Inhalation Injury
Inhalation of asphyxiates, carbon monoxide, smoke poisoning

Classification of Burns

Depth of Burn

Characteristics of Burns according to Depth

Superficial Partial Thickness
Sunburn, low intensity flash

Deep Partial Thickness

Scalds, Flash flame contact

Full Thickness
Flame, prolonged exposure to hot liquids, Electric current, chemical contact Epidermis, entire dermis, some times the subcutaneous tissue; may involve connective tissue, muscle and bone Pain free, shock, hematuria and hemolysis, possible entrance and exit wounds Dry; pale white, leathery or charred, broken skin with fat exposed, edema

Epidermis; possibly a portion of the dermis

Epidermis, Upper dermis, portion of deeper dermis

Tingling, hyperesthesia, pain

Pain, hyperesthesia, sensitive to cold air

Reddened; blanches with pressure; dry, minimal or no edema

Blistered, mottled red base, broken epidermis, weeping surface, edema

Extent of Body Surface Area Injured

Rule of Nine Lund and Browder Method Palm Method

Classification of Extent of Burn Injury

Minor Burn Injury Second-degree burns of <15% TBSA (adults), <10% TBSA (children) Third-degree burn of <2% TBSA not involving special care areas (eyes, ears, face, hands, feet, perineum, joints) Moderate, Uncomplicated Burn Injury Second-degree burns of 15-25% TBSA (Adults) or 10-20% TBSA (Children) Third-degree burns of <10% TBSA not involving special care areas Major Burn Injury Second-degree burns >25% TBSA (Adults) or >20% TBSA (children) All third Degree burns >10% TBSA All burn injury involving special care areas All inhalation injury, electrical injury, or concurrent trauma, and all high-risk patients.

Management of Burn Injury

Emergent/Resuscitative Phase
On-the-Scene Care Extinguish the flame
Drop and roll; smother; disconnect

Cool the burn

Soak with cool water, briefly

Remember the trauma ABCs Airway Breathing Circulation Priorities First aid Prevent shock Prevent respiratory distress Detect, treat concomitant injuries

Remove restrictive objects

Prevent constriction

Cover the wound

Decrease bacterial contamination

Irrigate chemical burns

Irrigate to remove the chemical

Acute /Intermediate Phase

48 72 hours after burn injury

Attention is directed toward continued assessment and maintenance of respiratory and circulatory status, fluid and electrolyte balance, and gastrointestinal function Infection control, wound care, pain management and nutritional support

Disorders of Wound Healing

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Scars Keloids Failure to heal Contractures