BURN INJURY : CLINICAL FEATURES | Tutorial F-4

1) Pain Pain is immediate, acute and intense with superficial burns. It is likely to persist until strong analgesia is administered. With deep burns there may be surprisingly little pain 2) Acute anxiety The patient is often severely distressed at the time of injury. It is frequent for patient to run about in pain or in an attempt to escape, and secondary injury may result 3) Fluid loss and dehydration Fluid loss commences immediately and, if replacement is delayed or inadequate, the patient may be clinically dehydrated. There may initially be tachycardia from anxiety and later a tachycardia from fluid loss 4) Local tissue edema Superficial burns will blister and deeper burns develop edema in the subcutaneous spaces. This may be marked in the head and neck, with severe selling which may obstruct the airway. Limb edema may compromise the circulation 5) Special sites Burns of the eyes are uncommon in house fires as the eyes are tightly shut and relatively protected. The eyes, however, may be involved in explosion injuries or chemical burns. Burns of the nasal airways, the mouth and upper airway may occur in inhalation injuries 6) Coma Following house fires, the patient may be unconscious and the reason for this must be ascertained. Asphyxiation or head injury must be excluded. Burning furniture is particularly toxic and the patient may suffer from carbon monoxide or cyanide poisoning

130110110177 | Gabriella Chafrina| 27/03/13

BURN INJURY : CLASSIFICATION | Tutorial F-4

A) Based on risk group patient Low-Risk Patients: between the ages of 10 and 50 years Higher-Risk Patients: under 10 years of age or over 50 years Poor-Risk Patients: underlying medical conditions, such as heart disease, lung disease, and diabetes B) Based on Mechanism of Injury -> used as a predictor of outcome Scalds -> caused by liquids (divide into spill and immersion), grease or steam Contact burns Fire -> divide into flash and flame burns Chemical Electrical Radiation C) Based on severity of burn and the patient risk group Major Burns - Any burns in infants or the elderly - Any burns involving the hands, face, feet, or perineum - Burns complicated by fractures or other trauma - Burns complicated by inhalation injury - Burns crossing major joints - Burns extending completely around the circumference of a limb - Electrical burns - Chemical burns - Full thickness burns of greater than 10% body surface area in any risk group - Partial-thickness burns more than 20% body surface area in the higher-risk group - Partial-thickness burns more than 25% of the body surface area in the low-risk group Moderate Burns - Partial-thickness burns of 15-25% body surface area in the low-risk group - Partial-thickness burns of 10-20% body surface area in the higher-risk group - Full-thickness burns of at least 10% body surface area or less in others - Superficial partial-thickness burns of the head, hands, feet, or perineum - Suspected child abuse - Concomitant trauma - Significant pre-existing disease - Extreme age Minor Burns - Less than 15% body surface area in the low-risk group - Less than 10% body surface area in the higher-risk group - Full-thickness burns that are less than 2% body surface area in others - Not involving the head, feet, hands, or perineum

130110110177 | Gabriella Chafrina| 27/03/13

BURN INJURY : CLASSIFICATION | Tutorial F-4

D) Based on depth Refers to the depth of the irreversible tissue damage. Can be determined from the appearance of the wound. Distinguishing first-degree and superficial second-degree injuries is usually simple: operative intervention is rarely required. A distinction between deep seconddegree and third-degree burns can often not be made until after 3 to 5 days of observation, but in either case surgery is the optimal treatment. Fourth-degree burns are readily apparent upon observation; they are always treated surgically.

130110110177 | Gabriella Chafrina| 27/03/13

BURN INJURY : CLASSIFICATION | Tutorial F-4

Reason change: percentage of full-thickness burn (those that definitely require surgery) is one of the major determinants of survival following burn injury
E) Based on Extent of Burn = expressed as total percentage of body surface area (TBSA) affected by the injury Multiple methods (not used for superficial burns) -> best use rule of nine but then the Lund and Browder method covers all age groups

expressed as the total percentage of body surface area (TBSA) affected by the injury. Accurate estimation of the TBSA of a burn is essential to guide management. Multiple methods have been developed to estimate the TBSA of burns. These methods are not used for superficial burns. The best known method, the rule of nines, is appropriate for use in all adults and when a quick assessment is needed for a child.
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More accurate methods are required for definitive estimation of the extent of burns in children. The Lund and Browder method covers all age groups and is considered the most accurate method to use in pediatric patients (Figure 5).

130110110177 | Gabriella Chafrina| 27/03/13

BURN INJURY : CLASSIFICATION | Tutorial F-4

130110110177 | Gabriella Chafrina| 27/03/13