BURNS

ROLL NO 1411
DEFINITION

 IT IS A TYPE OF COAGULATIVE NECROSIS THAT RESULT FROM DIRECT CONTACT OR

EXPOSURE TO ANY PHYSICAL, THERMAL, CHEMICAL, ELECTRICAL, OR RADIATION
SOURCE
CLASSIFICATION

 BASED ON CAUSE

 THERMAL
 ELECTRICAL
 CHEMICAL
 RADIATION
 INHALATION
 THERMAL INJURIES

 FLAME BURNS
 DIRECT CONTACT WITH FLAME (DRY HEAT)
 STRUCTURAL FIRES / CLOTHING CATCHING ON FIRE

 SCALDING BURNS
 DIRECT CONTACT WITH HOT LIQUID / VAPOURS (MOIST HEAT)
 COOKING, BATHING OR CAR RADIATOR OVERHEATING
 SINGLE MOST COMMON INJURY IN THE PEDIATRIC PATIENT
 ELECTRICAL BURNS

 USUALLY FOLLOWS ACCIDENTAL CONTACT WITH EXPOSED OBJECT CONDUCTING ELECTRICITY

 ELECTRICALLY POWERED DEVICES
 ELECTRICAL WIRING
 POWER TRANSMISSION LINES
 CAN ALSO RESULT FROM LIGHTINING
 DAMAGE DEPENDS UPON INTENSITY OF CURRENT AND RESISTANCE OF BODY TISSUES
THROUGHWHICH THE CURRENT IS PASSING
ELECTRICAL BURNS

 MANIFSTATIONS
 EXTERNAL BURN
 INERNAL BURN
 MUSCULOSKELETAL INJURY
 CARDIOVASCULAR INJURY
 RESPIRATORY INJURY
 NEUROLOGIC INJURY
 RHABDOMYOLYSIS AND RENAL INJURY
 CHEMICAL BURNS

 USUALLY ASSOCIATED WITH INDUSTRIAL EXPOSURE

 ACCIDENTAL MISHANDLING OF HOUSEHOLD CLEANERS

 ACIDS
 IMMEDIATE COAGULATION NECROSIS CREATNG AN ESCHAR ; SELF-LIMITING
EG; HYDOCHLORIC ACID, SULPHURIC ACID, NITRIC ACID, PHENOL
 BASES
 LIQUEFACTIVE NECROSIS WITH CONTINUED PENETRATION INTO DEEPER TISSUES RESULTING IN EXTENSIVE
INJURY
EG ; LIME,POTASSIUM HYDOXIDE ,CALCIUM HYDROXIDE
 CLASSIFICATION

 BASED ON DEPTH

 FIRST DEGREE BURNS (SUPERFICIAL PARTIAL THICKNESS BURNS) – EPIDERMIS IS INJURED AND PORTION OF DERMIS
MAY BE INJURED
 SECOND DEGREE BURNS (DEEP PARTIAL THICKNESS BURNS) – DESTRUCTION OF THE EPIDERMIS AND UPPER LAYERS OF
DERMIS
 THIRD DEGREE BURNS (FULL THICKNESS BURNS) – TOTAL DESTRUCTION OF EPIDERMIS AND DERMIS AND, IN SOME
CASES, UNDERLYING TISSUE AS WELL
DEGREE OF BURNS 1ST DEGREE 2ND DEGREE 3RD DEGREE

INVOLVEMENT EPIDERMIS EPIDERMIS + ENTIRE EPIDERMIS

RETICULAR DERMIS AND DERMIS

APPEARANCE

ERYTHEMA, OEDEMA, BLISTER, SOFT WAXY, TOUGH, DRY, ESCHAR,

NO BLISTERS THROMBOSED
WHITE, ELASTIC SUBCUTANEOUS VEIN
SYMPTOMS AND SENSATIONS INTACT, PAIN SENSATIONS TO PAIN SENSATION TO
SIGNS MILD TO MOD PAIN, NEEDLE PRICK NEDDLE PRICK
SKIN BALANCHES PRESENT, ABSENT

HEALING 3-5 DAYS WITHOUT 2-3 WEEKS 3-5 WEEKS, ESCHAR

SCAR WITHHYPERTROPHIC SEPARATES
SCAR
PATHOPHYSIOLOGY

HEAT CAUSES COAGULATIVE NECROSIS OF SKIN AND SUB CUTANEOUS TISSUE

RELEASE OF VASOACTIVE PEPTIDES

ALTERED CAPILLARY PERMEABILITY

LOSS OF FLUID SEVERE HYPOVOLAEMIA

DECREASED CARDIAC OUTPUT DECREASED MYOCARDIAL FUNCTION

DECREASED RENAL BLOOD FLOW(RENAL FAILURE) OLIGURIA

ALTERED PULMONARY RESISTANCE CAUSING PULMONARY SYNDROME

INFECTION

SYSTEMIC INFLAMMATORY RESPONSE SYNDROME (SIRS)

MULTIORGAN DYSFUNCTION SYNDROME (MORS)

RENAL

 DIMINISHED BLOOD FLOW AND CARDIAC OUTPUT LEADS TO DECREASED

RENAL BLOOD FLOW AND GFR
 TOXINS RELEASED FROM THE WOUND ALONG WITH SEPSIS CAUSES ACUTE
TUBULAR NECROSIS
 INJURY CAN OCCUR TO KIDNEY DUE TO MYOGLOBIN
LUNGS

 ALTERED VENTILATION – PERFUSION RATIO

 PULMONARY OEDEMA DUE TO BURN INJURY, FLUID OVERLOAD
 ARDS
 ASPIRATION
 SEPTICAEMIA
 GIT

BURNS MUCOSAL ATROPHY DECREASED ABSORPTION AND INCREASED INTESTINAL

PERMEABILITY INCREASED BACTERIAL TRANSLOCATION SEPTICEMIA

 ACUTE GASTRIC DILATATION WHICH OCCURS IN 2-4 DAYS

 PARALYTIC ILEUS
 CURLING’S ULCER
 ACUTE ACALCULOUS CHOLECYSTITIS,ACUE PANCREATITIS
 ABDOMINAL COMPARTMENT SYNDROME
EVALUATION
WALLACE’S RULE OF “9”

 HEAD AND NECK - 09

 UPPER LIMBS - 09 2
 TRUNK - 18 2
 LOWER LIMBS - 18 2
 PERINEUM - 01
 THE LUND AND
BROWDER CHART

BETTER METHOD FOR ASSESSING

THE BURNS

HERE EACH PART OF THE BODY IS

INDIVIDUALLY ASSESSED
PALM METHOD

 SIZE OF PATIENTS PALM 1% OF TSBA

 USED FOR IRREGULAR WOUNDS WITH SCATTERED DISTRIBUTION
MANAGEMENT OF
BURNS
 PRE – HOSPITAL CARE

 ENSURE RESCUER SAFETY

 STOP THE BURNING PROCESS – STOP, DROP AND ROLL
 CHECK FOR OTHER INJURIES
 COOL THE BURN WOUND; PROVIDES ANALGESIA, SLOWS THE DELAYED MICROVASCULAR INJURY,
MINIMUM OF 1MIN ,EFFECTIVE UPTO 1 HOUR AFTER THE BURN INJURY
 GIVE OXYGEN
 ELEVATE
HOSPITAL CARE