A burn is a type of injury to flesh caused by heat, electricity, chemicals, light, radiation or friction.

Most burns only affect the skin (epidermal tissue and dermis). Rarely, deeper tissues, such as muscle, bone, and blood vessels can also be injured. Burns may be treated with first aid, in an out-of-hospital setting, or may require more specialized treatment such as those available at specialised burn centers.

1. Stage of neurogenic shock proves to be lethal. It includes the fright, terror and hysterical reaction of the individual especially on the pain produced by the irritation of nerve endings in the skin

2. Stage of fluid loss first effect of burns is dilation of capillaries and increasing permeability. Plasma seeps out into the surrounding tissue to produce blisters and edema. Fluid loss reduces the blood volume, so that the blood becomes thicker, that the volume of the cellular elements of the blood increases in relation to the volume of fluid (plasma) of the blood. This change makes the circulation less efficient. The loss of fluid volume is reflected in the increasing hematocrit. Urinary output is reduced owing to fluid loss and hematocrit level is elevated or hypovolemia hypotension decrease renal perfusion and renal shutdown

3. Stage of Burn slough and infection eschar separates from underlying viable tissue by formation of slough this leaves a large open wound that is usually infected. The infecting organism vary in the upper part of the body often had colon bacilli as the infecting organism. Infection, however, does not occur suddenly, it probably begins soon after the burn occurs and then gradually grows in the sloughing tissue

4. Stage of Repair repair of the burned area and systemic repair

Classification Burns can be classified by mechanism of injury, depth, extent and associated injuries and comorbidities.

Currently, burns are described according to the depth of injury to the dermis and are loosely classified into first, second, third and fourth degrees. This system was devised by the French barber-surgeon Ambroise Pare and remains in use today

Nomenclature

Layer Time To Appearance Texture Sensation Complications Involved Healing

First degree

Epider Redness mis (erythema)

Dry

Painful

1wk or less

None

Nomenclature

Layer Time To Appearance Texture Sensation Complications Involved Healing

Extends Red with into Second clear degree superfic blister. ial (superficial Blanches (papilla partial with ry) thickness) pressure dermis

Moist Painful 2-3wks

Local infection/ cellulitis

Distinguishing between the superficialthickness burn and the partial-thickness burn is important, as the former may heal spontaneously, whereas the latter often requires surgical excision and skin grafting.

Nomenclature

Layer Time To Appearance Texture Sensation Complications Involved Healing

Red-andSecond Extends white with degree (deep into deep bloody Moist partial (reticular) blisters. thickness) dermis Less blanching.

Weeks Scarring, may contractures Painful progress (may require to third excision and degree skin grafting)

Nomenclature

Layer Time To Appearance Texture Sensation Complications Involved Healing

Extends Third degree Scarring, through Stiff and Requires Dry, (full Painless contractures, leathery excision entire white/brown thickness) amputation dermis

Nomenclature

Layer Time To Appearance Texture Sensation Complications Involved Healing

Fourth degree

Extends through skin, Amputation, subcutan Charred Requires significant eous Dry Painless with eschar excision functional tissue impairment and into
underlying

muscle and bone

Burn severity
In order to determine the need for referral to a specialised burn unit, the American Burn Association devised a classification system to aid in the decisionmaking process. Under this system, burns can be classified as major, moderate and minor. This is assessed based on a number of factors, including total body surface area (TBSA) burnt, the involvement of specific anatomical zones, age of the person and associated injuries

Major burns Major burns are defined as: Age 10-50yrs: Partial thickness burns >25% TBSA Age <10 or >50: Partial thickness burns >20% TBSA Full thickness burns >10% Burns involving the hands, face, feet or perineum Burns that cross major joints Circumferential burns to any extremity Any burn associated with inhalational injury Electrical burns Burns associated with fractures or other trauma Burns in infants and the elderly Burns in persons at high-risk of developing complications
y

Moderate burns Moderate burns are defined as: Age 10-50yrs: Partial thickness burns involving 1525% TBSA Age <10 or >50: Partial thickness burns involving 1020% TBSA Full thickness burns involving 2-10% TBSA
y

Minor burns Minor burns are: Age 10-50yrs: Partial-thickness burns <15% TBSA Age <10 or >50: Partial thickness burns involving <10% TBSA Full thickness burns <2% TBSA without associated injuries.
y y y

Burn surface area

Burns can also be assessed in terms of total body surface area (TBSA), which is the percentage affected by partial thickness or full thickness burns. First degree (erythema only, no blisters) burns are not included in this estimation. The rule of nines is used as a quick and useful way to estimate the affected TBSA. More accurate estimation can be made using Lund & Browder charts which take into account the different proportions of body parts in adults and children. The size of a person's hand print (palm and fingers) is approximately 1% of their TBSA. The actual mean surface area is 0.8% so using 1% will slightly over estimate the size. Burns of 10% in children or 15% in adults (or greater) are potentially life threatening injuries (because of the risk of hypovolaemic shock) and should have formal fluid resuscitation and monitoring in a burns unit.

Causes of Burns

Chemical - Most chemicals that cause chemical burns are strong acids or bases. Chemical burns can be caused by caustic chemical compounds such as sodium hydroxide or silver nitrate, and acids such as sulfuric acid. Hydrofluoric acid can cause damage down to the bone and its burns are sometimes not immediately evident

Electrical burns are caused by either an electric shock or an uncontrolled short circuit. (A burn from a hot, electrified heating element is not considered an electrical burn.) Common occurrences of electrical burns include workplace injuries, or being defibrillated or cardioverted without a conductive gel. Lightning is also a rare cause of electrical burns.

Since normal physiology involves a vast number of applications of electrical forces, ranging from neuromuscular signaling to coordination of wound healing, biological systems are very vulnerable to application of supraphysiologic electric fields. Some electrocutions produce no external burns at all, as very little current is required to cause fibrillation of the heart muscle. Therefore, even when the injury does not involve any visible tissue damage, electrical shock survivors may experience significant internal injury. The internal injuries sustained may be disproportionate to the size of the burns seen (if any), and the extent of the damage is not always obvious. Such injuries may lead to cardiac arrhythmias, cardiac arrest, and unexpected falls with resultant fractures or dislocations

Radiation burns are caused by protracted exposure to UV light (as from the sun), tanning booths, radiation therapy (in people undergoing cancer therapy), sunlamps, radioactive fallout, and X-rays. By far the most common burn associated with radiation is sun exposure, specifically two wavelengths of light UVA, and UVB, the latter being more dangerous. Tanning booths also emit these wavelengths and may cause similar damage to the skin such as irritation, redness, swelling, and inflammation. More severe cases of sun burn result in what is known as sun poisoningor "heatstroke". Microwave burns are caused by the thermal effects of microwave radiation.

Management First-aid treatment in the home: apply cold water In the hospital most important goal of initial therapy 1.Solution: Ringers Lactate is the choice because it most closely resembles the composition of the extracellular fluid compartment 2.Dosage: 3-4 ml/KBW/%TBSA 3.Schedule total quantity to be given in 24 hours  One-half during the first 8 hours  The other during the next 16 hours

Remove foreign adherent material b gentle washing with iodine-based solution or hexachlorophene and water, then thoroughly rinsing with NSS Shave hair from burned area and area immediately surrounding it Excision of fragments of dead devitalized tissues

Application of topical agents 1. Purpose: 0.5% silver nitrate unknown action; not very popular because it stains the skin 2. Gentamicin cream 3. Mafylon/Sulfamylon or Silver sulfadiazine (Silvadene) the burn butter 1.purpose: to prevent bacterial invasion 2.Method of application: applied evenly 1/8 inch in thickness 3.Side effects o Reduces buffering capacities of the blood because it increases bicarbonate excretion (when bicarbonates are broken down, they provide a heavy acid load). Remember: Monitor pH level of blood o Cause burning sensation for 20 minutes after application

Dressing may (Closed method) or may not (open method) be used. If closed method is used, dressings are changed everyday Wound debriment is done with each dressing change to prevent eschar ( a tough coagulum of necrotic tissue). Necrotic tissues are not only good media for bacteria, but also promote growth of granulation tissues Daily removal of dried cream by soaking in whirlpool bathtub prior to debridement Morphine sulfate, gr.1/4 relieve pain of second degree burns Use of Bradford frame for ease of turning and maintenance of good body alignment

Position flat on bed with legs extended specially during the first 24-48 hours in order to: 1.Avoid postural shock because of fluid loss, circulation to the head may become inadequate 2.Support healing of burn wounds 3.Prevent hip contractures 1.Proper splinting 2.Active and passive range of motion exercises Grafting is done to minimize growth of granulation tissues which results in contractures and ugly scars 1.Xenograft from animals 2.Homograft from other individuals 3.Autograft - oneself