BURN

OM VERMA
ASSISTANT PROFESSOR
GRACIOUS COLLEGE OF NURSING ABHANPUR( C.G)

3. “Damage to
the skin or other body
parts caused by extreme
heat,flame,contactwith
heated objects or
chemicals that is known
as Burn.”
-www.medterms.com

6. ANATOMY & PHYSIOLOGY OF SKIN

7. According to level of severity:-
1)First degree burn:-
A first-degree burn is
the most common and least
serious burn which affects the
top layer of skin i.e. epidermis.
Itcauses local inflammation of
the skin & this inflammation is
characterized by pain,redness
and a mild amount of
swelling.Theskin may be very
tender to touch.

9. 2) Second degree burn:-It
involve the epidermis and
the dermis.Thereare the
samesymptomsof pain
and swelling but the skin
color is usually a bright red
and blisters are produced.
Usually second-degree
burns produce scarring.

11. .
3)THIRD DEGREE BURN

13. 4
TH
DEGREE
•:-The 4
TH
degree burn may appear patches
which appear white,brownor black.Boththe
dermis and epidermis are destroyed and
other organs, tissues and bones may also be
involved.Third-degree burns are considered
the most serious

15. s

16. Etiology
1.Thermal burn injury
2.Chemical burn injury
3.Electrical burn injury
4.Radiation burn injury

17. Thermal burn
•Athermal burnis a type ofburnresulting
from making contact with heated objects,
such as boiling water, steam, hot cooking oil,
fire, and hot objects.

18. Chemical burn
•Achemical burnoccurs when your skin or
eyes come into contact with an irritant, such
as an acid or a base. Bases are described as
alkaline.Chemical burnsare also known as
causticburns. They may cause a reaction on
your skin or within your body.

19. Electrical burn
•Anelectrical burnis aburnthat results from
electricity passing through the body causing
rapid injury.

20. Radiation
•Aradiation burnis damage to the skin or
other biological tissue caused by exposure
toradiation. Theradiationtypes of greatest
concern arethermal radiation, radio
frequency energy, ultraviolet light and
ionizingradiation. The most common type
ofradiation burnis a sunburn caused by
UVradiation.

21. Extent of body surface area
injured
1. Rule of nine (system
assigns percentages in
multiples of nine to major
body surface)
2. Lund & Browder method
(By dividing the body into
very small areas & providing
an estimate of the proportion
of TBSA accounted for by such
body parts.)
3. Palm method (The size of
the pt’spalm is approximately
1% of TBSA)

22. s

24. Pathophysiology
Major Burns
↑edCapillary permeability
Na,H
2O & protein shift from intravascular to
interstitial spaces
Circulating blood volume
Hypovolemia > shock
Massive stress response SNS activation

25. Peripheral Tachy-Hyper-↑edcatabolism &
vaso- cardiaglycemiamatabolism
constriction
Tissue perfusion
↓renal ↓G I Anaerobic Tissue Cellular
blood bloodmetabolism damage dysfunction
flow flow
Metabolic Peritoneal Cell
ARF acidosis tissue swelling
necrosis

26. Clinical manifestation
S. N. BURN SKIN AREA INVOLVED CLINICAL PICTURES
1.
2.
3.
First degree
(Superficial
partial
thickness)
Second degree
(Deep partial
thickness)
Third degree
(Full thickness)
Epidermis layer only.
Epidermis with some dermis
Destruction of epidermis with most
of the dermis,epidermalcells,lining
hair follicles & sweat glands remain
intact,mayconvert to full thickness
injury.
Destruction of all layers of skin
down to or pass the subcutaneous
fat,sometimeinvolving
fascia,muscles& bone.Thenerves
are also destroyed.
Red,dry,painful,
moist,pink
skin,blisters.
Pale,pearly
white,mostly
dry,difficultto
differentiate full
thickness burn.
Thick,dryleathargy
eschar,whitecherry
red or brown/black in
color,bloodvessles
thrombosed.

28. Management
-Immerse the burned area immediately in cold running
water,thendry the area gently with a clean towel .
-Cover burns with a sterile or clean,drycloth.
-Do not prick blisters.
-Do not remove clothing adhering to the wound.
-Remove any watches,bracelets,rings,beltsor constricting
clothing from the affected area before it begins to swell.
-Do not apply butter,oilor creams.
-Do not press
-Assess for associated trauma.
-Monitoring respiratory distress .
-To give oxygination.

30. Assessment & diagnostic
evaluation
1.Survey,includingassessment of CIRCULATION. AIRWAY,
BREATHING as well as vital signs is done.
2. Effected of burns areas is determined by :
•Depth :-First,Second& Third degree burn injury
•Extent :-% of total body surface area (TBSA)
•Age :-The very young & very old have a poor prognosis.
•Area of the body burned :-face,hands,feet,perineum&
circumferential burns require special care.
•Medical history.
•Inhalation injury.
3. Obtain arterial blood gas & carboxyhemoglobin

31. CIRCULATION. AIRWAY, BREATHING
-The circulatory system must also be assessed
quickly.
-Apical pulse & Blood pressure are monitores.
-The neurologic status is assessed quickly in pt
with extensive burns.
-A head to toe survey of the ptis carried out to
identify other potentially life threatening injuries.
-Usually,rescueworkers will cool the
wound,establishan airway,supplyO
2 & insert at
least one large-bore intravenous line.

32. -Immediate I.V. fluid resuscitation is indicated for :
-Adults with burns involving more than 18-20% of
TBSA % Children with more than 12-15% of TBSA.
-Generally a crystalloid solution (Ringer’s lactate)
is used initially.
-Colloid is used during the second day
-One of several formulas may be used to
determine the amount of fluid to be given in the
first 48 hrs.

33. Formulae for calculation fluid
replacement for burn patients
•1.CONSENSUS FORMULA
•2.EVANS FORMULA
•3.BROOKE ARMY FORMULA
•4.PARKLAND/BAXTER FORMULA

34. 1.CONSENSUS FORMULA
•RL or other balanced saline solution 2-4 ml x
kg body weight x % TBSA burned.
•Half of the fluid need to be given in 8 hours
and remaining half over next 16 hours .

35. 2.EVANS FORMULA
•Colloids 1 ml x kg body weight x % TBSA
Burned
•Electrolyte (saline ) : 1ml x kg body weight x
%TBSA Burned
•Glucose ( 5%D) : 2000 ML for insensible water
loss
•Day 1 : half of the fluid need to be given in 8
hours and remaining half over next 16 hours.
•Day 2 : half of the previous day's colloids and
electrolyte all insensible water loss

36. 3.BROOKE ARMY FORMULA
•Colloids 0.5 ml x kg body weight x % TBSA
Burned
•Electrolyte (saline ) : 1.5 ml x kg body weight
x %TBSA Burned
•Glucose ( 5%D) : 2000 ML for insensible water
loss
•Day 1 : half of the fluid need to be given in 8
hours and remaining half over next 16 hours.
•Day 2 : half of the previous day's colloids and
electrolyte all insensible water loss

37. 4.PARKLAND/BAXTER
FORMULA

38. (i) First 24 hrs. :-4 ml of ringer’s lactate ×kg body wt ×% TBSA
burned.
(ii) One half amount of fluid is given in the first 8 hrs.calculated from
the time of injury. If the starting of fluid is delayed, then the same
amount of fluid is given over the remaining time.
(iii) The remaining half of the fluid is given over the next 16 hrs.
Example :-Patient’s weight :-70 kg, %TBSA burn :-80%
4 ml ×70 kg ×80% TBSA
= 22,400 ml of Ringer’s lactate
First 8 hrs. :-11,200 ml or 1,400 ml/hr. (11200 /8 = 1400ml/hr )
Second 16 hrs. :-11,200 ml or 700 ml/hr (11200/16 = 700 ml/hr )

39. CON……..
(2)Second 24 hrs. :-
0.5 ml colloid ×kg body wt ×% TBSA
GLUCOSE (5%D) 2000 ml dextrose 5% for water
insensible over the 24 hrs period.
Example :-0.5 ml ×70 kg ×80%+ D 5 2000 ML
= 2,800 ml colloid + D 5 2000 ML
First 8 hrs. :-1400 /8 = 175 ML colloid /HR
Second 16 hrs. :-1400 /16 =87.5 ML Colloid /HR
continue 2000 ml D5 all insensible water loss

40. 4) Emergency medical management :-
-A large bore intravenous catheter should be inserted.
-Most ptshave a central venous catheter inserted so that
large amounts of I V fluids can be given quickly.
-Pt. to protect the area from contamination.
-Burns are contaminated wounds,tetanusprophylaxis is
administered.
-Only intravenous pain medication usually morphine is
given.
-Topical antimicrobial agents includes silver
sulfadiazine,silvernitrate(0.5% solution),mafenide
acetate (10% cream or 5% solution) etc.
-Dressing may take may form of commercial
multilayered pads,standard4×4 gauze pads.

41. -Daily or twice daily wound cleansing with
debridement or hydrotherapy & dressing
changes.
-Early excision of deep second & third degree
burns is the goal.
-Burn wounds must be cleansed initially & usually
daily with a mild antibacterial cleansing agent &
saline solution or water.

52. BIOBRANE
•(a type of artificial skin) is a
manmadeskin substitutecomposed
ofnylon mesh, silicone and collagen
(derived from pig skin). It is a stretchable
dressing that is used as a temporary cover
for clean partial thickness burns and
donor sites or as a protective covering
over meshed skin grafts.

54. •INTEGRA
•is a product that is used to help re-grow
skin on body parts where skin has been
removed or badly damaged. It was
initially used to safely cover large areas
of burned tissue where skin needed to be
regrown. However,Integrais now used
far more widely as part of skingraftsin
reconstructive surgery.

56. CALCIUM ALGINATE DRESSING
usesis to provide homeostasis,calcium
alginateis more commonly thought of as
thedressingthat can absorb 20 times its
weight in exudate, soak up loose debris
from the wound bed, provide an optimal
environment for healing, and provide a
painlessdressingchange.

58. •VaselineGauze–Fine
mesh gauzewhich isnon-
adherentto wound sites
and helps maintain a moist
wound environment.

59. Surgical managemenT
-The basic goal is the early excision & grafting.
1.Tangential Excision:-A special blade is used to
slice off thin layers ( 0.5 mm thick ) of damaged
skin until live tissue is evidenced by capillary
bleeding.Commonlyused with deep partial
thickness burns & followed with immediate
dressing. Appling to deep dermal burns 3
rd
degree burns .
2.Fascial(Primary) Excision :-The skin,lymphatics
& subcutaneous tissue are removed down to
fascia with either immediate autograftingor
temporary coverage with biologic dressings.

60. ESCHAROTOMY
•is a surgical procedure used to treat full
thickness burn circumferential burn . In full
thickness burn ,both the dermis and
epidermis layer are destroyed along with
sensory nerve in the dermis .