Burns

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1. Burn
By: NabinaPaneru
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2. Introduction
When the skin is exposed to excessive heat,
electricity, or corrosive chemicals, the resulting
tissue damage is known as burn.
Burn due to dry heat: Burn
Burn due to moist heat: Scald
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3. Causes of Burn
1. Chemical Burn (Alkali Burn more
severe than Acid Burn)
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4. Contd.
2. Electric Burn
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5. Contd.
3. Radiation burn
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6. Contd.
4. Scaldin(Scald burn)
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7. Types of injury
•The Primary Injury
•The Secondary Injury
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8. Zones of burn as described by Jackson
in 1947
•Zone of coagulation: Irreversible tissue loss
due to coagulation of the constituent proteins.
•Zone of stasis: Area with vascular damage and
potentially reversible injury
•Zone of hyperemia: Outmost are, similar to
superficial burn. Heals rapidly.
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9. Nabina Paneru

10. Classification of burn by depth
•First Degree Burn
•Second Degree Burn
•Third Degree Burn
•Fourth Degree Burn
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11. Nabina Paneru

12. First Degree Burn
•Affects only the epidermis
•Burn site is reed, painful, dry
and with no blisters
•Usually take 3 to 7 days to heal
without scarring
•Most common type of first
degree burn is sunburn.
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13. Management of First Degree Burn
•Usually heals on their own within the week.
•Treatment may depend on the severity of the burn
and may include following:
Cold compress
Lotion or ointments
Acetaminophen or ibuprofen for pain
•Usually not bandaged
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14. Second Degree Burn
•Involves epidermis and part
of the dermis layer of skin.
•Site appears red, blistered,
and may be swollen and
painful.
•They heal in 7 to 21 days.
Scarring is usually confined
to changes in skin pigment.
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15. Management of Second Degree Burn
•Burn less than 10% of the skin’s surface can usually be
treated in outpatient basis
•Depend on the severity and may include:
Antibiotic ointments
Dressing change one or two times per day depending on
severity
Daily cleaning of wound to remove dead skin or ointment
Do not burst the blisters formed
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16. Third Degree Burn
•All layers of the skin is
destroyed
•Extend into the subcutaneous
tissues
•Nerve endings, sweat glands,
and hair follicles are destroyed.
•No pain
•Take over 21 days to heal
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17. Fourth Degree Burn
•Causes skin to be waxy white to a
charred black and tend to be painless
•Very slow healing
•All surfaces of skin including muscles,
tendon, ligament are affected
•Very fatal
•If the patient survives a fourth degree
burn then skin grafting is essential.
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18. Management of Fourth Degree Burn
•Early cleaning and debriding(removing dead skin and
tissue from the burned area).
•Iv fluids containing electrolytes.
•Antibiotic IV or by mouth.
•Nutritional supplements and a high-protein diet.
•Analgesics
•Skin grafting (Heterograft, Isograft, Allograft etc)
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19. Classification of Burn by Severity
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20. Calculation of Burn Percentage
•Wallace Rule of Nine
•Lund-Browder Chart: Calculation of burn in
child and infants
•Palm Method
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21. Wallace Rule of Nine
Head: 9%
Chest (Front): 9%
Abdomen (front): 9%
Upper/mid/low back
and buttocks: 18%
Each arm: 9%
Each leg: 18%
Groin: 1%
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22. Nabina Paneru

23. Palm Method
•The size of patient palm is approximately 1%
of the TBSA
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24. Management of Burn
•Emergent/ resuscitative phase (ABCDEF)
•Acute/ Intermediate phase
•Rehabilitation phase
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25. Emergent/ Resuscitative Phase
1.On the scene care:
Extinguish the flame
Cool the burn
Remove restrictive objects
Cover the wound
Irrigate the chemical burn
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26. Contd.
2.Emergency Treatment:
A: Airway management
B: Breathing and ventilation
C: circulation
D: Disability –neurological status
E: Environment control –keep warm
F: Fluid Resuscitation
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27. Fluid Resuscitation
•Resuscitate fluid till:
-Urine output is 0.5 –1.0 ml/kg/hr
-Systolic BP is 100mm Hg
-Pulse rate below 110 bpm
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28. Contd.
Parkland formula for fluid resuscitation
•RL solution: 4ml * body wt (kg) * % TBSA
•Resuscitation fluid volume for the first 24 hours
•Half of this fluid is given in first 8 hrs and other half is
given over remaining 16 hrs.
•Hartmann solution is used, but other isotonic fluid may
be used.
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29. Contd.
<10% TBSA: Crystalloid solution E.g. NS
10-15% TBSA: ½ colloidal + ½ crystalloid
>15% TBSA: Colloidal ( Blood, Haemoceleetc)
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30. Acute/ Intermediate Phase
1.Extensive monitoring
2.Infection prevention
3.Wound Care
4.Wound grafting
5.Pain management
6.Nutritional Support ( High protein, high calorie diet)
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31. Rehabilitation phase
•Prevention of hypertropicscarring
•Prevention of contracture
•Excharotomy: A surgical incision into the
eschar( devitalized tissue resulting from burn),
to relieve the constricting effect of the burned
tissue.
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32. Complications of Burn
•Failure to heal
•Contracture formation
•Compartment syndrome
•Hypertropicscar
•Sepsis
•Heart Failure
•Acute Respiratory Syndrome
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33. Gangrene
Gangrene is a medical term used to describe the
depth of an area of the body. It develops when
the blood supply is cut off to the affected part as
a result of various processes, such as infection,
vascular disease, or trauma.
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34. Nabina Paneru

35. Nursing Diagnosis for Patients with Burn
1.Impaired gas exchange related to upper airway
obstruction/ gaseous poisoning
2.Ineffective airway clearance related to edema
3.Fluid volume deficit related to fluid loss from wound
4.Hypothermia related to loss of skin integrity
5.Pain related to nerve injury
6.Anxiety related to impact of burn injury
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