BURNSDr. Maria Auron, Ilembula 2014

BURNS• Injury to tissues caused by• heat, electricity, chemicals, radiation

• Thermal burns • scalds (liquid), contact burns or flame burns

• Smoke inhalation can cause • Airway burns, edema, atelectasis, pneumonia and possible CO

intoxication

• Electrical burns may cause deep tissue necrosis with few initial signs

• Children <5 years and elderly >70 years have highest mortality

FIRST AID

1. Stop the burning

• Extinguish, roll on the ground if on fire, remove burning clothes

• If chemical: large amounts of water

2. Cool the burn

• 20 min cool, running water • No ice, avoid hypothermia

3. Cover

• Clean cloth

Thermal burns

Assessment

1.Extent

Calculate body surface area (BSA) by the ”Rule of nines”

Assessment

2. Depth

Partial thickness

•1st degree (epidermal)• Red, blanches with pressure, painful, pin-prick

sensation preserved

•2nd degree (part of dermis)• Swollen, red, BLISTERS, moist, pin-prick

sensation preserved

Full thickness

•3rd degree (full thickness of dermis)

• Dry, painless, pale/charred, thrombosed skin vessels

Assessment

• 2nd – 3rd degree burns cause • loss of tissue fluid, most fluid

loss in the first 24 hours but continues up to 36 hours

• Risk for infection with Strep. pyogenes and Pseudomonas

Prevent dehydration and infection of the burn site!

Severe burns

• Extent: • Adults >15% of BSA• Children >10% of BSA

• Full thickness burns

• Burns in critical areas (face, hands, feet, perineum)

• Circumferential burns of limb or chest

• Electrical burns

• Inhalation injury • look for smoke around mouth/nose, facial burns, black sputum,

respiratory distress -> usually a sign of serious inhalation injury

PRIMARY SURVEY for severe burns• Airway – intubate if upper airway obstruction or impending

respiratory failure

• Breathing – humid oxygen by mask

• Circulation – assess color, refill, HR, blood pressure• Insert 1-2 peripheral iv lines

• Formal fluid resuscitation in 2nd – 3rd degree burns is critical• Use when burned skin area >15% BSA (10% in children)• Crystalloid solution with Parkland formula

PARKLAND FORMULA for fluid resuscitation

MANAGEMENT• Analgesia

• Keep patient warm

• Wound care• Clean with normal saline• Remove loose debris and large blisters• Cover with paraffin gauze + chlorhexidine dressing,

change dressings every 1-2 days• Elevate limbs with circumferential burns, assess distal

perfusion (capillary refill, pulse, warmth, color)-> escharotomy if perfusion is compromised! (cool to touch, weak or no pulse)

MANAGEMENT

• Tetanus prophylaxis

• There is no proven benefit from systemic prophylactic antibiotics

• Partial thickness burns heal in 2-3 weeks

• Full thickness burns need skin grafting, delayed for 2 weeks

• Later complications: contractures, scar hypertrophy and keloids

THANK YOU!