Burns

Burns
Joseph Katawa Mwale

Acknowledgements:
• Dr Yotham Phiri Mmed (Surg)
Functions of the Skin
• Keeps fluids and electrolytes on the inside
• Protects from bacterial invasion from the outside
• Regulates body temperature
• Sensory integration with the environment
• Social Interaction
Anatomy of the skin
The Skin – Nerve fibres
• A burn is a type of injury to skin, or other tissues, caused
by heat, cold, electricity, chemicals, friction, or radiation.
• Most burns are due to heat from hot liquids, solids, or fire
Burns - Initial Care at Scene
• Stop the burning process

• ABC
• Unless a chemical injury, burn wounds are the Lowest
priority!
Initial Care at the Scene:
Chemical Injury
• Remove clothing, jewellery, contacts
• Brush off powders
• Flush with LARGE volumes of water (irrigate eyes with
normal saline)
• Personal protective equipment
• Keep patient warm!
• Determine what chemical caused the burns
Electrical
• Do NOT touch a patient who is in contact with
electricity
• Break electrical circuit
• ABCs
• CPR
• Trauma care
• Keep patient warm
Transport
• Warm transport vehicle!
• Support airway and breathing
• Assess and treat trauma
• Large bore IVs: Ringer’s Lactate preferred
• Elevate burned extremities
• Cover with dry sheet/blanket
History
• Time of burn
• Cause
• Smoke Inhalation?
• Trauma?
• Pre-existing medical conditions/medications?
• First responder care at the scene
Severity of Burn Injury
• Burn depth (degree)
• Areas of circumferential full-thickness
• Burn size (% TBSA)
• Burns of “special areas”
• Concomitant injuries
• Smoke inhalation
• Trauma
Burn Depth - Degree
Burn Severity - First Degree
Burn
• Superficial, involving only epidermis
• Local pain and erythema
• Little or no systemic response
• Usually heals in 3-5 days without scarring
• Does not count in burn calculation!
Severity of Burn – Depth
Partial Thickness (Second
Degree)
• Extends into dermis
• Best identified by MOIST surface
• Exquisitely painful and oedematous
• Usually red
• Associated with scalds, flashes and brief contact with hot
objects
Blisters are usually partial-thickness
Healing of the Partial Thickness
Burn
• Heals by epithelialization
from epidermal remnants
in the dermis
• Heals in 7-21+ days with

variable amounts of
scarring
Full Thickness Burn
(Third Degree)
Severity of Burn - Depth
• Extends through skin into deeper tissue
• Usually dry, leathery and painless
• May be white, brown, black, greenish
• Associated with flame, grease, very hot object, or
extended duration of contact
• Circumferential eschar around extremity or trunk can
have tourniquet effect
Third degree burn (Full-
thickness)
Circumferential Eschar
• Monitor BP/pulse
• Complaints of numbness and
tingling
• Loss of motor function
• Decreased capillary refill
• Cyanosis
• Aching, throbbing pain
Circumferential Eschar
• Circumferential
trunk eschar can
lead to
respiratory
embarrassment
Escharotomies
• Done in bed, with scalpel or electrocautery
• Incisions just through eschar
A Skin Graft is applied for definitive closure
of the wound.
Burn Size Determination
Severity of Burn - Size
• Rule of Nines
• Lund and Browder Chart
• Rule of the Palm
• Fluid resuscitation and surgery plans will be based on

this calculation
Special Burned Areas
Severity of Burn – Special Burns
• Face
• Hands
• Feet
• Across joints
• Perineum
• Circumferential full-thickness
Face
• Airway
• Maintaining
• Securing
• Eyes
• Disfigurement
• Contracture
Hands
• Oedema
• Function
• Webbing
• Contracture
• Pain
• Body image
Across Joints
• Contracture
• Disability
Perineum
• Contamination
• Faecal management
• Webbing
• Pain
• Body Image
Smoke Inhalation
Significance
• In Burned individuals,
• Smoke inhalation increases mortality significantly
• increases resuscitation fluid requirements
• Fire consumes oxygen – can lead to an hypoxic arrest
when patients are in a closed space
How much Fluid do you give in
burns?
1. Using Parklands formula:
2-4 X wt(Kg) X %(BSA) = mls in 24 hrs
Give half this volume in 8 hrs, the other half in 16 hrs.
e.g. 2 X 60kg(patient) X 20% Burnt body surface area = 2,400mls in
24hrs.
Therefore, ½ X 2400mls = 1200ml in 8hrs, then 1200mls in 16 hrs
Intravenously
.
2. Muir and Barclay formula:
Wt(Kg) X % (BSA)/2 = mls colloid/unit time
Unit time: 4,4,4,6,6,12(hrs)
e.g. 60kg(patient) X 20% burnt body surface area/2 = 600mls/unit time
Therefore, give 600mls every 4 hrs X 3 unit times = 1,800mls in 12hrs
then 600mls every 6 hrs X 2 unit times = 1,200mls in 12hrs
then 600mls in 12 hrs X 1 unit time = 600mls
.
•Thank You

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Burns

Joseph Katawa Mwale

• Stop the burning process

• Heals in 7-21+ days with

• Fluid resuscitation and surgery plans will be based on

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