‫‪first aid in burn related injuries‬‬

‫‪Supervision by:‬‬
‫م‪.‬م حسين عوض‬
‫‪Done by:‬‬
‫ميالد امجد عبد العزيز‬
‫أماني عماد عبد االمام‬
‫زهراء اسامة علي‬
‫فاطمة احمد خليل‬
‫زهراء علي عبد الحافظ‬

‫‪Anesthesia technique’s department‬‬

‫‪Stage 4.‬‬
Burn injuries

Burn injuries are an under-appreciated trauma that can affect anyone, anytime
and anywhere. The injuries can be caused by friction, cold, heat, radiation,
chemical or electric sources, but the majority of burn injuries are caused by
heat from hot liquids, solids or fire. Although all burn injuries involve tissue
destruction due to energy transfer, different causes can be associated with
different physiological and pathophysiological responses. For example, a flame
or hot grease can cause an immediate deep burn, whereas scald injuries (that is,
from hot liquids or steam) tend to appear more superficial initially, due to rapid
dilution of the source and energy. Alkaline chemicals cause colliquative
necrosis (whereby the tissue is transformed into a liquid, viscous mass), whereas
acidic burn causes a coagulation necrosis (whereby the architecture of the dead
tissue can be preserved)

Thermal injury can also occur through cold. Frostbite is caused by a number of
mechanisms including direct cellular injury from crystallization of water in
tissue and indirect injury from ischaemia and reperfusion. These mechanisms
lead not only to skin necrosis but also to deep tissue damage. The particular
cause of a burn injury determines the treatment approach. For example,
although deep thermal burns are operated on immediately, the same approach
would be an error in frostbite, in which the therapy of choice is moist
rewarming, possible thrombolysis and watchful waiting.

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burns are classified as either minor or major. A minor burn is usually a burn that
encompasses <10% of the total body surface area (TBSA), with superficial
burns predominating. severe burn injuries are: >10%TBSA in elderly patients,
>20%TBSA in adults and >30%TBSA in children.

The Rule of Nines, is a tool utilized by medical providers to assess the total
body surface area (TBSA) involved in burn patients. The measurement of the
initial burn surface area is important in estimating fluid resuscitation
requirements, as patients with severe burns will have insensible fluid losses due
to loss of the skin barrier

● The entire head: 9% (4.5% for anterior and posterior)

● The entire trunk: 36% (can be further broken down into 18% for the
anterior torso and 18% for the posterior
torso)
● The anterior aspect of the trunk: Can
further be divided into the chest and
abdomen, each representing 9%
● The upper extremities: 18% (includes 9%
for each upper extremity)
● Each upper extremity: Can be further
divided into its respective anterior and
posterior portions (4.5% each).
● The lower extremities: 36% (18% for
each); can be further divided into 9% for the
anterior and 9% for the posterior aspect
● The groin: 1%

Only second- and third-degree burns, more commonly referred to as partial- and
full-thickness burns, respectively, are included in the determination of the
TBSA. This method aids hospital and prehospital providers in making a quick
assessment to determine the severity, indications for intravenous fluid
resuscitation, and the need for transfer to a certified burn center. Age and body
mass index (BMI) are several factors that may affect changes to the Rule of
Nines.

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Skin and burns classification

Knowing the skin's structure is crucial in identifying the appropriate burn depth. The
skin comprises 2 layers: the epidermis and the dermis. The outermost layer, the
epidermis, contains multiple layers and significant cell components such as
melanocytes and keratinocytes. Underneath the epidermis lies the dermis, which
consists of the superficial papillary dermis and deep reticular dermis. The papillary
dermis is thin and comprises capillaries and various connective tissues like elastin,
mainly collagen, and reticular fibers. The reticular dermis is more dense and contains
more organized elastin, collagen type I and III, and larger blood vessels than the
papillary dermis. The epidermis primarily acts as a protective layer that prevents fluid
loss, while the dermis provides skin elasticity and strength.

Superficial Burns
A superficial (first-degree) burn involves the epidermis only. These burns can be
pink-to-red, without blistering, are dry, and can be moderately painful. Superficial
burns heal without scarring within 5 to 10 days.
Partial-Thickness Burns
A second-degree burn, also known as a superficial partial-thickness burn, affects the
superficial layer of the dermis. Blisters are common and may still be intact when first
evaluated. Once the blister is unroofed, the underlying wound bed is homogeneously
red or pink and will blanch with pressure. These burns are painful. Healing typically
occurs within 2 to 3 weeks with minimal scarring.
A deep partial-thickness burn involves the deeper reticular dermis. Similar to
superficial partial-thickness burns, these burns can also present with blisters intact.
Once the blisters are debrided, the underlying wound bed is mottled and will
sluggishly blanch with pressure. The patient with a partial-thickness burn experiences
minimal pain, which may only be present with deep pressure. These burns can heal
without surgery, but it takes longer, and scarring is unavoidable.
Full-Thickness Burns
A third-degree burn, also known as a full-thickness burn, is most severe and affects
the epidermis and dermis skin layers. They also extend into the subcutaneous tissue.
These burns result in a leathery, stiff, and dry appearance. At this depth, the affected
area does not blanch under pressure due to compromised blood supply. The nerves at
this depth are also damaged, resulting in the patient experiencing no sensation or pain.
These burns take more than 8 weeks to heal and require surgical treatment.

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Burn Complications
Burn injuries can lead to several complications, especially in severe cases.
These complications can affect not only the burned area but potentially the
entire body, especially if the burn is extensive. Here are the primary
complications associated with burns:

1-Infection

Burns break the skin barrier, increasing the risk of bacteria entering and
causing infection. Infection can spread to surrounding tissue (cellulitis) or enter
the bloodstream, leading to sepsis, a life-threatening systemic
infection.Symptom include Redness, swelling, warmth, discharge, or fever.

2. Fluid Loss and Dehydration

Severe burns can cause plasma and fluids to leak out of blood vessels,
especially with second- and third-degree burns.This can lead to hypovolemic
shock (a significant drop in blood volume), which can affect organ
function.Symptoms include Dizziness, low blood pressure, rapid heart rate, and
confusion.

3. Hypothermia

Since the skin regulates body temperature, large burns can impair this function,
leading to a drop in body temperature. Hypothermia can occur if heat loss is too
significant, especially in severe burns covering a large area of the body.
Symptoms include Shivering, fatigue, confusion, and slowed breathing.

4. Scarring and Contractures

Burns that damage deeper skin layers often result in scar tissue formation. Scar
tissue lacks the elasticity of normal skin. Contractures (tightening of skin and
underlying tissues) can limit mobility and function, especially near joints.
Thickened, tight skin, and restricted movement in the affected area.

5. Psychological Effects

Severe burns and the resulting scars can impact a person’s body image and
emotional well-being. Anxiety, depression, and post-traumatic stress disorder
(PTSD) are common, particularly in burns involving visible areas like the face.

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Minor Burns first aid
For burn injuries, immediate and proper first aid can greatly affect healing and
reduce complications. The minor burns also known as first-degree burns and
superficial burns that effect only the outer layer of the skin.

1. Stop the Burning

Remove the source of the burn (hot object, flames, etc.). Remove any jewelry or
tight clothing near the burn site, as swelling may occur.

2. Cool the Burn

Cool-packs or even ice are unsuitable, as they can lead to a sustained and
harmful decrease in capillary perfusion around the burned skin as it can worsen
the injury, Run cool area water over the burn for 10-20 minutes. This helps
reduce pain and prevents further tissue damage.

3. Protect the Burn

Cover with a sterile, non-stick bandage or clean cloth. Avoid applying creams,
butter, or oils, as these can trap heat and cause infection.

4. Prevent Infection

Do not pop blisters if they form, as they protect the underlying skin. Cover with
a clean dressing and change it daily or as directed.

5.Pain Relief

Take an over-the-counter pain reliever, like ibuprofen or acetaminophen, as

directed.

6. Seek Medical Help for Severe Burns

Call emergency services if the burn is large, deep, located on the face, hands,
feet, genitals, or a joint, or if it’s from chemicals/electricity.

Seek immediate help for burns in children or the elderly, as they can be more
serious.

Proper first aid helps prevent further damage, reduces pain, and minimizes
scarring. For serious burns, immediate medical attention is crucial.

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Major burns first aid
Major burns are severe injuries that affect multiple layers of the skin and, in
some cases, the underlying tissue. These burns require immediate medical
attention and are often classified as second-degree (partial-thickness) or
third-degree (full-thickness) burns.

For severe burns, emergency response is critical to minimize damage and

stabilize the patient until professional medical help arrives.

1. Call Emergency Services

Seek immediate medical help, as severe burns can be life-threatening and need
prompt professional attention.

2. Ensure Safety First

Make sure the scene is safe to approach. If it involves fire, chemicals, or

electricity, ensure you and the victim are away from the hazard. If possible, turn
off the source of the burn (e.g., electrical current, flames).

3. Do Not Remove Burned Clothing Stuck to Skin

Carefully remove any loose, non-stuck clothing or jewelry around the burned
area, as swelling can occur.

4. Cover the Burn

Cover the burn area with a cool, moist, sterile bandage, clean cloth, or a
non-stick dressing. This can help reduce pain, prevent contamination, and keep
the area cool.Avoid ice or very cold water as it can cause further damage to the
tissue.

5. Monitor Breathing and Vital Signs

If the person is unresponsive, check for breathing and pulse. Begin CPR if
needed. Keep the person calm and check for signs of shock (pale, clammy skin,
rapid pulse, dizziness), which can be common in severe burns.

6. Elevate the Burned Area (if possible)

If it doesn’t cause pain, try to keep the burned area elevated above the level of
the heart to reduce swelling.

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7. Keep the Person Warm and Comfortable

Use a dry blanket or clothing to cover the person, avoiding any contact with the
burn area. Severe burns can impair the body’s ability to regulate temperature,
leading to hypothermia.

8. Avoid Applying Creams or Ointments

Do not apply creams, oils, or any home remedies as they can interfere with
medical treatment and increase infection risk.

9. Do Not Give Food or Drink

Do not give anything by mouth, especially if the person may need surgery or
anesthesia soon.

*The first aid for treating severe burns is based on guidelines provided by
medical sources, including the Mayo Clinic, the American Burn Association,
and emergency care protocols widely recommended by organizations such as
the American Red Cross.

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Resource
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from 2009–2018

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2020).

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Hussain M. Clinical and demographic features of burn injuries in karachi: a six-year
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Let a Layman Do the Assessment. J Burn Care Res. 2018 Feb 20;39(2):295-301.

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Zhang Y, Timashev P. Skin tissue regeneration for burn injury. Stem Cell Res Ther.
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9-Giretzlehner M, Ganitzer I, Haller H. Technical and Medical Aspects of Burn Size

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