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Burns 2

Burns are thermal injuries classified into four degrees based on severity, with 1st degree affecting only the epidermis and 4th degree extending to underlying tissues like muscle and bone. Assessment of burn severity considers factors such as age, extent, depth, site, and associated injuries, while management includes immediate care, fluid replacement, and local treatment. The Rule of Nines is used to estimate the extent of burns in adults, but alternative methods are necessary for children due to proportional differences in body size.

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Kaung Khant
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10 views5 pages

Burns 2

Burns are thermal injuries classified into four degrees based on severity, with 1st degree affecting only the epidermis and 4th degree extending to underlying tissues like muscle and bone. Assessment of burn severity considers factors such as age, extent, depth, site, and associated injuries, while management includes immediate care, fluid replacement, and local treatment. The Rule of Nines is used to estimate the extent of burns in adults, but alternative methods are necessary for children due to proportional differences in body size.

Uploaded by

Kaung Khant
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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General Surgery Eindra

BURNS
DEFINTION

 Burn – is a thermal injury caused by a dry heat


 Scald – is a thermal injury caused by a moist heat

AETIOLOGICAL AGENTS
A. Physical Agents
1. Heat
 Dry heat ( eg: flame, burn )
 Moist heat ( eg: hot water, steam )
2. Irradiation
3. Sunburn
4. Friction
5. Electrical burn
6. Cold injury ( eg: frostbite )
B. Chemical agents
1. Acid
2. Alkali
3. Phosphorous

CLASSIFICATION OF BURNS

According to degree of burn


1. 1st degree burn
 Only involves epidermis
 Erythema, blister & discomfort & Pain ( + )
 Within a few days, heal without scarring

2. 2nd degree burn


 Super partial-thickness
 Involves papillary dermis
 Blister, discomfort & Pain (+)
 Spontaneous healing can occur
 Deep partial-thickness
 Involves reticular dermis
 Pale, do not blanch & painful to pin-prick test
 Heal only under most optimal condition

3. 3rd degree burn ( Full thickness )


 All epidermis & dermis are destroyed
 No erythema, blister, no skin sensation of Pin-Prick test
 Hard, leathery feeling
 Spontaneous healing cannot occur , requires skin graft

4. 4th degree burn


 Extends beyond dermis & involves skin, fat, fascia, m/s & bone

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General Surgery Eindra

According to Severity of burn


1. Major burn
2. Minor burn

ASSESSMENT OF SEVERITY OF BURN

1. Age
 Extremes of age ( <3yr / >60yrs ) – Major burn

2. Extent of burn
 Wallace’s Rule of Nines ( used for adults )
 Rule of Palm ( used for children )
 Lund & Browder chart ( useful for both children & adults )
 >15% in adult & >10% in child – Major burn

3. Depth of burn
 1st & 2nd degree burn of >15% in adult
 1st & 2nd degree burn of >10% in children Major Burn
 3rd degree burn of 5% in both adults & children

4. Site of burn
 Burn at primary areas ( Face, Neck, Hand, Feet & Perineum ) – Major burn

5. Associated injuries Or illness


 Associated injuries ( eg: #, other wounds ) Major Burn
 Underlying illness ( eg: CRF, CVS disease, DM )

6. Respiratory tract Burns


 Laryngeal odema, bronchospasm, hypoxia, stridor, wheezing – Major Burn

MANAGEMENT OF BURN PATIENT

I. Immediate care & resuscitation


 Remove the patient from burning
 Remove the burnt clothing
 Irrigate with copious amt of clean water
 Keep airway patent , Maintain Breathing , Adequate Circulation & arrest of H’ge
 Send the patient to nearest hospital

II. Definitive Treatment


 Differentiae Major or Minor burn
 Minor Burn  treated as outpatient
 Analgesics, antibiotics, Anti-tetanus toxoid
 Clean the wound
 Antibiotics cream applied over the wound
 Cover the wound with 3 layered dressing
 Major Burn  admitted to the hospital

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General Surgery Eindra

A. Fluid replacement
 Fluid loss is maximal in 1st 24 hrs

1. Indications for fluid infusion - >15%burn in adults & >10% in children

2. Type of fluids
 Crystalloids ( N/S or RL )
 Colloids ( plasma, plasma expander , albumin )
 Blood
st
1 24 hrs  crystalloids should be given
2nd 24 hrs  colloids should be given ( to restore serum albumin )
3rd day & after  oral fluids or Nasogastric tube feeding should be given

3. Amt – can be calculated by various formula. But, formulae are rough guideline. So,
clinical monitoring ( esp: Urine Output ) is more important.

Muir & Barclays formula ( Commonest Colloid-based formula )

% 𝑜𝑓 𝑏𝑢𝑟𝑛 𝑥 𝑏𝑜𝑑𝑦 𝑤𝑒𝑖𝑔ℎ𝑡


One ration (ml) =
2

 Upto 12hrs of injury  give 3 rations


 12 to 24 hrs of injury  give 2 rations
 24 to 35 hrs of injury  give 1 rations

Parkland formula

Adult  4 x body weight ( kg) x % of burn


Child  3 x body weight ( kg ) x % of burn
 1st 8hrs  50% of total amt calculated
 2nd 8hrs  25% of total amt calculated
 3rd 8hrs  25% of total amt calculated

B. Local treatment of burn wound

 Em escharotomy is indicated for circumferential burn of extremities or chest .

For 1st & 2nd degree


 Open Dressing Technique
 Clean the wd with soap & water, wound debridement, wash with antiseptic
solution
 Isolate the patient & allow the wound to evaporate & to form dry thick scab
over the burn wound
 The scab will act as physiological dressing
 When epithelial healing has occurred , the scab will fall off by itself

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General Surgery Eindra

 Closed dressing Technique


 Clean the wd with soap & water, wd debridement, wash with antiseptic
solution
 Wound is covered with 3 layers dressing
1st layer  antibiotics cream or sliver
2nd layer  non-adherant gauze with absorbent cotton
3rd layer  bandage
 Semi-open Technique
 Application of silver nitrate or silver sulphadiazine solution over the wound
repeatedly

For 3rd & 4th degree


 Wait spontaneous desloughing & apply skin graft at 3 weeks
 Early excision & skin graft application

C. General Tx
 Adequate analgesiscs
 Antibiotics
 Anti-tetanus toxoid
 Adequate hydration
 Nutritional support

D. Monitoring
 Clinical  vital sigsn ( Temp, PR, BP, SpO2, UO )
 Investigation  U&E, Cr, RBS, Serum albumin, ABGA

E. Prevention & Treatment of Cx


 For Respi tract burn  oxygen, ventilator support
 For Curling ulcer  IV PPI
 For ARF  adequate hydration
 Correct electrolyte imbalance
 Psychological support

Add Note : : RULE OF NINE

 It is used to assess extent of burnt body surface area in adult

1. Entire head 9%
2. Each are/forearm 9%
3. Anterior chest 9%
4. Abdomen 9%
5. Upper back 9%
6. Buttock & Lower back 9%
7. Each thigh 9%
8. Each leg 9%

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General Surgery Eindra

9. Perineum 9%

 Estimated burnt body surface area can be used to calculate amt of fluid or resuscitation
 Rule of NINE cannot be applied in children because head is larger in proportion to body &
lower limb is smaller in proportion to body
 In children, Rule of palm  patient’s palm are = 1% of body surface area

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