1. BURNS MANAGEMENT
Dr. Mansoor Khan, MBBS, FCPS-I, PGY2
Khyber Teaching Hospital, Peshawar

2. “Coagulative necrosis of tissue
due to extremes of temperature,
chemicals or irradiation”

3. Carelessness(40%), Accidents(35%), Fit or
faint(5%),Alcohol(5%), Psychiatric(5%)
Scalds account for 60% of burns in children
Flame accounts for 50% of burns in adults
Contact(10%),Electrical(5%),Chemical(3%)

4. SCALDS

5. FLAME

6. CONTACT

7. ELECTRIC

8. CHEMICAL

9. RADIATION

10. RADIATION

11. Jackson’s burn wound model

12. Jackson’s burn wound model

13. S
K
I
N

14. FIRST DEGREE BURNS
Epidermal layer, Pink, painful, and edematous
Heals 3-5 days w/o scarring
Causes: Flame, Sun, Flash from explosion

15. SUPERFICIAL SECOND DEGREE
Epidermis and papillary region of dermis, Blisters, bullae, serous fluid
Cherry red moist appearing, Painful, sensation intact, Edematous
Heals in 7-28 days with minimal scarring
Cause: flame, flash, scald, contact

16. Epidermis and reticular region of dermis
Blisters, bullae, serous fluid, Pale ivory moist appearing
Painful, sensation intact, Edematous, Heals in 7-28 days with variable scarring
Cause: flame, flash, scald, contact
DEEP SECOND DEGREE

17. THIRD DEGREE FULL THICKNESS
Extends into subcutaneous tissue, White, yellow, brown leathery
Appearance, Thrombosed vessels, loss of elasticity, marked edema
Possible escharotomy, Painless to touch, Requires grafting
Causes: flame, electricity, chemicals, prolonged exposure
May take 2-3 days to fully present true depth

18. FOURTH DEGREE
Extends to muscle, Loss of function, Black, charred appearance
May require amputation, May require escharotomy and fasciotomy
Causes: very prolonged exposure to flame, chemicals, and high voltage

19. Total body surface area burned
Palmar Surface of Patient’s Hand =1%
Wallace’s “Rule of Nines”
Lund and Browder Charts

20. Lund-Browder chart

23. Management of the Burns Patient
Prevention
First Aid Measures
Emergency treatment/triage
Acute/on-going phases
Reconstruction/rehabilitation

24. First Aid Measures for Burns
Remove patient from cause.
Put out flames “stop, drop and roll”.
Blanket or douse with water
Remove clothing in scalds
Airway, protect c/spine, give oxygen
Calm and reassure patient

25. COOL THE BURN SURFACE
Cold running water or packs between 8 and 25
deg C for 30 mins.
15 deg C is ideal temp
Temperatures below 5 deg may deepen burn
Watch for HYPOTHERMIA!
Wrap patient in clean sheet or towel and keep
warm

26. Emergency treatment/triage
ABCDE
Secondary Survey
Triage Area,depth Minor vs Major
Analgesia
?Resuscitate ?Monitoring
?Admit
Dressing

27. Burns are extremely painful
Morphine 0,05-0,1 mg/kg as
starting dose
Avoid oral or im routes
Entonox
Ketamine

28. Tetanus Prophylaxis
Antibiotics

29. Parkland formula
4 mL/kg body weight per percentage burn TBSA
half the volume is given in the first 8 hours postburn,
with the remaining volume delivered over 16 hours

30. Burns Surgery
Escharotomy
Tangential Excision
Excision
Excision to deep fascia
Repair-direct, graft or flap
Reconstruction

31. Escharotomy
Circumferential deep burns to
limbs, chest and abdomen
Incisions
Depth of incision
No anaesthetic except for kids

33. Excision/direct closure

34. Skin grafting:

35. Skin grafting:

36. Reconstruction

39. THANKS