Short Summery of Burn for MBBS Students

1. Dr. Md. Majedul Islam
FCPS(Surgery)
Burn

2. Burn
 Def: Thermal injury characterized by coagulation
necrosis of the affected tissue.
 Burn is caused by contact with
1. Dry Heat(Fire)
2. Moist Heat(Steam, hot liquid)
3. Chemical(Acid or alkali)
4. Electricity
5. Radiation energy
6. Electromagnetic energy

3. Classification
 Burns can be classified by depth, mechanism of
injury, extent, and associated injuries. The most
commonly used classification is based on the
depth of injury and extent

4. According to the
depth(Bailey&Loves)
Superficial partial-thickness burns:
 goes no deeper than the papillary dermis. The
clinical features are blistering and/or loss of the
epidermis. The underlying dermis is pink and
moist. The capillary return is clearly visible
when blanched. Pinprick sensation is normal.
 This burns heal without residual scarring in 2
weeks. The treatment is non-surgical

5. Deep partial-thickness burn
 Involve damage to the deeper parts of the reticular
dermis .
 Clinically, the epidermis is usually lost.
 The colour does not blanch with pressure under the
examiner’s finger. Sensation is reduced, and the
patient is unable to distinguish sharp from blunt
pressure when examined with a needle.
 Deep dermal burns take 3 or more weeks to heal
without surgery and usually lead to hypertrophic
scarring.

6. Full-thickness burns
 The whole of the dermis is destroyed in these burns
 Clinically, they have a hard, leathery feel. There is no
capillary return. Often, thrombosed vessels can be
seen under the skin. These burns are completely
anaesthetised: a needle can be stuck deep into the
dermis without any pain or bleeding.

7. Traditionally
 1. First Degree burn: only epidermis
 2. Second Degree burn: Epidermis & part of
dermis.
 3. Third Degree Burn: Full thickness burn.

8. Features of burn
 1st Degree: erythema with minimal skin edema and
minimal tissue damage, no systemic effect. Pain is
the main symptom. healing without sacr. Usually
caused by sunburn, scalding(moist heat).
 2nd Degree: Blister formation.Heal with minimal
scarring.
Remember: 2nd degree burn converted into 3rd
degree burn when it is infected.

9.  Feature of 3rd Degree burn:
1. White waxy appearance
2. No blister
3. Lack of sensation
4. Heals by fibrosis with eventual contracture and
deformities

10. Burn wound asessment
Assessing the area of a burn
 The patient’s whole hand is 1 per cent TBSA,
and is a useful guide in small burns
 The Lund and Browder chart
 The rule of nines

12. Complication of Burn
 Immediate
1. Hypovolemia & shock with electrolyte imbalance.
2. Renal failure
3. laryngeal oedema, chemical alveolitis and
respiratory failure in inhalation burn injury and also
metabolic poisoning by Inhaled poisons, such as
carbon monoxide
4. Hypothermia
5. Curling’s ulcer(Acute GIT ulcer)
6. limb-threatening ischaemia (in circumferential limb
burn)

13. Complication Contd
 Delayed:
1. Wound infection
2. Respiratory complication like pneumonia
3. Renal failure
4. Septicemia
 Late:
1. Hypertrophic scar or keloid
2. Post burn contracture or deformity
3. Marjolin’s ulcer of the burn scar

14. Pathology of Shock in Burn
 Burns produce an inflammatory reaction
 This leads to vastly increased vascular
permeability
 Water, solutes and proteins move from the intra-
to the extravascular space
 The volume of fluid lost is directly proportional to
the area of the burn
 Above 15 per cent of surface area, the loss of
fluid produces shock

15. Dangers in a Burn Patient
 1. Hypovolemia & shock(Mainly due to loss of
plasma and fluid)
 2. Multiple organ failure(Kidneys, liver and lungs)
 Sepsis
 Hypothermia

16. Management of burn patient
Pre-hospital care The principles of pre-hospital care are:
 Ensure rescuer safety.
 Stop the burning process. Stop, drop and roll is a
good method of extinguishing fire burning on a person.
 Check for other injuries. A standard ABC (airway,
breathing, circulation) check followed by a rapid
secondary survey will ensure that no other significant
injuries are missed.
 Cool the burn wound. This provides analgesia and
slows the delayed microvascular damage that can occur
after a burn Injury
 Elevate. Sitting a patient up with a burned airway may
prove life-saving in the event of a delay in transfer to
hospital care. Elevation of burned limbs will reduce

17. Hospital Care
Initial assessment:
1. Take History of patient and burn(Type, site of
burn, nature, any associated injury)
2. Vitals(BP, Pulse, Resp rate, Temp)
3. Extent(Rule of 9) & Depth of burn

18. Immediate Management
1. Secure airway (specially for inhalational burn)
2. Start I.V fluid, send blood for grouping and
cross matching
3. Immunization against Tetanus
4. Relief of pain by analgesics(morphine or
pathidine)
5. Blood Transfusion if available
6. Antibiotic
7. Anti ulcerant
8. Local wound care

19. Fluid Resuscitation in Burn
1st Twenty four(24) hous:
 Crystalloid solution(most commonly Ringers
lactate. If not available the normal saline)
 Modified Parkland/Brooke formula: (2-4ml X Wt
in Kg X %of burn in TBSA =1st 24 hr )
 Here Half fluid(50%) given in first 8 hours, then
remaining half or 50% fluid in next 16 hours.

20. Second 24 Hours
 Colloid solution is added with crystalloid solution
 Brooke army formula for colloid solution:
0.5ml X Wt in kg X % of TBSA(Total body
surface area) burned
 Colloid solution are :
1. Plasma
2. 4.5% Albumin
3. Whole blood
4. Dextran

21.  Subsequent fluid therapy is adjusted by
observing:
1. State of hydration of the patient
2. Urine output
3. Measurement of serum electrolytes, blood urea
and creatinine

22. For children
 In children, maintenance fluid must also be given
with resuscitation. This is normally dextrose–
saline given as follows:
 100 mL/kg for 24 hours for the first 10 kg;
 50 mL/kg for the next 10 kg;
 20 mL/kg for 24 hours for each kilogram over 20
kg body weight.

23. Remember
 When IV fluid is given : In children with burns
over 10 per cent TBSA and adults with burns
over 15 per cent TBSA, consider the need for
intravenous fluid resuscitation

24. Monitoring of a Burn Pt
 Vitals
 Urine Output(0.5ml/kg/hour)
 Central venous pressure(CVP)
 ABG(arterial blood gas analysis)
 Blood(electrolyte, creatinine, sugar,urea,)

25. Local Wound Care
 Clean water or normal saline to wash the wound
 For superficial burn: Silver sulphadiazine cream
then occlusive dressing to minimize exposure to
air and to hasten re-epithelisation and to
decrease pain
 For deep burn: debridement and skin grafting and
splintage

26. Measure to prevent complication
 Dressing every alternate day for 3 week
 Escarotomy for deep or full thickness burn
 High protein diet
 Physiotherapy to prevent deformity or contracture
 Psychological support

27. Escharotomy
 Circumferential full-thickness burns to the
limbs require emergency surgery. The
tourniquet effect of this injury is easily treated by
incising the whole length of full-thickness burns.
 This should be done in the mid-axial line,
avoiding major nerves .
 One should remember that an escharotomy can
cause a large amount of blood loss; therefore,
adequate blood should be available for
transfusion if required.

29. Escarotomy