 Burn wounds occur when there is contact between

tissue and an energy source, such as heat,

chemicals, electrical current, or radiation.

 The
effects of the burn are influenced by the:
intensity of the energy
duration of exposure
type of tissue injured
0 - 4 years, from kitchen, bathroom.
 5-74 years, outdoors, kitchen.
 Teenagers, suicide (females).
 > 75 years, kitchen, outdoors.
examples: cleaning agents...

Remember….
• Tissue destruction may continue for up to 72 hours.
• It is important to remove the person from the burning agent or
vice versa.
• The latter is accomplished by lavaging the affected area with
copious amounts of water.
 Can damage the tissues of the
respiratory tract

 Although damage to the respiratory

mucosa can occur, it seldom happens
because the vocal cords and glottis
closes as a protective mechanisms.
 Injury from electrical burns results from coagulation
necrosis that is caused by intense heat generated from an
electric current.

 The severity depends on:

amount of voltage
tissue resistance
current pathways
surface area in contact with the current
length of time the current flow.
 Fractures oflong bones and vertebra
 Cardiac arrest or arrhythmias--can be delayed
24-48 hours after injury
 Severe metabolic acidosis--can develop in
minutes
 Myoglobinuria--acute renal tubular necrosis.
 Fluids--Ringers lactate or other fluids-flushes
out kidneys--you want 75-100 cc/hr until urine
sample clear
 an osmotic diuretic (Mannitol) may be given to
maintain urine output
Severity is determined by:
• depth of burn
• extend of burn calculated in percent of total body
surface (TBSA)
• location of burn
• patient risk factors
1st
Erythema

Super.

2nd Dermal

Deep
Dermal

Full
3rd
Thickness
Age in years 0 1 5 10 15 Adult
A-head (back or front) 9½ 8½ 6½ 5½ 4½ 3½
B-1 thigh (back or front) 2¾ 3¼ 4 4¼ 4½ 4¾
C-1 leg (back or front) 2½ 2½ 2¾ 3 3¼ 3½
Vital organs of burn:
 Face, neck
 Chest
 Perineum
 Hand
 Joint regions
 Other areas
 Associated trauma
 Inhalation injuries
 Circumferential burns
 Electricity
 Age (young or old)
 Pre-existing disease
 Abuse
• emergent (resuscitative)
• acute
• rehabilitative
 Remove from area! Stop the burn!
 If thermal burn is large--FOCUS on the
ABC’s
A=airway-check for patency, soot around nares,
or signed nasal hair
B=breathing- check for adequacy of ventilation
C=circulation-check for presence and regularity
of pulses
 Burn too large--don’t immerse in water due to
extensive heat loss
 Never pack in ice
 Pt. should be wrapped in dry clean material to
decrease contamination of wound and increase
warmth
 Lasts from onset to 5 or more days but usually
lasts 24-48 hours
 begins with fluid loss and edema formation and
continues until fluid motorization and diuresis
begins
 Greatest initial threat is hypovolemic shock
to a major burn patient!
 Airway management-early nasotracheal or
endotracheal intubation before airway is
actually compromised (usually 1-2 hours after
burn)
 ventilator? ABGs? Escharotomies?
 6-12 hours later: Bronchoscopy to assess lower
respiratory tact
 chest physiotherapy, suction
• Cardiovascular
• Respiratory
• Renal systems
1 or 2 large bore IV lines
 Fluid replacement based on:
• size/depth of burn
• age of pt.
• individualized considerations.
 options- RL, D5NS, dextam, albumin, etc.
 there are formula’s for replacement:
• Parkland formula
• Brooke formula
 Urine output is most commonly used parameter
 Urine osmolarity is the most accurate parameter

 UOP= 30-50 ml/hr in an adult

 Escharotomy / Fasciotomy
 Escharectomy + homograft
 Dressing / hydrotherapy
 Debridement
 Application of autograft
Splinting

 PB contractures management
 Staffshould wear disposable hats, gowns, gloves,
masks when wounds are exposed
 appropriate use of sterile vs. nonsterile techniques
 keep room warm
 careful handwashing
 any bathing areas disinfected before and after
bathing
 Face
• eye
• ear

 Hands & arms

 Perineum

 Physiotherapy
 Analgesicsand Sedatives
 Tetanus immunization
 Antimicrobial agents: Silver sulfadiazine

Nutritional Therapy
• Burn patients need more calories & failure to
provide will lead to delayed wound healing
and malnutrition.
 Burn wound either heals by primary
intention or by grafting.
 Scars may form & contractures.
 Mature healing is reached in 6 months
to 2 years
 Avoid direct sunlight for 1 year on
burn
 new skin sensitive to trauma
B - breathing
U - urine output
R - rule of nines
resuscitation of fluid
N - nutrition
S - shock
silvadene
 2nd or 3rd Degree Burns
 >10% TBSA
 Burns to vital organs of burn
 circumfrential burns
 Electrical Burns
 Chemical Burns
 Inhalation Injury
 Concomitant trauma (If Major Trauma, The
Trauma Center , Not the Burn Center should be
the initial stabilizing unit)
 When in doubt , consult with a burn center
www.elroubyegypt.com