By:
AILEEN C. CONTRERAS-LIMJOCO M.D.
Burns
are a type of traumatic injury caused by
Essentials of Diagnosis:
Estimates of the burn location, size and depth
TYPES OF BURNS
Types of Burns
THERMAL BURNS
burns due to external heat sources which raise the temperature of the skin
RADIOLOGICAL
CHEMICAL
Caused by strong acids or alkali substances. They
Classification of Burns
Classification of Burns
Determining burn depth is important.
Things to consider are temperature,
First degree
Includes only the outer layer of skin, the
epidermis
Skin is usually red and very painful
Equivalent to superficial sunburn without
blisters
Dry in appearance
Healing occurs in 3-5 days, injured epithelium
peels away from the healthy skin
Hospitalization is for pain control and maybe
fluid imbalance
Classification of Burns
Normal skin
Sunburn
Second degree
Can be classified as partial or full thickness.
the dermis
Wound will be pink, red in color, painful and wet
appearing
Wound will blanch when pressure is applied
Should heal in several weeks (10-21 days)
without grafting, scarring is usually minimal
Classification of Burns
Normal skin
Scald Injury
Second degree
Deep Partial thickness
Can be red or white in appearance, but will
appear dry.
Involves the destruction of the entire epidermis
and most of the dermis
Sensation can be present, but diminished
Blanching is sluggish or absent
Deep partial thickness will most likely need
excision & skin grafting to heal
These burns do not heal in less than three
weeks and often result in scarring and
contractures
Classification of Burns
Normal Skin
Third Degree
All layers of the skin is destroyed
Extend into the subcutaneous tissues
Areas can appear, black or white and will be
dry
Can appear leathery in texture
Will not blanch when pressure is applied
No pain
Can result to contractures
Classification of Burns
Normal Skin
Fourth degree
Full thickness that extends into muscle and
bone.
most severe form of burn affects structures
well beyond the skin, such as muscle and
bones.
The skin may appear blackened or charred.
If nerve damage is substantial, you may feel
no pain at all.
Fourth degree
Management OF BURNS
Goal:
Protect the wound from desiccation and avoid
Assess:
Airway
Breathing: beware of inhalation and rapid
airway
compromise
Circulation: fluid replacement
Disability: compartment syndrome
Exposure: percentage area of burn.
of 9s)
Good IV access and early fluid replacement.
Rule of 9s
Depth of Burn
Layers Involved
Characteristics
First Degree
Epidermis
Red without
blisters
Dry, Painful
Second Degree
Superficial
Partial Thickness
Extends into
superficial dermis
Second Degree
Deep Partial
Thickness
Yellow or white.
Less blanching.
May be blistering.
Fairly dry,
Pressure and
Discomfort
Third Degree
Full Thickness
Extends through
entire dermis
Stiff and
white/brown No
blanching,
Leathery,Painless
Fourth Degree
Extends through
entire skin, and
into underlying fat,
Depth of Burn
Healing Time
Prognosis
First Degree
5-10 days
(reepitheliazation)
Second degree
Superficial Partial
Thickness
Local infection/
cellulitis may occur
but no scarring
Second Degree
Deep Partial
Thickness
3-8 weeks
Scarring,
Contractures may
occur (may require
excision and skin
grafting)
Third Degree
Prolonged(months)
and Incomplete
Scarring,
contractures,
amputation (early
excision
recommended
Fourth Degree
Amputation,
significant functional
impairment and, in
some cases, death
Management:
1.) CHEMOPROPHYLAXIS
A.) Tetanus Immunization
B.) Antibiotics
2.) SURGICAL MANAGEMENT
A.) Debridement, dressings, and topical and
systemic
antibiotic therapy
Management
First Degree
1. Prompt cold applications (ice water or cold
Management
Second degree
1. Vesicles or blebs should not be opened or
2.
3.
4.
5.
Management
Third degree and Fourth degree
Admit patients and administer intravenous fluid to
BURN PREVENTION
In the Kitchen
Keep pot handles turned away from the edges of the stove &
In the bathroom
Stir bath water with your hand to avoid hot
Flammable Liquids
Do not clean with gasoline
Do not use gasoline or other flammable liquids to start
Thank you