1. Dr. Maria Auron, Ilembula 2014
Burns
Dr. Maria Auron, Ilembula 2014

2. Burns Injury to tissues caused by Thermal burns
heat, electricity, chemicals, radiation
Thermal burns
scalds (liquid), contact burns or flame burns
Smoke inhalation can cause
Airway burns, edema, atelectasis, pneumonia and possible CO intoxication
Electrical burns may cause deep tissue necrosis with few initial signs
Children <5 years and elderly >70 years have highest mortality

3. First aid Stop the burning 2. Cool the burn 3. Cover
Extinguish, roll on the ground if on fire, remove burning clothes
If chemical: large amounts of water
2. Cool the burn
20 min cool, running water
No ice, avoid hypothermia
3. Cover
Clean cloth

4. Thermal burns Assessment Extent
Calculate body surface area (BSA) by the ”Rule of nines”

5. Assessment 2. Depth Partial thickness 1st degree (epidermal)
Red, blanches with pressure, painful, pin-prick sensation preserved
2nd degree (part of dermis)
Swollen, red, BLISTERS, moist, pin-prick sensation preserved
Full thickness
3rd degree (full thickness of dermis)
Dry, painless, pale/charred, thrombosed skin vessels

6. Assessment Prevent dehydration and infection of the burn site!
2nd – 3rd degree burns cause
loss of tissue fluid, most fluid loss in the first 24 hours but continues up to 36 hours
Risk for infection with Strep. pyogenes and Pseudomonas
Prevent dehydration and infection of the burn site!

7. Severe burns Extent: Full thickness burns
Adults >15% of BSA
Children >10% of BSA
Full thickness burns
Burns in critical areas (face, hands, feet, perineum)
Circumferential burns of limb or chest
Electrical burns
Inhalation injury
look for smoke around mouth/nose, facial burns, black sputum, respiratory distress -> usually a sign of serious inhalation injury

8. Primary survey for severe burns
Airway – intubate if upper airway obstruction or impending respiratory failure
Breathing – humid oxygen by mask
Circulation – assess color, refill, HR, blood pressure
Insert 1-2 peripheral iv lines
Formal fluid resuscitation in 2nd – 3rd degree burns is critical
Use when burned skin area >15% BSA (10% in children)
Crystalloid solution with Parkland formula

9. Parkland formula for fluid resuscitation

10. Management Analgesia Keep patient warm Wound care
Clean with normal saline
Remove loose debris and large blisters
Cover with paraffin gauze + chlorhexidine dressing, change dressings every 1-2 days
Elevate limbs with circumferential burns, assess distal perfusion (capillary refill, pulse, warmth, color)
-> escharotomy if perfusion is compromised! (cool to touch, weak or no pulse)

11. Management Tetanus prophylaxis
There is no proven benefit from systemic prophylactic antibiotics
Partial thickness burns heal in 2-3 weeks
Full thickness burns need skin grafting, delayed for 2 weeks
Later complications: contractures, scar hypertrophy and keloids

12. Thank you!