From Wikiversity
Burn Burn is a dry heat injury caused by the application of
flame or heated solid substances to the body resulting coagulation
necrosis of the tissues.
Scalds Scald is a moist heat injury caused by the application
of a liquid, at or near its boiling point or in its gaseous form
(such as steam), to the body.
Causes of burn 1. Dry heat burn – Partial & full thickness
a. Burn b. Flame 2. Moist heat burn – Partial thickness a. Scald 3.
Chemical burn – Partial & full thickness a. Acid b. Alkali 4.
Cold injury – Partial thickness a. Frost bite b. Acute cold burn or
Freezing 5. Friction burn – Partial thickness 6. Irradiation –
Partial thickness 7. Electric burn – Partial & full
thickness
Classification of burns
A) Modern 1. Superficial burn Epidermis fully affected,
sometimes up to part of dermis. 2. Deep burn all layers are
affected. B) Wilson’s Classification 1. First degree burn 2. Second
degree burn 3. Third degree burn C) Traditional 1. Superficial
partial thickness burn 2. Deep partial thickness burn 3. Full
thickness burn
Classification of burn and characteristics:
Depth of burn Characteristics Cause First degree (Superficial)
Erythema Pain Absence of blisters Sunburn
Second degree (Deep partial thickness) Superficial or Deep
Involve epidermis & dermis Blister Intact pain Red or mottled
Flash burns Heals with scars Contact with hot liquids Fire
Third degree (Full Thickness) Involve all skin layers Painless
Dark and leathery Dry Fire Electricity or lightning Prolonged
exposure to hot liquids/ objects
Management of Burn
A) Immediate Pre-hospital Emergency Care • Ensure rescuer safety
first If the rescuer is able to secure himself then he can save
the victim • Stop the burning process STOP-DROP-ROLL is a good
method of extinguishing fire burning on a person • Removal of the
victim from the source of burn • Removal of clothing to reduce
contact burn and further burning • Ensure ABC – airway, breathing,
circulation • First Aid COOL-COVER-CALL Immediate care of a burn
injury should always include: • Cooling all burns with tepid to
cool water, regardless of degree. Continue flushing the area for up
to 10 minutes. Do not apply ice, ointments, butter or other “home
remedies”. • Cover affected areas with a thin clean dry cotton
cloth but no contact with the raw skin. • Call for medical
attention and hospitalize if burn is larger than the victim’s hand
size, if the victim is a child or elderly person.
B) Burn assessment in hospital • Brief history • Ensure ABCDE
(Airway, Breathing, Circulation, Disability limitation,
Environmental exposure control) • Ensure immediate opening of
intravenous channels in different sites • Assessment of extend of
burn by – • Rules of 9’s (Adult, children >10 yrs) • Rules of
9’s – modified (Children <10 yrs) • Rules of palm (Small burn
& Infant) – Palm represents 1% • The Lund and Browder chart –
mostly in specialised burn care centre like DMCH burn unit or City
Hospital • Assessment of the depth of burn (Superficial partial to
deep)
.^ Within a month of our being here, we began hearing talk about Syria requiring visas from Iraqis, like most other countries.
^ Our area averages about 4 hours electricity daily and the rest is generator electricity, which means we can use our ceiling fans, but there’s no way we can use air conditioners.
Formula Parkland
Formula: 4 X body weight in Kg X % of burn = volume in ml
(additional to normal daily needs) Regimen • 1st day – ½ of the
measured fluid in first 8 hrs
½ of the measured fluid in next 16 hrs
• 2nd day – ½ of the measured fluid in next 24 hrs • 3rd day
onward – Maintenance fluid + daily requirement on output. Fluid is
given when – adult burn >15%, children >10%, infant >5% •
Blood transfusion when – adult burn >30% and children >25% •
Monitoring of urinary output, better to catheterize. It should be
0.5-1 ml per Kg body weight per hour. • Prevention of infection by
• Inj TT • Inj Penicillin 10 lac IU 6 hrly (after skin test) or •
Other suitable antibiotics • High protein diet
D) Local Management • Open method (Superficial burn) • Clean
room with good ventilation • Low humidity • No dressing • Local
antiseptic cream (Nebanol) • Closed Method (Deep burn) Dressing in
three layers • Innermost : antiseptic cream • Middle :
Gauze (lubricated) • Outer : Absorbent wool • In body surface
of adult we use 1% Silver Sulphadiazine Cream
(Silcream/Burnsil/Dermazin) • In the face and in children we use
neomycin+bacitracin+polymyxin B combination ointment (Nebanol plus
ointment) • Skin Grafting – in full thickness burn
E) Prevention of Contracture • Keeping the affected part in the
functional position • Regular passive movement
Additional aspect 1. Varieties in burn dressing a.
.^ They've kept us occuppied with them- singing, and soccer, and smoking, stuff like that, satellites used for things which are blasphemous while they occuppy themselves with science etc.
b. Recent advances in medical science invent
hydrocolloid dressing, permeable dressing, silicon sheet, duoderm,
biological synthetic membranes or most effective amniotic membrane.
2. Analgesia a. Strong analgesics initially needed in severe burn
in IV routes but do not use IM. b. Subsequently oral analgesics can
be given afterwards. 3. Gastro protection a. Gastro protective
should be given to prevent stress ulceration in GI tract b. We use
H2 blockers (Neoceptin R/Neotack) or proton pump inhibitors
(Losectil/Proceptin) 4. Nutrition a. Burn is a catabolic state so
it needs extra protein rich diet like egg, milk, meat, fish, pulses
etc. b. In addition vitamin supplementation needed like B-complex,
zinc and most importantly vitamin C c. Fresh lemon are the best
source of Vit. C which helps in rapid healing. d. Calorie
requirement 50-60 Kcal/kg/day 5. Control of infection a. Restrict
the visitor as the victim is immuno-compromised (very difficult
here in Bangladesh, patients attendances are not cooperative) b.
Cleanliness of the care taker of the patient is very important. 6.
Physiotherapy a. It should be started on day 1 b. It prevents the
limbs from future bending or rigidity following post burn
contracture.
Complications
1. Immediate • Compartment syndrome from circumferential burns
(limb burns → limb ischaemia, thoracic burns → hypoxia from
restrictive respiratory failure) • prevent by urgent
escharotomy
2. Early • Hyperkalaemia (from cytolysis in large burns).
Treat with insulin and dextrose. • Acute renal failure
(combination of hypovolaemia, sepsis, tissue toxins). Prevent by
aggressive early resuscitation, ensuring high GFR with fluid
loading and diuretics, treat sepsis. • Infection (beware of
Streptococcus). Treat established infection with systemic
antibiotics. • Stress ulceration (Curling’s ulcer). Prevent with
antacid, H2-blocker or proton pump inhibitor prophylaxis.
3. Late • Contractures.
Figure: Hypertrophic Scar and Electric burn wound
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