Burns

Burns classified by

• Depth

• TBSA (Total Body Surface Area)

• Location

• Patient risk factors

Burns Major complications

• Hypovolemic shock

• Airway compromise

• Infection

• Electrolyte imbalance

THERMAL BURNS

Heat → protein denaturation + tissue destruction

• Can cause: Upper airway edema & Lower airway injury (steam inhalation)

THERMAL BURNS Clinical Manifestations

• Burns to face/neck

• Hoarseness, stridor

• Mucosal edema

• Dyspnea

CHEMICAL BURNS

Corrosive substances → liquefactive necrosis

Damage continues up to 72 hours

Immediate irrigation with water + Use PPE

ELECTRICAL BURNS

 Electrical current → deep tissue damage

Causes: Coagulation necrosis / Rhabdomyolysis /Cardiac arrhythmias

• Small surface burn but severe internal damage

• Entry/exit wounds

SUPERFICIAL Burns

Epidermis only

PARTIAL-THICKNESS

Epidermis + dermis

• Blisters

• Wet, shiny

• Painful

• Blanches

FULL-THICKNESS

Destruction of: Skin / Nerves / Muscle/bone

• Dry, leathery (eschar)

• No pain (nerve destruction)

Requires surgery (grafts)

INHALATION INJURY

Carbon monoxide + cyanide → tissue hypoxia

NEED 100% oxygen

INHALATION INJURY Clinical Manifestations

• Soot in mouth/nose

• Hoarseness

• Stridor

• ↓ SpO2 despite oxyge

BURN SHOCK

• ↑ capillary permeability → fluid shift (3rd spacing)

• ↓ intravascular volume → hypovolemic shock

BURN SHOCK Clinical Manifestations

• Hypotension

• Tachycardia

• Edema

• ↓ urine output

FLUID RESUSCITATION

• 2 large IVs if >20% TBSA

• Lactated Ringer’s

Goals

• Urine output:

• Adults: 0.5–1 mL/kg/hr

• Children: 1–1.5 mL/kg/hr

Parkland Formula

• 2–4 mL × kg × %TBSA

• Half in first 8 hrs

PHASES OF BURN CARE

1. EMERGENT (0–72 hrs)

• Airway

• Fluid resuscitation

• Shock prevention

2. ACUTE

• Wound healing

• Diuresis

• Infection prevention

3. REHABILITATION

• Mobility

• Psychosocial recovery

Burns to face/neck

intubate early

Urine output

best indicator of perfusion

Blisters

partial thickness

No pain 

 full thickness

internal damage > external

Electrical burns

Rules of Nines 

- Head and Neck 9% ( 4.5% Anterior/Posterior)

- Each Arm 9% (4.5% Anterior/Posterior)

- Chest/Abdomen 18%

- Back 18%

- Each Leg 18% (9% Anterior/Posterior)

- Perineum/Genitalia 1%