Burns

Burns: Comprehensive Study Notes

Types of Burns

Dry heat
Moist heat
Scald
Contact
Chemical
Electrical
Thermal
Flash
Conductive electrical
Radiation

Causes of Burns

FLAMES: $41\%$
SCALD: $31\%$
ELECTRICAL: $3.6\%$
CHEMICAL: $3.5\%$

Classification of Burns

Minor
Moderate
Major

Severity Criteria for Burns

TBSA (Total Body Surface Area)
Depth
Location
Age
Causative agent
Other injuries
Respiratory involvement
Overall health

Criteria for Major Burns requiring specialized care

Full-thickness burns greater than $10\%$ TBSA
Partial-thickness burns greater than $25\%$ TBSA
Age older than $60$ years
Presence of a chronic cardiac, pulmonary, or endocrine condition
Presence of electrical burn injury
Presence of inhalation injury or other complicated injury
Burns to the eyes, ears, face, hands, feet, or perineum

Expected Findings in Burn Injuries

Singed hair, eyebrows, eyelashes
Sooty sputum
Edema of the nasal septum
Smoky smelling breath
Decreased cardiac output
Hypovolemia and shock
Hypotension
Tachycardia
PAIN

Depth of Injury Classification

Superficial Thickness Burn

Area Involved: Damage to the epidermis.
Appearance: Pink to red, no blisters, mild edema, no eschar.
Sensation/Healing: Painful/Tender, sensitive to heat. Heals within $3$ to $6$ days. No scarring.
Example: Sunburn, flash burn (sudden intense heat).

Superficial Partial Thickness Burn

Area Involved: Damage to the entire epidermis and some parts of the dermis.
Appearance: Pink to red, blisters, mild to moderate edema, no eschar.
Sensation/Healing: Painful. Heals within $2$ to $3$ weeks. No scarring, but minor pigment changes.
Example: Flash flame and scalds, brief contact with hot objects.

Deep Partial Thickness Burn

Area Involved: Damage to entire epidermis and deep into the dermis.
Appearance: Red to white, blisters rare, moderate edema, eschar is soft and dry.
Sensation/Healing: Painful and sensitive to touch. Heals in $2$ to $6$ weeks. Scarring is likely. Possible grafting required.
Example: Flame and scalds, grease, tar, or chemical burns, prolonged exposure to hot objects.

Full Thickness Burn

Area Involved: Damage to the entire epidermis and dermis. Can extend into the subcutaneous tissue, causing nerve damage.
Appearance: Red, black, brown, yellow, or white; no blisters, severe edema, eschar is hard and inelastic.
Sensation/Healing: Sensation is minimal or absent. Heals within weeks to months. Scarring and grafting are necessary.
Example: Scalds, grease, tar, chemical, or electrical burns, prolonged exposure to hot objects.

Deep Full Thickness Burn

Area Involved: Damage to all layers of skin, extending to muscle, tendons, and bones.
Appearance: Black, no blisters, no edema, eschar is hard and inelastic.
Sensation/Healing: No pain. Heals within weeks to months. Scarring and grafting are necessary.
Example: High-voltage or prolonged electrical burns, flames.

Methods to Assess Burn Size

Rule of 9s
Lund & Browder chart
Palmar method

Location-Specific Concerns for Burns

Face, neck, & chest: High risk for respiratory obstruction.
Hands, feet, joints, eyes: Concern for impaired self-care abilities.
Ears, nose, buttocks, perineum: Increased risk for infection.

Poor Outcome Risk Factors

Preexisting heart, lung, &/or kidney disease
Peripheral vascular disease
Concurrent traumas
Alcoholism, drug abuse, malnutrition
Diabetes mellitus

Complications of Burn Injuries

Airway Injuries
Fluid Imbalances
Compartment Syndrome
Sepsis
Contractures
Paralytic Ileus
PTSD (Post-Traumatic Stress Disorder)

Laboratory Findings in Burns

$\uparrow$ Hct (Hematocrit) & Hgb (Hemoglobin)
$\uparrow$ Glucose
$\uparrow$ BUN (Blood Urea Nitrogen)
$\uparrow$ Potassium
$\uparrow$ Chloride
$\downarrow$ Sodium
Total protein/albumin levels (to be monitored)
Carboxyhemoglobin (especially for inhalation injury suspects)

Fluid Replacement Therapy

Rationale: Decreased plasma volume due to fluid loss with capillary leak.
Necessity: Fluid replacement is critical.
Formulas: No single