LC 11: BURNS

BURNS

INITIAL/RESUSCITATIVE PERIOD

  • Assessment of burn injury

  • Classification of burn injury

  • Initial ER management

  • Fluid resuscitation

  • Monitoring

  • Prevention

Assessment of Burn Injury

  • Primary Survey (ABCDE):

    • Airway: Check patency and possible obstructions; assess history of trauma.

    • Breathing: Evaluate chest expansion and breathing issues.

    • Circulation: Monitor for hypotension and compartment syndrome signs, check for pulses and bleeding.

    • Deficits and Disability: Assess neurologic problems, history of falls.

    • Extremities, Exposure, Environment: Check injuries and assess total body surface area (TBSA) for burns.

Types of Burns

  • Thermal Burns: Flame, contact, scald burns.

    • Scald Burns: From hot liquids, can lead to deeper burns.

    • Flame Burns: Common causes include house fires and vehicular accidents; often associated with high mortality.

    • Electrical Burns: Serious, classified as high voltage or low voltage; can cause extensive damage underneath the skin.

    • Chemical Burns: Depend on chemical type; alkali burns are usually more severe than acidic burns.

Estimate the Burn Size

  • %BSA Measurement:

    • Expressed as %TBSA; excludes first-degree burns.

    • Utilizes Rule of Nines or Lund and Browder charts for accuracy.

Assess the Burn Depth

  • Depth is critical for treatment planning and prognostication.

  • Depth of Skin Damage:

    • First Degree: Epidermis only; red, painful, no blisters.

    • Second Degree: Partial thickness, may or may not include dermis.

    • Third Degree: Full thickness, no pain (anesthetic), requires grafting.

    • Fourth Degree: Involves deeper tissues, including muscle and bone.

Check for Other Injuries/Medical Problems

  • Assess other comorbid conditions and injuries that may complicate burn treatment and recovery.

BURN PATHOPHYSIOLOGY

LOCAL RESPONSE

  • Described by Jackson’s zones of tissue injury:

    • Zone of Coagulation (Full Thickness): Most severely burned area, necrotic tissue.

    • Zone of Stasis (Partial Thickness): Contains ischemic tissue which can convert to necrosis if not managed properly.

    • Zone of Hyperemia (Superficial Partial Thickness): Outermost layer, heals rapidly with minimal scarring.

SYSTEMIC RESPONSE

  • Inflammatory Response: Significant when burns exceed 30% TBSA, leading to vascular changes and potential organ dysfunction.

  • Metabolic Changes: Increased basal metabolic rate (up to 3-4 times baseline), necessitating early enteral nutrition.

  • Immunological Changes: General downregulation can increase susceptibility to infections.

CLASSIFICATION OF BURN INJURY

  • Guidelines for Referral to a Burn Center:

    • Partial thickness burns >10% TBSA, full thickness burns >2% TBSA, burns involving critical areas, sign of infection, complicating factors, etc.

PROGNOSIS

  • Use of Baux Score for mortality risk assessment; affected by age, %TBSA, inhalation injury.

INITIAL MANAGEMENT

MINOR BURNS

  • Cool with water, tetanus prophylaxis, thorough cleaning, possible debridement.

MAJOR AND CRITICAL BURNS

  • Ensure sterile technique, airway management, and intubation if necessary.

  • Set IV lines and monitor urine output.

  • Assess for complications: compartment syndrome, inhalation injuries.

FLUID RESUSCITATION

PARKLAND FORMULA

  • Use: ( ext{Weight in kg}) imes ( ext{%TBSA}) imes (4) for initial resuscitation over 24 hours.

  • Administer in specific hourly guidelines.

TRANSFUSION

  • Associated with increased infection risk; use cautiously for physiologic needs.

INHALATION AND VENTILATOR MANAGEMENT

CARBON MONOXIDE POISONING

  • High affinity for hemoglobin, treated primarily with 100% oxygen.

BRONCHOSCOPY

  • Diagnostic standard for assessing inhalation injury severity.

WOUND DRESSING

  • Various topicals, including silver sulfadiazine and others, used according to specific needs and conditions of the burn.

DEFINITIVE MANAGEMENT

EXCISION AND GRAFTING

  • Involves removing non-viable tissue and promptly grafting to support healing.

NUTRITION

  • Increased caloric intake to support hypermetabolism and tissue healing; use specific formulas for children and adults.

COMPLICATIONS

  • Include sepsis, ARDS, contractures; proactive management critical.

REHABILITATION

  • Immediate and ongoing physical therapy; psychological recovery important as well.

PREVENTION AND PREPAREDNESS

  • Emphasize community education and regulations to minimize burn risk.

CASE OF THE DAY

  • Case details illustrate practical application of fluid resuscitation and management in burns.

REFERENCES

  • Brunicardi, F.C. (2019). Schwartz’s Principles of Surgery (11th ed.). McGraw-Hill Education.

  • Villanueva-De Grano, A. P. (October 2025). Burns [PPT].

Note: This comprehensive guide captures the entirety of the transcript, detailing each aspect of burn management and treatment protocols.