The skin, the largest organ of the body, consists of two layers-the epidermis

and dermis. The depth or degree of burn depends on which layers of skin are
damaged or destroyed. The epidermis is the outer layer that forms the
protective covering. The thicker or inner layer of the dermis contains blood
vessels, hair follicles, nerve endings, sweat and sebaceous glands. When the
dermis is destroyed, so are the nerve endings that allow a person to feel pain,
temperature, and tactile sensation.

The most important function of the skin is to act as a

barrier against infection. The skin prevents loss of
body fluids, thus preventing dehydration. The skin
also regulates the body temperature by controlling the
amount of evaporation of fluids from the sweat
glands. The skin serves a cosmetic effect by giving the
body shape.
When the skin is burned, these functions are impaired or
lost completely. The severity of the skin injury
depends upon the size of the injury, depth of the
wound, part of the body injured, age of the patient,
and past medical history. Because of the importance of
the skin, it becomes clear that injury can be traumatic
and life threatening.

OBJECTIVES
To estimate burn size & to determine the presence
of associated injuries.
To learn the initial assessment & treatment of
thermal injuries.
To identify problems encountered in Rx of
patients with thermal injuries & how to solve
them.
Criteria for transfer burned patients.

Thermal inj. are major causes of morbidity & mortality & to

minimize them basic principles of initial trauma
resuscitation & timely applied simple emergency
measures should be followed. These include:
1. Smoke inhalation
? Airway compromise.
2. Identify & Mx associated mechanical injuries.
3. Maintenance of haemodynamic normality & volume
resuscitation.
4. Prevent & Rx of potential complications , e.g.
rhabdomyolysis.
5. Temp. control.
6. Removal from inj. Site.

Immediate Lifesaving Measures For Burn

Injuries
Priorities
Airway
Stopping burning process
Establishing I.V. access
Airway
The airway is extremely susceptible to
obstruction as a consequence of heat. This
obstruction may not be immediately obvious, but
signs may warn to such obstruction.

Q&A
Q- If there is inhalation injury what should I do?
A- Transfer to a burn center.
Q- If the transfer time is prolonged?
A- intubate before transfer to protect airway.
Q- what are other indications of intubation?
A- 1- stridor
2-circumferential burns of neck.

Q&A
Q- If there is inhalation injury what should I do?
A- Transfer to a burn center.
Q- If the transfer time is prolonged?
A- intubate before transfer to protect airway.
Q- what are other indications of intubation?
A- 1- stridor
2-circumferential burns of neck.

I.V. Access:
Any patient with burn > 20% of BSA
requires fluid.
After establishing airway & Rx
immediately life threatening injuries ,I.V.
access established in a peripheral V. with
large caliber line (#16 gauge).
Begin with isotonic crystalloids.

Assessment of Burned Patient:

A- HISTORY
B- BODY SURFACE AREA(BSA)
Rule of Nines is a useful & practical
guide to determine SA of burn.
In infants & young children a helpful
guide is the palmar surface (including
fingers) of patients hand representing
about 1% of BSA.

Are you one of those people that stays up to date on

the latest sports scores and plays?
Improper use, handling, and
storage of hazardous
materials can lead to a
different type of scoring
its called burn scoring
which measures the
percentage of the body
burned. The score you rate
on this chart can last you a
lifetime.

Recovery from burn injury

involves four major aspects:
1.Burn wound management.
2.Physical therapy.
3.Nutrition.
4.Emotional support.

st
Superficial (1 degree)
nd
Partial-thickness (2 degree)

Very painful, dry, red burns which blanch with pressure.

They usually take 3 to 7 days to heal without scarring.
Also known as first-degree burns. The most common
type of first-degree burn is sunburn. First-degree burns
are limited to the epidermis, or upper layers of skin.

Very painful burns sensitive to temperature change and

air exposure. More commonly referred to as second-degree
burns. Typically, they blister and are moist, red, weeping
burns which blanch with pressure. They heal in 7 to 21
days. Scarring is usually confined to changes in skin
pigment.

Burns which cause the skin to be waxy

white to a charred black and tend to be
painless. Healing is very slow, if at all,
and may require skin grafting. Severe

1. Treatment should begin immediately to

cool the area of the burn. This will help
alleviate pain.
2. For deep partial-thickness burns or fullthickness burns, begin immediate plans to
transport the victim to competent medical
care. For any burn involving the face,
hands, feet, or completely around an
extremity, or deep burns; immediate
medical care should be sought.
3. Remove any hot or burned clothing.

Primary resuscitation

1. AIRWAY
2.BREATHING
3.CICULATORY BLOOD
VOLUME

CIRCULATION : ?Type of fluid ? Rate.

Monitoring
hrly UOP
insert a
catheter .
A good rule to follow is :
In children of BWT < 30 KG
1 ML of
urine / KG BWT / hr
In adults
0.5 -1 ML of urine KG BWT /
hr
Fluid resuscitation
2 4 ML * KG BWT * %
burn of BSA
In children
calculated fluid + maintenance.

Special Burns Requirement :

Chemical B.
Acid, Alkalis, Petroleum.
Alk. Penetrate > than acids.
severity --- conc., amount & time
of contact.
Mx rinse with large amount of water for 20-30 M.
powder . brush then wash.
Alk. Eye burn ---- continuous irrigation

Electrical B.
More sever than they appear
Rhabdomyolysis
ARF

Patient transfer to a burn center

criteria for transfer ( ABA) :

1. Partial & full thickness burn >10% of BSA in patients<10

y or >50 y.
2. As above > 20% in other age groups.
3. Same as above in face, eyes, ears, hands, feet, genitalia,
perineum & skin over maj. Joints.
4. Full thickness > 5% in any age group.
5. Significant elect. Burn.
6.
=
chemical burn.
7. Inhalation inj.
8. Preexisting illness.
9. Associated sign. Trauma.
10. Hosp. not qualified for children
11. Burn needs rehab., social or emotional care, e.g. child
abuse.

COLD INJURY : Systemic Hypothermia

Hypothermia
Core body temp. < 35 degrees.
Mild --- 35 32
Moderate --- 32 -30
Severe ---- < 30
Susceptible pat. Are elderly , children & trauma pat.. Effects
can be
by administer warm I.V. fluids & blood ,
exposure & warm environment.
Signs 1- core body temp. 2- level of
consciousness.
3- change in vital signs ( resp. & cardiac activ ity)
4- pat. Is gray & cyanotic. 5- cold to touch.

Blistering or easily unroofed burns which are wet or

waxy dry, and are painful to pressure. Their color may
range from patchy, cheesy white to red, and they do not
blanch with pressure. They take over 21 days to heal
and scarring may be severe. It is sometimes difficult to

4. Use cool (54 degree F.) saline solution to cool the area for 15-30

minutes. Avoid ice or freezing the injured tissue. Be certain to

maintain the victims body temperature while treating the burn.

5. Wash the area thoroughly with plain soap and water. Dry the area
with a clean towel. Ruptured blisters should be removed, but the
management of clean, intact blisters is controversial. You should
not attempt to manage blisters but should seek competent medical
help.
6. If immediate medical care is unavailable or unnecessary, antibiotic
ointment may be applied after thorough cleaning and before the
clean gauze dressing is applied.

Scalding-typically result from hot water, grease,

oil or tar. Immersion scalds tend to be worse than
spills, because the contact with the hot solution is
longer. They tend to be deep and severe and should
be evaluated by a physician. Cooking oil or tar tends
to be full- thickness requiring prolonged medical
care.
a. Remove the person from the heat source.
b. Remove any wet clothing which is retaining heat.
c. With tar burns, after cooling, the tar should be
removed by repeated applications of petroleum
ointment and dressing every 2 hours.

Looks and tastes great,

right? You should see what
a hot liquid will do to a
childs skin when the two
come into contact.

Be sure to keep
hot liquids out of
reach of small
children.

Flame
a. Remove the person from the source of the heat.
b. If clothes are burning, make the person lie down to keep
smoke away from their face.
c. Use water, blanket or roll the person on the ground to
smother the flames.
d. Once the burning has stopped, remove the clothing.
e. Manage the persons airway, as anyone with a flame burn
should be considered to have an inhalation injury.

Electrical burns: are thermal injuries resulting

from high intensity heat. The skin injury area
may appear small, but the underlying tissue
damage may be extensive. Additionally, there
may be brain or heart damage or musculoskeletal
injuries associated with the electrical injuries.
a. Safely remove the person from the source of the
electricity. Do not become a victim.

b. Check their Airway, Breathing and Circulation

and if necessary begin CPR using an AED
(Automatic External Defibrillator) if available and
EMS is not present. If the victim is breathing, place
them on their side to prevent airway obstruction.
c. Due to the possibility of vertebrae injury secondary
to intense muscle contraction, you should use
spinal injury precautions during resuscitation.
d. Elevate legs to 45 degrees if possible.
e. Keep the victim warm until EMS arrives.

Chemical burns- Most often caused by strong

acids or alkalis. Unlike thermal burns, they can cause
progressive injury until the agent is inactivated.
a. Flush the injured area with a copious amount of water
while at the scene of the incident. Dont delay or waste
time looking for or using a neutralizing agent. These
may in fact worsen the injury by producing heat or
causing direct injury themselves.

Conclusion
Burns are serious injuries. If you have received a burn
injury, please seek appropriate medical attention.
Medical questions concerning burn injuries and their
treatment should be directed to your personal
physician, University Health Services or other
appropriate medical professionals.
For information on fire safety and prevention, please
contact the University of Georgia Fire Safety Program
(369-5706), or the National Fire Protection Association
website @ www.nfpa.org

Credits
The Fire Safety Program extends its thanks
to the following for providing the
information in this presentation:
Dr. Ronald Forehand-University Health
Center, University of Georgia.
www.healthseek.com