Defination

• A burn is a type of injury

to skin and flesh caused by
heat, electricity, chemicals,
light, radiation or friction

• Scalding is caused by hot

liquids (water or oil) or
gases (steam).
BLAST / EXPLOSION
The epidermis layer of the skin consists of
dry, mostly dead, mostly insensitive skin. It
is the ‘top’ and outside layer. Burns to the
epidermis are generally 1st degree, or partial
thickness, and are not considered clinically
significant. Sunburns fall into this category
The dermis lies beneath the epidermis, is
wet, has blood flow, and contains hair
follicles and sweat glands. It also houses
sensory nerves. Burns to the dermis are 2nd
degree, or partial thickness and generally
require medical attention
The Subcutaneous layer lies beneath
the dermis. It consists of a thin layer
of fat, fascia and then muscle.
Subcutaneousburns are 3rd degree, or
full thickness, and always require
medical attention
 Burn Size: The Rule of Nines
• Another (perhaps easier) way to think of this:
– 9% for whole head
– 9% for left arm
– 9% for right arm
– 9% for abdomen
– 9% for anterior thorax (chest)
– 9% for posterior thorax (upper back)
– 9% for posterior abdomen (lower back)
– 9% for anterior right leg
– 9% for anterior left leg
– 9% for posterior right leg
– 9% for posterior left leg
 BURN IN INFANTS
Burn in infants are very
dangerous and mostly
caused by hot liquids, sun
exlosure, etc.
Scalding is the most
common type of burn in
infants because they do not
realize the danger from
burning. Children under 4
years and adults over 60
years have a higher chance
of compilcations and death
from severe burn.
 First Degree Burns
First degree burns (epidermal burns) are red,
appear DRY, blanch when pressed upon, and
blister mildly. These burns are very painful.
 Second Degree Burns
Second degree (dermal) burns tend to be red or
yellowish, appear WET, usually blister, and may
or may not blanch. These burns are painful.
 Third Degree Burns
Third degree (subcutaneous) burns appear very DRY,
may be yellow, gray or black, do not blanch, and are
‘leathery’ to the touch. They generally are not heavily
blistered. Healing is very slow. These burns are normally
painless.
 Airway Burns
• Burn to the airway is caused by inhaleing smoke, steam,
superheated air and toxic fumes, often in a poorly ventilated
room.

• Burns to the airway are Serious, becomes Un-Conscious, Life-

Threatening injuries.

– As edema develops the airway may close making both intubation and
surgical airways impossible. Patients HAVE died in exactly this way

• Almost all burns to the airway require immediate, aggressive

management because it causes difficulty in Breathing and SUFFOCATION

• 100% oxygen is indicated in all patients with airway burns,

REGARDLESS OF PULSE OXIMITRY
 THERMAL ( HEAT) BURN
It is caused by explosure to heat or
fire (iron burn, strove, etc)

• After exposing the patient and

assessing the burn, cover the burned
area with a dry, clean-ish sheet
– Covering with a dry sheet protects the
patient from air currents, which can be
very painful, and helps to prevent from
infection and hypothermia
• Do not apply ice to large burns
• Initiate fluid resuscitation
 ELECTRICAL BURN
It is caused by electic shock or uncontrolled short circuit.

• Internal burning, bleeding and trauma are often

associated with electrical burns. This is impossible to
assess by visualizing the burn site. Therefore continuous
monitoring of vital signs and patient complaints is
important
 Chemical Burns
It is caused by strong acids or bases (bleech,
HAZCHEM, other household chemicals).

• Decontamination is required before treatment can

begin.
• Flush all chemical burns with water. There is no such
thing as too much water, but there is such thing as
not enough
 CALL To 16

Do not become a VICTIM, so SAFETY first.......

 EMD
• Instruct patient or caller for SAFETY first.
• EMD should keep online till ambulance crew
arrives, and should for ask these Questions.....?
• Is anyone trapped or still in danger?
• Ask for Consciousness?
• Check Breathing status?
• The degree of pain is not related to the severity of
the burns, the most serious burns can be painless.
 FIRST AID
• Safely remove the patient from the source of burn.
• Use water, blanket or roll on the ground or smother the fire or
flames.
• Remove the burning clothes.
• Flush the body area and avoid direct contact.
• Do Not immerse a severe burn in cold water, this can cause
SHOCK
• Cool the burn area with cold water for atleast 10mins
if it is not a 3rd degree burn
 MANAGEMENT
• Evaulation of area and depth for burn injury.

• Proper fluid management is critical to the survival of

patients with extensive burns to avoid hypothermia.

• It is not only possible, but EASY to give excessive fluid

to burn patients.

• Sterile dressing and medication like oinments (cream)

and antibiotics is necessary to prevent the infection.
Misconceptions Regarding Burns
– “Burn patients require tons of fluid”
• False: Burn patients require just the right amount of
fluid. Too much fluid will harm them just as much as
too little

– “Burns should be cooled with ice or open air to ‘take

the heat out’”
• False: Except in chemical burns, burning stops when
the heat source goes away. They do not need to be
cooled. In fact, because burn patients cannot control
their body temperature, cooling burns can induce
dangerous hypothermia

– “Wet dressings may prevent the dressing from

sticking to the wound”
• False: Wet dressings encourage sticking, and increase
hypothermia. Dry dressing is only acceptable
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