Dóra Ujvárosy MD. Medical University of Debrecen Oxyology and Emergency Department

Functions

Definition A burn is a type of injury to the skin caused by heat, electricity, chemicals, light, radiation or friction. Most burns only affect the skin (epidermal tissue and dermis). Rarely deeper tissues, such as muscle, bone, and blood vessels can also be injured. Managing burns is important because they are common, painful and can result in disfiguring and disabling scarring. Burns can be complicated by shock, infection, multiple organ dysfunction syndrome, electrolyte imbalance and respiratory distress. Large burns can be fatal, but modern treatments, developed in the last 60 years, have significantly improved the prognosis of such burns, especially in children and young adults.

CLASSIFICATION Burns are classified by depth, type and extent of injury Every aspect of burn treatment depends on assessment of the depth and extent A number of different classification systems exist. The traditional system divided burns in first-, second-, or thirddegree.this system is however being replaced by one reflecting the need for surgical intervention. The burn depths are described as either superficial, superficial partial-thickness, deep partial-thickness, or full-thickness.

By degree First-degree burns are usually limited to redness (erythema), a white plaque and minor pain at the site of injury. These burns involve only the epidermis. Most sunburns can be included as firstdegree burns.

First-degree

By degree Second-degree burns manifest as erythema with superficial blistering of the skin, and can involve more or less pain depending on the level of nerve involvement. Seconddegree burns involve the superficial (papillary) dermis and may also involve the deep (reticular) dermis layer. Burns that require more than three weeks to heal are often excised and skin grafted for best result.

Second-degree

By degree Third-degree burns occur when the epidermis is lost with damage to the subcutaneous tissue. These burns may require grafting. These burns are not painful, as all the nerves have been damaged by the burn and are not sending pain signals; however, all thirddegree burns are surrounded by first and second-degree burns, which are painful.

Other classifications A newer classification of "Superficial Thickness", "Partial Thickness" (which is divided into superficial and deep categories) and "Full Thickness" relates more precisely to the epidermis, dermis and subcutaneous layers of skin and is used to guide treatment and predict outcome.

Other classifications Nomenclature Traditional nomenclature Depth Clinical findings Example Superficial thickness first degree Epidermis involvement Erythema, significant pain, lack of blisters Partial thickness superficial second degree Superficial (papillary) dermis Blisters, clear fluid, and pain Partial thickness deep Full thickness second degree third degree Deep (reticular) dermis Epidermis, Dermis, and complete destruction to subcutaneous fat, eschar formation and minimal pain, requires skin grafts Whiter appearance or fixed red staining (no blanching), reduced sensati Charred or leathery, thrombosed blood vessels, insensate

Measurement charts

Assessing extent Estimation of the percentage of body surface area burnt is difficult for non-experts. Use Lund and Browder charts appropriate for the age of the patient. The palmer surface of the patient s palm represents 1% body surface area.

Rule of nines

Lund and Browder charts

Management

Details of the incident

Management

Management Burns over 10% in children and 15% in adults need hospital admission and fluid resuscitation due to the risk of hypovolaemic shock. Major burns should be managed using the principles of Advanced Trauma Life Support (ATLS). This consists of a primary survey to identify and treat immediately life threatening conditions and then a secondary survey. The primary survey in burns patients should follow the ABCDE guidelines (Airway & axial spine control, Breathing & ventilation, Circulation and arrest of haemorrhage, neurological Disability, Exposure to allow accurate assessment and Estimation of burn surface area and Fluid resuscitation).

Management Regardless of the cause, and cool the burn wound,but not the patient. Cold water should not be applied to a person with extensive burns for a prolonged period (greater than 20 minutes), however, as it may result in hypothermia. Do not directly apply ice to a burn wound as it may compound the injury. Iced water, creams, or greasy substances such as butter, should not be applied either.

Management The key to the management of all burn injuries is the management of the burn wound itself. The wound is the cause of the morbidity and mortality of burn injuries and until the wound is healed the patient remains at risk of complications. The essential aspects of wound management are an initial assessment, to determine burn area and depth, and then debridement (removing devitalised tissue and contamination), cleaning and then dressings.

Management Obtain IV access with two large peripheral cannulae. Burn wounds are painful so analgesia (pain relief) should be given. Give IV fluids. Start with isotonic crystalloid at 2-4 ml of crystalloid per kg body weight per % body surface area burned Check pulse, BP Check COHb and ABG(SpO2)

Circumferential burns of the chest

Carbon Monoxide Intoxication

Signs and Symptoms of Carbon Monoxide Intoxication

Carboxyhemoglobin Levels/Symptoms

Management of Carbon Monoxide Intoxication

CARBON MONOXIDE ALARM!!!

Effects of hypothermia

Prevention of hypothermia

Burn Injury: Prevention

Prognosis The outcome of any injury or disease depends on three things: the nature of the injury, the nature of the patient and the treatment available. In terms of injury factors in burns the prognosis depends primarily on the burn surface area (% TBSA) and the age of the patient. Infection is a major complication of burns. Infection is linked to impaired resistance from disruption of the skin's mechanical integrity and generalized immune suppression.

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