1. Burn
By, Kranti Jadhav ​

2. Content
1.Review of anatomy and physiology of skin
2.Introduction
3.Incidence
4.Definition
5.Etiology
6.Classification
7.Jackson’s thermal wound injury
8.Pathophysiology
9.Clinical manifestations
10.Diagnostic evaluation
11.Management
12.Complications
13.Prevention
14.summary
15.conclusion
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BURN

3. REVIEW OF ANATOMY AND physiology of
skin
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4. INTRODUCTION
Burns is one of the most devastating conditions
encountered in medicine. The injury represents an
assault on all aspects of the patient from the
physical to the psychological. The visible physical
and invisible psychological scars are long-lasting.
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5. DEFINITION OF BURN
–Burn can be defined as any injury that results from direct contact or
exposure to any thermal, chemical, electrical, or radiation source.

6. INCIDENCE OF BURN
•India records 70 lacs burn injury annually of which 1.4
lacs people die and 2.4 suffers from a disability.
•70% of cases are in the 15-35 years age group.
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7. INCIDENCE OF BURN
• 4 out of 5 cases are either women or children.
• 80% cases with women are related to kitchen-related accidents.
• 1th leading cause of death/injury of children age 1-9 years.
• 250 to 300 acid attacks are reported in India every year.
• 80% to 90% of burns occur at home
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8. ETIOLOGY OF BURN
1. Thermal burns
2. Chemical burns
3. Electrical burns
4. Radiation burns
5. Inhalation burns
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9. CLASSIFICATION OF BURN INJURY
1. According to burn depth
2. According to extent of the burn
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10. •ACCORDING TO BURN DEPTH
a) Based on skin layers involvement
b) Based on the degree of burn
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11. Based on skin layers involvement
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12. Based on degree of burn
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13. ACCORDING TO EXTENT OF BURN
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•Rule of nine
•Lund and Browder chart
•Palmer method

14. Rule of nine (adult)
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15. Rule of nine (child)
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16. Lund and Browder Chart
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17. Palmer method
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18. Pathophysiology
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19. CLINICAL FEATURES
First degree burns:
• Reddened skin
• Pain at burn site
• Involves only epidermis
• Have an in-tact epidermal barrier
• Do not result in scarring
• Examples : Sun-burn, minor scald from a kitchen accident
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20. CLINICAL FEATURES
Superficial 2nd degree burns :
• Intense pain
• White to red skin
• Blisters
• Involves epidermis & papillary layer of dermis
• Spares hair follicles, sweat glands etc.
• Erythematous & blanch to touch
• Very painful/sensitive .
• No or minimal scarring.
• Spontaneously re-epithelialization from retained epidermal structures in
7-14 days Second Degree Burns
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21. CLINICAL FEATURES
Deep second degree burns:
• Injury to deeper layers of dermis, i.e, reticular dermis.
• Appears pale & mottled.
• Do not blanch to touch.
• Capillary return sluggish or absent.
• Less painful, remain painful to pinprick.
• Takes 14 to 35 days to heal by re-epithelialization from
hair follicles & sweat gland, keratinocytes often with
severe scarring.
• Contractures possible.
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22. CLINICAL FEATURES
3rd Degree Burn:
• Dry, leathery skin (white, dark brown, or charred).
• Loss of sensation (little pain).
• All dermal layers/tissue maybe involved.
Fourth degree burn:
• Involves structures beneath the skin- muscle, bone.
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23. SYSTEMIC CHANGES
Cardiac: Decreased cardiac output.
Pulmonary: Respiratory insufficiency as a secondary
process. Can progress to respiratory failure.
Gastrointestinal: Decreased or absent GI motility.
Curling’s ulcer formation.
Metabolic: Hypermetabolic state. Increased oxygen and
calorie requirements. Increase in core body temperature.
Immunologic: Loss of protective barrier. Increased risk of
infection. Suppression of humoral and cell-mediated
immune responses.
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24. DIAGNOSTIC EVALUATION OF BURN
1. History taking
2. Physical examination
3. Diagnostic tests-
• Complete blood count
• ABG analysis
• Human chorionic gonadotropin testing
• Serum urea, electrolytes
• Chest X-ray
• CT scan
• Laser Doppler imaging
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25. History Taking
1. Time of injury
2. Place of injury (open/closed)
3. unconsciousness during the incidence
4. Mechanism of burn injury/agent
5. Duration of exposure to agent
6. Intentional burn injury
7. Last Tetanus shot
8. Any known Allergies
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26. PHYSICAL EXAMINATION
1. Complete head-to-toe assessment
2. Systematic assessment
3. Burn estimation/severity assessment
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27. Burn severity assessment
MINOR
• Adult <10% TBSA
• Young or old <5% TBSA
• <2% Full thickness Burn
MODERATE
• Adult 10-20% TBSA
• Young or old 5- 10%
TBSA
• 2-5% Full thickness burn
• High voltage injury
• Possible inhalation
injury
• Circumferential burn
• Other health problems
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MAJOR
• Adult >20% TBSA
• Young or old >10%
TBSA
• >5% Full thickness burn
• Known inhalation injury
• Significant burn to face,
joints, hands or feet
• Associated injuries

28. DIAGNOSTIC TESTS
1. Complete blood count
2. ABG analysis
3. Serum biochemistry
4. Chest X-ray
5. CT scan
6. Laser Doppler imaging
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29. PHASES OF BURN CARE
PHASE
• Emergent /
resuscitative phase=
DURATION
- From onset of injury to
completion of fluid
resuscitation.
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PRIORITIES
• First aid
• Prevention of shock
•Prevention of
respiratory distress
•Detection and treatment
of concomitant injuries

30. PHASES OF BURN CARE
PHASE
• Acute /
intermediate
phase
DURATION
• From beginning of
diuresis to near
completion of wound
closure.
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PRIORITIES
• Wound assessment
and care
• Wound closure
• Prevention and
treatment of
complications, including
infection
• Nutritional support

31. PHASES OF BURN CARE
PHASE
• Rehabilitation
support
DURATION
• From major wound
closure to return to
individual’s optimal
level of functioning
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PRIORITIES
• Prevention of scars and
contractures
• Physical, occupational and
vocational rehabilitation
• Cosmetic reconstruction
• Psychosocial counselling

32. Emergent / resuscitative phase
Medical management
1. Assess burn severity
a) Burn depth
b) Burn size
c) Burn location
d) Age
e) General health
f) Mechanism of injury
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33. Emergent / resuscitative phase
• Medical management
2. Treat minor burns
3. Major burns
a) Monitor airway and breathing
b) Prevent burn (hypovolemic) shock (see formula)
c) Prevent aspiration
d) Minimizing pain and anxiety
e) Wound care
f) Prevent tetanus
g) Prevent tissue ischemia
h) Transport to burn facility
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34. Emergent / resuscitative phase
• Calculation of fluids:
1. Consensus formula:
Ringer's lactate solution= 2-4 ml X body weight kg X TBSA ½
solution in first 8 hours and rest half in next 16 hours
2. Parkland formula:
Volume of Ringer’s lactate= 4 ml X % BSA x weight (kg) ½
solution in first 8 hours and rest half in next 16 hours
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35. Nursing management of patient in
Emergent / resuscitative phase
1. Maintaining proper oxygenation and tissues perfusion
2. Maintaining fluid and electrolyte balance
3. Relieving pain
4. Preventing hypothermia
5. Providing initial wound care
6. Preventing infection
7. Promoting comfort
8. Relieving anxiety and proving psychological support
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36. ACUTE / INTERMEDIATE PHASE
Medical management
1. Prevent infection
• Asepsis
• Prophylactic antibiotics
• Immunization
• Environmental control
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37. ACUTE / INTERMEDIATE PHASE
•Medical management
3. Minimizing pain
• Patient controlled analgesia devices
• Inhalation analgesic (nitrous oxide)
• Oral analgesics; opioid analgesics, NSAID’s
• Hypnosis, art and play therapy
• Guided imaginary, relaxation techniques
• Distraction therapy, biofeedback
• Music therapy
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38. ACUTE / INTERMEDIATE PHASE
• Medical management
4. Provide wound care
a) Wound cleansing
b) Wound debridement
i. Natural debridement
ii. Mechanical debridement
iii. Chemical debridement
iv. Surgical debridement
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39. ACUTE / INTERMEDIATE PHASE
• Medical management
c) Topical antimicrobial treatment
• Silver sulfadiazine 1%
• Mafenide acetate 5%
• Silver nitrate 0.5%
• acticoat
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40. ACUTE / INTERMEDIATE PHASE
Medical management
d) Wound dressing
• Moist dressing
• Occlusive dressing for new grafts
• Non-adhesive dressings covers
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41. ACUTE / INTERMEDIATE PHASE
•Medical management
5. Maximize function
• Splinting
• Positioning
• Exercise
• Ambulation performance of ADI
• Pressure therapy
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42. ACUTE / INTERMEDIATE PHASE
•Medical management
6. Provide psychological support
• Meeting the psychological needs
• Involvement in physical therapy
• Encouragement in wound care
• Ventilation of feeling, emotions, fear
• Promoting self image
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43. ACUTE / INTERMEDIATE PHASE
•Surgical management
1. Escharotomy: An escharotomy is a surgical procedure used to
treat full-thickness circumferential burns. In full-thickness burns,
both the epidermis and the dermis are destroyed along with
sensory nerves in the dermis.
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44. ACUTE / INTERMEDIATE PHASE
Surgical management
2. Fasciotomy or fasciectomy
Fasciotomy or fasciectomy is a surgical procedure where
the fascia is cut to relieve tension or pressure in order to
treat the resulting loss of circulation to an area of tissue or
muscle.
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45. ACUTE / INTERMEDIATE PHASE
• Surgical management
2. Wound grafting
# Biologic dressing / graft
# biosynthetic and synthetic grafts
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46. ACUTE / INTERMEDIATE PHASE
Surgical management
2. Wound grafting
# Biologic dressing / graft types
• Autograft
• Isograft
• Allograft
• Xenograft
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47. ACUTE / INTERMEDIATE PHASE
Surgical management
2. Wound grafting
# Biosynthetic and synthetic graft types
• Biobrane
• Integra
• Calcium alginate
• Non-adhering fine mesh gauze
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48. • INTEGRA
Integra is a product that is used to help re-grow skin on body
parts where the skin has been removed or badly damaged. It
was initially used to safely cover large areas of burned tissue
where skin needed to be regrown. However, Integra is now used
far more widely as part of skin grafts in reconstructive surgery.
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49. 1.CALCIUM ALGINATE: Calcium alginate dressings are used
primarily for the granulating phase of wound repair. They are
made from alginate, a derivative of seaweed. The calcium in the
dressing interacts with sodium in the wound, providing a wound
exudate that stimulates myofibroblasts and epithelial cells and
speeds wound homeostasis.
2.NON-ADHERING FINE MESH GAUZE: Nonadherent dressings are
basically low adherent wound pad for pain-free removal of
the dressing and it is mostly used for minor wounds
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50. Nursing management of patient in acute /
intermediate phase
1. Maintaining proper oxygenation and tissues perfusion
2. Maintaining fluid and electrolyte balance
3. Relieving pain
4. Preventing hypothermia
5. Providing wound care
6. Preventing infection
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51. 8. Relieving anxiety and proving psychological support
9. Graft care
10.Nutritional support
11.Improving mobility
12.Promoting comfort
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52. REHABILIATION PHASE
Medical management
1. Minimizing functional loss
• Exercise
• Splinting
• positioning
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53. REHABILIATION PHASE
3. Medical management
2. Provide psychological support
• Self image issues
• Physical limitations
• Reintegration into society
• Fear of rejection
• Good communication
• Encourage independence
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54. REHABILIATION PHASE
3. Abnormal wound healing
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55. REHABILIATION PHASE
3. Medical management
4. Prevention and treatment of scars
• Pressure use of topical silicon
• Scar massage
• Steroid injections
• Application of elastic pressure garments
• Cosmetic interventions
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56. Nursing management of patient in
Rehabilitation
1. Improving mobility
2. Improving self esteem
3. Promoting independence
4. Cosmetic counselling
5. Vocational training
6. Improving body image
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57. COMPLICATIONS OF BURN
1. Burn shock
2. Pulmonary complications due to inhalation burn
3. Acute renal failure
4. Infections and sepsis
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58. 5. Curling’s ulcers/stress ulcer
6. Extensive and disabling scarring
7. Psychological trauma
8. Marjolin’s ulcer: A Marjolin ulcer is a cutaneous malignancy that
arises in the setting of previously injured skin, longstanding scars, and
chronic wounds
9. Multiple organ failure
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59. Summary
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60. Thank
you