BURNS

Definition
A burn is a type of injury to the skin, or other tissues, caused by heat,
electricity, chemicals, or ultra violet radiation (like sunburn). Most
burns are due to heat from hot liquids (called scalding), solids, or fire.
A burn is an injury is to the skin or other organic tissue primarily
caused by heat or due to sunlight ,radiation, electricity, friction or
contact with chemicals.
Burns occur when there is injury to the tissues of the body caused by
heat ,chemicals ,electric current or radiation.
 Causes
• Chemicals, such (Such as cement, strong acids and alkaline).
• Radiation(Radiation therapy, x-rays and radioactive fallout).
• Electricity(Electric current).
• Sun (ultraviolet or UV light).
• Thermal(Hot liquid, hot iron or object, and fire)
• Gas explosion
 Classifications
Burns classification is based on Aetiology ,Depth, and Surfaces
area(extent).
Aetiology
1)Thermal Burns :are burns caused by flame, scald or contact with hot
liquid or object. This is the most common type of burn injury.
2)Chemical Burns :result from strong acids, alkalis and organic
compounds .In addition to tissue damage ,eyes can be injured if they
are splash with chemical.
3)Electrical Burns: are the results of intense heat generated from an
electric current. Most often, in an electric burn all the body systems are
affected or at risk .
The severity of electric injury depends on the amount of voltage ,tissue
resistance ,current pathways ,surface contact with the current and
length of time that the current flow was sustained.
4)Radiation Burns :sun burn is type of radiation burn .Other source of
radiation like x-ray or radiation therapy to treat cancer ,can also cause
these.
 Depth
First Degree Burns (Superficial Burns):This affects only
the epidermis.
Features
• Painful, dry, and red
• Turn white when pressed
• Usually, they heal in 3 to 6 days without scarring
• An example is a non blistering skin burn
 Second Degree Burns(Superficial Partial
Thickness Burns):This involves the epidermis and
dermis.

Features
• Painful to the extent of being sensitive to even air
movement or air temperature
• Red and seep fluid
• Usually form blisters
• Turn white when pressed
• Heal within 7 to 21 days
• Affected skin becomes permanently dark or light in color
• Does not lead to scar formation
• An example is a sunburn that forms blisters after several
hours
 Third Degree Burns (Full Thickness Burn):This
involves the epidermis ,dermis and subcutaneous layer.

Features
• Painful with deep pressure
• Almost always form blisters
• Do not turn white with pressure
• Take more than 21 days to heal
• Usually results in severe scarring
• An example is a burn that blisters immediately
 Fourth Degree Burns: The skin is destroyed completely with
damage to the underlying structures, such as muscles, nerves,
tendons, and bones.

Features
• Usually painless (due to destruction of the nerve endings)
• Waxy white to leathery gray or charred black color
• Affected skin looks dry
• Does not turn white when touched
• Cannot heal without surgical treatment
• Usually result in severe scarring
 Extent
Wallace Rule of Nine is use to determine the extent (percentage)of
burns in an adult. The body is divided into areas and each having
specific percentage as follows:
Head and Neck 9%
Each upper limb9%
Anterior trunk 18%
Posterior truck 18%
Each Lower limb 18%
Perineum 1% Total =100%
Rule of Nines Adults (Age ≥ 14 years)
Role of Nines for Children (Age 1-14 years)
Rule of Nines for Infant (Age < 1 year
The Lund–Browder burn diagram and table above
indicate the varying proportions in surface area in
persons with different ages. A careful burn diagram
should be completed at the time of initial evaluation,
including wound size, location, and estimated burn
depth. Lund–Browder chart should be used in pediatric
patients because the body surface area relationships
vary with age.
Paediatric Lund and Browder Chart
 Clinical features
1.Pain at the area of burns.
2.Erythematous,discoloured and excoriated skin (chemical burns)
3.Red,white blistered skin (thermal burns).
4.Oedema in the tissue under the burns area .
5.Hypotension ,tachycardia.
6.Seizure,unconsciousness,respiratory or cardiac arrest(electrical
burns).
Pre-Hospital Management of Thermal
Burns
• Ensure safety for self and patient
• Check patient for response
• Call for help
• Remove whatever is causing the burns from the patient or take patient away from the
source burns.
• Lay the patient flat in a safe environment.
• Reassure patient and his /her relatives
• Assess patient ABCDE or CAB and intervene where necessary
• Remove burnt clothing ,including jewelry ,clothing stuck to the skin must be left alone.
•S
• Apply cold clean water to the burn area of the body for above
10minutes
• Do not pierce the blisters to avoid infecting the wound.
• Cover the burnt area with sterile dressing soaked in normal saline or
clean water.
• If there is no sterile dressing ,use clean handkerchief to cover the
burnt area.
• Cover the uninjured parts of the body with a blanket to prevent
chilling .
• Elevate the legs to prevent shock.
• Transport patient to the hospital in a comfortable position.
Pre-Hospital Management Of Chemical
Burns
• Ensure safety for self and patient
• Check for response
• Call for help
• Remove patient from the source of burns to a safe environment
• Place patient in a comfortable position
• Reassure patient and his/her relative
• Assess patient’s ABCDE or CAB and intervene where necessary
• Remove clothing from area of burns
• If dry powder is involve ,dust the patient off as possible and then rise
with copious amount of water
• Wash liquid chemicals from the skin with cleaning running water for
at least 15 minutes
• Lavage the entire burnt area with copious amount of water
• Cover the burnt area with sterile dressing soaked in normal saline or
clean water
• Cover the uninjured parts of the body to prevent chilling
• Trans patient to hospital along with the sample or container of the
chemical for identifications
Pre-Hospital Management Of Electrical
BURNS
• Ensure safety for self and patient
• Check for response
• Call for help
• Switch off the source of power before touching the patient
• Having made your patient safe to handle ,quickly assess patient
ABCDE OR CAB and CPR where necessary
• If patient is breathing spontaneously ,assess neurological status and
document .
• If patient is unconscious ,place him/her in a recovery position
• Treat any external wound sustained
• Immobilized any fracture, sustained due to seizure
• If patient is conscious ,lie him /her flat and elevate the legs
• Transport patient to the hospital while monitoring patient’ vital sign
and neurological status.