Burns

TAEI TSG
BURNS
Prof. J. JAGAN MOHAN, M.S., M.Ch.,

Professor of Plastic Surgery,
HOD, Dept. Plastic, Reconstructive & Facio
Maxillary Surgery,
MADRAS MEDICAL COLLEGE & RGGGH
Thermal Burns
Chemical Burns
Electrical Burns
Radiation Burns
Layers of Skin
Depth of Burn
Classification
Depth
 First degree: injury localised to epidermis. Painful,
red, blanches to touch. Heals spontaneously. E.g.
sunburn.
 Second degree superficial: injury to the epidermis

and superficial dermis. Red painful, blistering,
blanches to touch. Usually heals from intact skin
appendages with some skin discoloration.
 Second degree deep: injury through the epidermis

deep into dermis. Pale mottled, does not blanch to
touch, painful to pin prick. Heals with scarring
Classification
Third degree : full thickness injury into
subcutaneous fat. Hard leathery eschar, painless
black, white or red. No visible skin appendages.
Skin grafting necessary.
Fourth degree : injury to underlying muscle and
bone
I degree Burn
II degree Burn
III degree Burn
Jackson's burn zones
1. Zone of coagulation
Irreversible tissue loss due to coagulative
necrosis.
2. Zone of stasis
Decreased tissue perfusion. Tissue is viable but
can deteriorate to necrosis if not adequate
resuscitation.
3. Zone hyperaemia
Outermost zone with increased tissue perfusion.
Tissue usually recovers in absence of severe
infection or severe tissue hypo perfusion.
Jackson’s Zones
Resuscitation - Effects
Pathophysiology
Oedema
Wallace Rule of Nines for Adults
• Head & Neck = 9%

• Each upper extremity (Arms) = 9%
• Each lower extremity (Legs) = 18%
• Anterior trunk= 18%
• Posterior trunk = 18%
• Genitalia (perineum) = 1%
Rule of Nines Chart
The Lund and Browder chart
Rule of Palm
 Patient’s palm equals

1% of his body surface
area
 Best used for burns <

10% BSA
Fluid resuscitation
First 24 hours
• Modified Parkland Formula : 3ml /kg body wt /
% for first 24 hours
• Give one-half of the fluid calculated in the first

8 hours postburn (i.e. from the time of burn)
• Give the balance in next 16 hours postburn

Admission Criteria
• Partial thickness burns more than 20% of TBSA
• Full-thickness burns more than 2 % of TBSA
• Face, hands, feet, genitalia, perineum, or joints
involved
• Electrical burns
• Chemical burns
• Inhalation burns
• Burns in conjunction with preexisting medical
conditions
• Risk of morbidity or mortality
Fluid Administered
• For Adults : Ringer Lactate only
• For Children : Ringer Lactate as calculated by formula
• In addition 5% Dextrose
• 100ml /kg till 10 kg
• 50ml /kg for 11-15 kg
• 30 ml /kg for above 15 kg body weight
• The Dextrose fluid calculated is divided into 3 equal
doses for administration every 8 hours.This is given
because Children have poor Glycogen storage in their
Liver and hence prone for Hypoglycemia.
Monitoring
• Urinary output is the most sensitive
noninvasive assessment parameter for cardiac
output and tissue perfusion
• Foley Catheter insertion
• Ideal rate of Urine output
Adults : 0.5 to 1.0 ml /kg / hr
Children : 1.0 to 1.5 ml /kg / hr
Infants : 1.5 to 2.0 ml /kg / hr
• Palpable peripheral pulses
• Clear sensorium
Monitoring
• Tissue Perfusion – Pulse Oximeter
• Basic investigations :
Serum electrolyte levels
Hemoglobin and hematocrit levels
Blood Glucose
Blood Urea & Serum Creatinine
• Tetanus Toxoid
• Pain management
• Prophylactic antibiotics
• Wound Culture
24 to 48 hrs
• The amount of fluid administration is based on the
hydration measured mainly by urine output
• Usually ½ of first day requirements.
• Adults : Normal saline/ Ringer Lactate 5% Dextrose

added if there is no hyperglycemia.
• Children : Normal saline/ Isolyte P / 5% Dextrose

are administered
• Colloids are administered in the form of Fresh
Frozen Plasma (FFP) – 2units /day.
• The exact quantity and nature of fluids

administered are based on Patient clinical
condition, Jugular venous pressure and
Investigation reports.
• Goal: Prevent shock by maintaining adequate

circulating blood volume and maintaining vital
organ perfusion
48 to72 hrs
• Infection control :
Wound Cultures repeated every 3 days and
appropriate antibiotics are administered.
• To Continue Wound care : Topical Antibiotics
and Dressings
• Wound closure
• Nutritional support
• Pain management
• Physiotherapy
Topical Antimicrobials
• Mafenide acetate for Ear

• Bacitracin for Face
• Silver sulfadiazine for Trunk & Extremities
• Mupirocin
• Chlorhexidine
• Acriflavin
• Acticoat
Surgical Procedures
• Debridement
• Tangential Excision
• Escharotomy
• Fasciotomy
• Escharectomy
• Split Skin Grafting
• Flap cover
• Amputation
Collagen
Skin Graft Mesher
Chemical Burns
• Acid Burns – Coagulation Necrosis Form a thick,
insoluble mass where they contact tissue Limits
burn damage.
• Alkali Burns – Liquefaction Necrosis Destroy cell

membrane deeper tissue penetration.
Chemical Burns - Acid
Electrical Burns
Electrical Flash Burns
Burns ICU - Cubicles
FIRST AID
Pour Water immediately
Use clean cloth
Cover with clean cloth
Thank you
Rajiv Gandhi Government General Hospital , Chennai

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TAEI TSG

Prof. J. JAGAN MOHAN, M.S., M.Ch.,

 Second degree superficial: injury to the epidermis

 Second degree deep: injury through the epidermis

• Head & Neck = 9%

 Patient’s palm equals

 Best used for burns <

• Give one-half of the fluid calculated in the first

• Give the balance in next 16 hours postburn

• Adults : Normal saline/ Ringer Lactate 5% Dextrose

• Children : Normal saline/ Isolyte P / 5% Dextrose

• The exact quantity and nature of fluids

• Goal: Prevent shock by maintaining adequate

• Mafenide acetate for Ear

• Alkali Burns – Liquefaction Necrosis Destroy cell

Rajiv Gandhi Government General Hospital , Chennai

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