On completion of this chapter, the learner will be able to:

1 -Discuss the definition of burn injury.

2- Describe the factors that affect the severity of burn injury.

3- Describe the local and systemic effects of a major burn injury.

4- Describe the goals of burn care and the emergency specialist’s role in wound assessment, wound cleansing, topical antibacterial therapy, wound dressing, débridement, excision, and skin grafting.

5- Describe patient care and the recovery process for burn patients.

The skin, the largest organ of the body, consists of two layers-the epidermis and dermis. The epidermis is the outer layer that forms the protective covering. The thicker or inner layer of the dermis contains blood

vessels, hair follicles, nerve endings, sweat and sebaceous glands. The depth or degree of burn depends on which layers of skin are damaged or destroyed. When the dermis is destroyed, so are the nerve endings that allow a person to feel pain, temperature, and tactile sensation.

The most important function of the skinThe most important function of the skin is to act as a barrier against infection. The skin prevents loss of body fluids, thus preventing dehydration. The skin also regulates the body temperature by controlling the amount of evaporation of fluids from the sweat glands. The skin serves a cosmetic effect by giving the body shape.

When the skin is burnedWhen the skin is burned, these functions are impaired or lost completely. The severity of the skin injury depends upon the size of the injury, depth of the wound, part of the body injured, age of the patient, and past medical history. Because of the importance of the skin, it becomes clear that injury can be traumatic and life threatening. Recovery from burn injury involves four major aspects: burn wound management, physical therapy, nutrition, and emotional support.

Definition

• BurnBurn is defined as: loss of epithelium and a varying degree of dermis due to exposure to physical form of energy, certain chemical or radiation.

• Pathophysiology:

Burn injury is a result of heat transfer from one site to another. Tissue destruction results from coagulation, protein denaturation, or ionization of cellular contents .The skin and the mucosa of the upper airways are sites of tissue destruction. Deep tissues, including the viscera, can be damaged by electrical burns ,or by prolonged contact with a heat source.

Disruption of the skin can lead to increased fluid loss, infection, hypothermia, scarring, compromised immunity, and changes in function, appearance, and body image.

Burns Types of burns:a. Thermal.b. Electrical.c. Chemical.d. Radiation. Extent of burn damage depends on:a. Temperature of agent.b. Concentration of heat.c. Duration of contact. Depth (degree) of burn: a. Superficial burn ( FirstFirst degree burn)b. Partial - thickness burn ( SecondSecond degree burn)c. Full - thickness burn ( ThirdThird degree burn)

• Superficial burn ( FirstFirst degree burn).

• Partial - thickness burn ( SecondSecond degree burn)

• Full - thickness burn ( ThirdThird degree burn)

Superficial Burn (1st degree burn)

Involves only the epidermis Sunburn is a good example of a first degree burn. Signs & symptoms:

a. Pain at burn site.

b. Redness.

c. Swelling.

Superficial Burn (1st degree burn)

Superficial Burn (1st degree burn)

Partial–Thickness Burn (2nd degree burn)

Involves all the epidermis and much of the dermis.

Signs & symptoms:

a. Intense pain.

b. Redness.

c. Blisters.

d. Swelling.

Partial–Thickness Burn (2nd degree burn)

Partial–Thickness Burn (2nd degree burn)

Full-Thickness burn (3rd degree burn)

Involves the entire epidermis and entire dermis down to the deeper layers which is destroyed by coagulation necrosis.

Signs & symptoms:a. Skin destroyed .b. Tissues damaged .c. Loss of sensation ( little pain)d. Shock (pale, clammy skin, weakness, bluish lips and

finger nails) e. White or charred skin.

Full-Thickness burn (3rd degree burn)

Full-Thickness burn (3rd degree burn)

Assessment of area of burn

• This is done using the "rule of nines".

• The body is divided up into eleven areas, each

representing 9% of the total body surface.

• Body Area Percentage Of Burn

Head and Neck 9%

• Anterior Trunk 18%

• Posterior Trunk 18%

• Rt. Lower Extremity 18%

• Lt. Lower Extremity 18%

• Rt. Upper Extremity 9%

• Lt. Upper Extremity 9%

• Ext. Genitalia and Perineum 1%

RULE OF NINES - ESTIMATING BURNS

Rules of nine

Guide To Management

• Minor burns (less than 10%) can be treated in the

hospital on out patient basis

• Moderate and severe burns…….hospitalized for treatment

• Adult patients sustaining more than 20% burn require

intravenous therapy.

Emergency Care of Superficial Burn

1.1. CoolingCooling: If the skin is not broken, run cool water over the burned area or soak it in a cool water bath. Keep the area in the bath for five minutes. If the burn occurred in a cold environment, DO NOT apply water. A clean, cold, wet towel will also help reduce pain.

2.2. ReassuranceReassurance: Burns can be extremely painful, reassure the victim and keep them calm.

3. Sterilization: After flushing or soaking the burn for several minutes, cover the burn with a sterile non- adhesive bandage or clean cloth.

Emergency Care of Superficial Burn (cont’d)

4.4. Protection:Protection: Protect the burn from friction and pressure.

5.5. Medications:Medications: Over-the-counter pain medications may be used to help relieve pain; they may also help reduce inflammation and swelling.

6.6. Follow –upFollow –up: Minor burns will usually heal without further treatment.

Emergency Care for Severe Burns (Second & Third-Degree)

1.1. DO NOT remove burnt clothingDO NOT remove burnt clothing (unless it comes off easily), but do ensure that the victim is not in contact with burning or smoldering materials.

2.2. Make sure the victim is breathingMake sure the victim is breathing. If breathing has stopped or the victim's airway is blocked then open the airway and if necessary begin CPR.

3. If the victim is breathing, cover the burn with a cool cover the burn with a cool moist sterile bandagemoist sterile bandage or clean cloth. DO NOT apply any ointments and avoid breaking blisters.

4. If fingers or toes have been burned, separate them with dry sterile, non-adhesive dressings.

Emergency Care for Severe Burns (Cont’d)

5.5. Elevate the burned areaElevate the burned area and protect it from pressure or friction.

6.6. Take steps to prevent shockTake steps to prevent shock. Lay the victim flat elevate the feet about 12 inches, and cover the victim with a coat or blanket. DO-NOT place the victim in the shock position if a head, neck, back, or leg injury is suspected or if it makes the victim uncomfortable.

7.7. Continue to monitor the victim's vital signsContinue to monitor the victim's vital signs (breathing, pulse, blood pressure).

Emergency Care of Electrical Injuries

1. Make certain that you and the victim are in a SAFE ZONE then,

2. Provide airway care.3. Provide basic cardiac life support as required, be

prepared to perform defibrillation if necessary.4. Care for shock and administer high – concentration

oxygen.5. Care for spine injuries, head injuries and severe

fractures (the victim may have been thrown by a high –voltage current)

Emergency Care of Electrical Injuries (Cont’d)

6. Evaluate electrical burns.

7. Cool the burn areas and smoldering clothing the same as you would for a flame burn.

8. Apply dry dressing to the burn sites.

9. Transport as soon as possible.