BURN INJURIES

Stephen F. Marcelo, M.D. FICSGeneral Surgeon6 September 2014

Neti

Skin

Causative Factors:

Heat Cold Chemical Electricity

Classification of burns

First degree burns = affect only the outer layer of the skin. = Symptoms: pain, redness, swelling.

Second-degree / Partial thickness burns = affect both the outer and underlying layers of skin. = Symptoms: pain, redness, swelling, and blistering.

Classification of Burns

Third-degree / Full thickness burns = extend into deeper tissues. = Symptoms: white or blackened, charred skin that may be numb.

Classification of Burns

Symptoms

Red skin Blisters Pain = degree of pain is not related to severity of burns (most serious burns can be PAINLESS) Peeling skin White or charred skin Swelling Shock ( Watch for pale, clammy skin, weakness,

bluish lips and fingernail)

Rule of Nines

RULE of NINES * used to approximate the percentage of Body

Surface Area involved (BSA) :• Head = 9%• Chest (front) = 9%• Abdomen (front) = 9%• Upper/mid/low back and buttocks = 18%• Each upper extremity = 9% ( Each palm =1% )• Groin = 1%• Each lower extremity = 18%

What constitutes Major Burn Injuries?

1. Burns > 10% TBSA in patients < 10 years old or >50 years old

2. Burns >20% TBSA for 11 – 49 years old3. Significant burns of the face, hands, feet,

genitalia, perineum, or major joints

Major Burn Injuries…

4. Full thickness burns >5% TBSA5. Significant electrical injury6. Significant chemical injury7. Lesser burns with: inhalation injury,

concomitant mechanical trauma, or significant pre-existing medical disorders

First Aid

MINOR BURNS

MINOR BURNS

1. If the skin is unbroken = run cool water over the area of the burn or soak it in a cool water bath (not ice water)

= Keep the area submerged for at least 5 minutes * a clean, cold, wet towel will also help reduce pain.

MINOR BURNS

2. Calm and reassure the person.

3. After flushing or soaking, cover the burn with a dry, sterile bandage or clean dressing.

MINOR BURNS4. Protect the burn from pressure and friction. 5. Give analgesics/ pain relievers = Ibuprofen or Acetaminophen can help relieve pain and swelling. = DO NOT give aspirin to children under 12 y.o. 6. Once the skin has cooled, moisturizing lotion can also help.

MINOR BURNS7. Minor burns will usually heal without further

treatment. *Exemptions: = burn area more than 2 to 3 inches in diameter, = burns located on the hands, feet, face, groin, buttocks, or a major joint treat the injury as a major burn.

MINOR BURNS

8. Provide tetanus immunization

First Aid

Major Burns

Major Burns1. If someone is on fire, tell the person to stop,

drop, and roll.2. Wrap the person in thick material to smother

the flames = wool or cotton coat, rug, or blanket.

3. Douse the person with water. 4. Call for HELP! (911)

MAJOR BURNS5. Make sure that the person is no longer in contact

with smoldering materials.6. DO NOT remove burned clothing that is adherent

to the skin. 7. Make sure the person is breathing. * If breathing has stopped, or if the person's

airways are blocked, open the airways. 8. If necessary, begin rescue breathing and CPR.

MAJOR BURNS9. Cover the burn area with a dry sterile bandage (if available) or clean cloth. = A cloth or bed sheet will do if the burned area

is large. 10. DO NOT apply any ointments. 11. Avoid breaking burn blisters. 12. If fingers or toes have been burned, separate

them with dry, sterile, non-adhesive dressings.

MAJOR BURNS

13. Elevate the body part that is burned above the level of the heart.

14. Protect the burn area from pressure and friction.

MAJOR BURNS15. Take steps to prevent shock =Lay the person flat, = elevate the feet about 12 inches, and = prevent hypothermia cover the person with

a coat or blanket. * DO NOT place the person in this shock position

if a head, neck, back, or leg injury is suspected or if it makes the person uncomfortable.

MAJOR BURNS16. Continue to monitor the person's vital signs until

medical help arrives. = pulse rate = respiratory rate = blood pressure

CHEMICAL INJURIES

Chemical Injuries * Immediate wound care takes

priority over resuscitation

Chemical Injuries* What to do:

Remove all contaminated clothing Copious water lavage for at least 30 minutes Use specific antidotes/ neutralizers for certain

chemicals hazardous chemicals should be properly and clearly labeled

(should include antidote/ neutralizer)

ELECTRICAL INJURIES

Electrical Injuries * high voltage injury not only

causes tissue damage at the contact site, but also to underlying tissues and organs along the route of the current

Electrical Injuries * What to do: prevent renal failure Monitor heart for arrhythmias ( 48 hours ) Check for neurological deficits Debridement Amputation

AIRWAYS BURN

Symptoms of Airways burn• Charred mouth; burned lips • Burns on the head, face, or neck • Wheezing • Change in voice • Difficulty breathing; coughing • Singed nose hairs or eyebrows • Dark, carbon-stained mucus

RECAP

Treatment of minor burn

To treat a minor burn, run cool water over the area of the burn or soak it in a cool water bath (not ice water). Keep the area submerged for at least 5 minutes.

Treatment of minor burns

After flushing or soaking for several minutes, cover the burn with a sterile bandage or a clean cloth.

Ibuprofen or Acetaminophen, may be used to help relieve the pain.

Minor burns will usually heal without further treatment.

REMEMBER !

When to seek medical help?• The burn is extensive (the size of your palm or larger). • The burn is severe (third degree). • You aren't sure how serious it is. • The burn is caused by chemicals or electricity.

When to seek medical help?• The person shows signs of shock.• The person inhaled smoke. • Physical abuse is the known or suspected

cause of the burn. • There are other pre-existing medical

conditions

REMEMBER ! ** For Major Injuries:• Do NOT apply ointment, butter, ice, medications,

cream, oil spray, or any household remedy to a severe or major burn.

• Do NOT breathe, blow, or cough on the burn wound.

• Do NOT disturb blistered or dead skin. • Do NOT remove clothing that is adherent to the

skin.

REMEMBER !• Do NOT give the person anything by mouth, if there

is a severe burn. • Do NOT immerse a severe burn in cold water. This can cause shock. • Do NOT place a pillow under the person's head if

there is an airways burn or you suspect a cervical spine injury. This can close the airways.

Thank You !