Burns: Causes and Classification

10 Questions

What is the first step in managing burn injuries?

Stop the burning

What is the recommended fluid of choice for fluid resuscitation in burn patients?

Ringer's lactate

What is the recommended urine output for burn patients?

30-50 ml/hr

When should blood transfusion be initiated in burn patients?

After 48 hours

What is the recommended method for local management of burn wounds?

Both open and closed methods

What is the purpose of cooling the burn area with tap water?

To prevent further tissue damage

What is the purpose of tube insertion in burn management?

For aspiration and later for feeding

What is the purpose of using colloids like plasma, gelatin, and dextran in burn fluid resuscitation?

To maintain serum albumin levels

When should sodium supplementation be needed in burn management?

When burns are greater than 20% of the body surface area

What is the purpose of applying antibiotic cream and covering the burn wound with gauze?

To prevent infection

Study Notes

Causes of Burns

Thermal injury: scald, flame, flash burns, and contact with hot metals/objects/materials
Electrical injury
Chemical burns: acid/alkali
Cold injury: frostbite
Ionizing radiation

Classification of Burns

First-degree burn: • Involves epidermis only • Red and painful • No blisters • Heals rapidly in 5-7 days • By epithelialization without scarring
Second-degree burn: • Involves epidermis and dermis • Mottled, red, and painful • With blisters • Heals in 14-21 days • Superficial burn heals, causing pigmentation • Deep burn heals, causing scarring and pigmentation
Third-degree burn: • Involves full thickness of skin • Charred, painless, and insensitive • Thrombosis of superficial vessels • Requires grafting • Eschar is charred, denatured, and insensitive • Heals by re-epithelialization from wound edge
Fourth-degree burn: • Involves underlying tissues: muscles, bones

Classification of Burns by Percentage

Mild: • Partial thickness burn < 15% in adult or < 10% in children • Full thickness burn < 2% in adult or < 10% in children
Moderate: • Second-degree burn 15-25% in adult or 10-20% in children • Third-degree burn 2-10% in adult or > 10% in children
Major: • Second-degree burn > 25% in adult or > 20% in children • Third-degree burn > 10% in adult or > 10% in children • Burns involving eyes, ears, feet, hand, or perineum • All inhalational and electrical burns

Signs and Symptoms

Blisters
Pain
Swelling
White or charred skin
Peeling skin

Complications

Arrhythmia
Dehydration
Disfiguring scars and contractures
Edema
Organ failure
Hypotension leading to shock

Assessment of Burns

Burned surface area
Depth of burn
Wallace Rule of Nine: method to estimate burned surface area in adults and children

Management of Burns

Stop the burning process
ABCDE assessment
Determine percentage area of burn (Rule of 9's)
Good IV access and early fluid replacement
Cool the area with tap water
Clean and dress the wound
Sedation and analgesia
Assessment of percentage, degree, and type of burn for fluid management
Chemoprophylaxis: tetanus toxoid, antibiotics, and local antiseptics

Fluid Resuscitation

Ringer lactate is the fluid of choice
Blood transfusion after 48 hours
First 24 hours: crystalloids only
After 24 hours: colloids like plasma, gelatin, and dextran
Urine output: 30-50 ml/hr
Albumin 5% to maintain serum albumin levels at 2 g/dl
Sodium supplementation may be needed for burns > 20% BSA

Local Management

Open Method: application of silver sulphadiazine without dressings
Closed Method: with dressings to soothe and protect the wound