Classification of Burns Overview

Study Notes

Injuries to any tissue caused by heat, flame, chemicals, electricity or radiation.
Depending on the severity, burns are categorized as moderate or major.
Burn center referral is required in specific cases such as severe burns and certain pre-existing conditions.

First Degree: Only involves the epidermis, exhibits erythema, pain, slight edema; heals within 5-10 days. Example: Sunburn.
Second Degree: Involves both the epidermis and dermis; exhibits blisters, subcutaneous edema, pain, and a mottled red surface; healing takes place within 10-14 days. Considered moderate when less than 25% of the total body surface area (TBSA) in adults or less than 20% for children. Considered major when greater than 25% TBSA in adults or greater than 20% for children.
Third Degree: Involves the entire epidermis and dermis, subcutaneous tissues are destroyed; exhibits a charred appearance and may be painless due to nerve damage. Healing takes place after 2-3 weeks with full-thickness dead skin liquefies partially or by autolysis and leukocytic digesting.

Skin: Impairment in the skin's protective function, leading to dehydration and infection.
Vascular System: Damage to blood vessels can cause fluid loss, hypovolemia, and shock.

Airway Management: Ensure a patent airway and address any inhalation injuries.
Cooling: Apply cool water (not ice) to the burn for 10 to 15 minutes.
Remove constrictive clothing: Remove constrictive clothing to avoid circulation impairment.
Cover burn with sterile dressing: Cover the burnt area with a sterile dressing to prevent contamination and protect from further injury.

Lund and Browder Chart: Used to evaluate the TBSA based on age-specific body proportions.
Rule of Nines by Pulaski and Tennison: A simplified method to estimate the TBSA based on body regions.
Parkland Formula: Used to calculate fluid resuscitation needs based on body weight and TBSA.

Sedation and Analgesics: Pain control is essential for both physical and psychological well-being.
Escharatomy and Fasciotomy: These procedures relieve pressure caused by tissue swelling, improving circulation.
Gastric Decompression: Avoids aspiration and reduces the risk of complications.
Burn Wound Care: Frequent cleansing, debridement, and dressing changes are essential to prevent infection and promote healing.
Topical Chemotherapy: Antibacterial and anti-inflammatory medications are applied to reduce infection and promote healing.
Synthetic Coverings: Artificial skin substitutes can aid in wound closure and minimize scarring.

Infection: Common complication due to compromised skin integrity, managed with antibiotics and wound care.
Contractures: Scar tissue can restrict movement, requiring physical therapy.
Hypertrophic scarring: Raised, thickened scars requiring more intricate treatment, including laser therapy or steroid injections.

Partial-thickness and full-thickness burns exceeding 10% TBSA in individuals under 10 or over 50 years old.
Burns affecting the face, hands, feet, genitalia, perineum, or major joints.
Full-thickness burns surpassing 5% TBSA.
Any electrical burns, including lightning injury.
Chemical burns.
Inhalation injury.
Burn injuries coupled with traumatic injuries.
Burn injuries in patients with pre-existing conditions that can complicate management.
Burn injuries in patients who require specialized social, emotional, or rehabilitative interventions.
Burn injury patients in hospitals lacking qualified personnel for pediatric burn care.