BURN

First Aid
LHV (1st year)

ABDUL MAJID
Akbar Institute of Medical
Sciences & Nursing College
(AIMS NC) Mansehra
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 Objectives
 Define Burn
 Discuss Causes of Burn
 Elaborate Sign and Symptom of Burn
 Describe Types of Burn
 Discuss about Stages of Burn
 Elaborate Management of burn
 Discuss about Complication of Burn

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 Skin Structures

 Epidermis – outer most

layer of keratinized
cells.
 Dermis – contains skin
appendages, vascular
supply and nerve
endings.
 Subcutaneous Tissue.
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 Functions of the Skin

 Barrier to infection  Control of body

 Protection from fluids
external injury  Sensory organ
 Temperature control  Determines identity

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 Burn Definition
 A burn is an injury to the skin or other
organic tissue primarily caused by heat or
due to radiation, radioactivity, electricity,
friction or contact with chemicals.
 Wounds caused by exposure to excessive
heat, chemicals, fire/steam, radiation,
electricity.
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 The Loss Of Skin Tissue Causes
 Attack of microorganisms, present in the environment
 Allows for the massive loss of body fluids.
 Alteration in body temperature
 Disturbance in immune system
 Excessive demands on the metabolic and reparative
processes that are needed to restore the body’s
interface with the environment.
 Disruption of the skin also leads to infection, scarring,
and changes in function, appearance, and body image.
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 Burn Depth

Factors
 Temperature
 Duration of contact
 Dermal thickness
 Blood supply
 Special Consideration: Very young and very old
have thinner skin
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 Causes
 Fire.
 Hot liquid or steam.
 Hot metal, glass or other objects. (heater)
 Electrical currents.
 Radiation, such as that from X-rays.
 Sunlight or other sources of ultraviolet radiation, such
as a tanning bed.
 Chemicals such as strong acids, lye, paint thinner or
9 gasoline.
 Stages of Burn
 First-degree (superficial) burns
First-degree burns affect only the epidermis,
or outer layer of skin. The burn site is red,
painful, dry, and with no blisters. Mild
sunburn is an example. Long-term tissue
damage is rare and usually consists of an
increase or decrease in the skin color.

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 Stages of Burn
 Second-degree -(partial thickness) burns
Second-degree burns involve the epidermis and part
of the dermis layer of skin. The burn site appears red,
blistered, and may be swollen and painful.
 Third-degree (full thickness) burns
Third-degree burns destroy the epidermis and dermis.
Third-degree burns may also damage the underlying
bones, muscles, and tendons. The burn site appears
white or charred. There is no sensation in the area
11 since the nerve endings are destroyed.
 Signs & Symptoms
 Superficial burn or first-degree burn:
– Skin is painful and red
– No blisters but skin turns white when touched
– Mainly the epidermis is involved.
 Partial-thickness burns or second-degree burn:
– Swelling Painful red areas of skin that turned white when
touched
– Blister formation
– Hair may still be present on the skin.
12 – The epidermis and the dermis layer of skin is involved.
 Signs & Symptoms
 Full-thickness burns or third-degree burn:
– Severe Pain / Painless
– No sensation to touch
– Skin area may be whitish or charred dry and have
leathery appearance.
– All three layers of skin (epidermis, dermis, and
subcutaneous tissue) are involved.
– In severe full-thickness burns, muscle tissue and/or
bone may be observed.
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 Types of burn
 Thermal burns: Burns due to external heat
sources which raise the temperature of the
skin and tissues and cause tissue cell death or
charring. Hot metals, scalding liquids, steam,
and flames, when coming in contact with the
skin, can cause thermal burns.

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 Types of burn
 Radiation burns: Burns due to prolonged
exposure to ultraviolet rays of the sun, or to
other sources of radiation such as x-ray
 Chemical burns: Burns due to strong acids,
alkalies, detergents, or solvents coming into
contact with the skin and/or eyes
 Electrical burns: Burns from electrical current,
either alternating current (AC) or direct current
(DC)
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 Pathophysiology

Contact between tissues and BURNS

energy sources

Increased capillary
permeability Immediately there is an Increased
blood flow
Release of vasoactive substances

Fluid shifting
Edema and
16 hypovolemia
 Conti…

Pathophysiological response

Minor burns < Excessive burns >

25% of TBSA 25% of TBSA

Localized effect Systemic effect

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 TBSA Assessment for burn

 Lund & Browder

 Wallace Rule of Nines
 Palmar Method

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 Palmar Method

 The palmar method is the simplest way to calculate

the total body surface area of a burn. To simplify
calculations, the palmar method is often described as
representing 1% of the patient's total body surface
area. A recent literature review has concluded that
palm and digits are 0.8% and the palm without digits
is 0.5% of the patient’s body surface area.
 The palm including digits in the estimation of smaller
or scattered burns.
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 Palmar Method

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 Wallace Rule of Nine (09)

Head & Neck = 9%

Each Arm = 9%
Each Legs = 18%
Anterior trunk= 18%
Posterior trunk = 18%
Genitalia (perineum)
22 = 1%
 LUND AND BROWDER METHOD

• A more precise method of estimating the extent of a

burn is the Lund and Browder method.
• It recognizes that the percentage of total body surface
area (TBSA) of various anatomic parts, especially the
head and legs, and changes with growth.
• By dividing the body into very small areas and providing
an estimate of the proportion of TBSA accounted for by
such body parts, one can obtain a reliable estimate of
the TBSA burned.
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 Management
Putting water over the burned area is extremely helpful.
 Emergency care: resuscitation and stabilization with IV
fluids.
 After hospitalization: Fuid replacement:
 Modified Parkland formula:
– Initial 24 hours: RL 4 ml/kg/% burn (adults)
– Next 24 hours: Begin colloid infusion of 5% albumin 0.3–
1 ml/kg/% burn/16 per hour.

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 Management

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 Management
– Fluids to prevent dehydration , maintenance of nutritional
demands.
– Antibiotic therapy and pain alleviation.
– Maintenance of cardiac and respiratory functions.
– Patients should be kept warm by infusing warm iv fluids,
elevating room temperatures.
– Tetanus immunization
– Dressings
– Emotional support

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 Management
 The wound is cleaned, debrided, and covered.
 Isolation measures.
 Topical agents (e.g., Silver sulfadiazine, sulfacetamide
acetate, silver nitrate), applied and dressed with gauzes.
 Skin grafts:
• Autograft (skin obtained from the person’s own body)
• Homograft (skin obtained from another human being)
• Heterograft (skin obtained from another species, such as
pigs).

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 Rehabilitation
 Rehabilitation includes positioning, splinting, and
physical therapy to prevent contractures and
maintain muscle tone.
 Elastic pressure garments, used to prevent
hypertrophic scarring.
 Emotional support
 Involvement in support group

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 Nursing Diagnose
 Deficient fluid volume r/t active fluid volume loss
 Impaired skin integrity r/t destruction of the skin
 Risk for infection r/t tissue injury s/t burns
 Imbalanced nutrition i;e less than body requirements r/t
difficulty in swallowing
 Dehydration r/t excessive fluid loss
 Impaired physical mobility r/t tissue injury s/t burns
 Disturbed body image r/t tissue injury s/t burns
 Ineffective breathing pattern r/t respiratory tract injury s/t
burns
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 Nursing interventions

 Maintain patent airway/ respiratory function.

 Assess V/S
 I/O charting and observation for renal functions
 hemodynamic stability.
 Alleviate pain.
 No aspirin
 Strict surgical asepsis
 High protein, high calorie diet
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 Conti….

 Prevent complications.
 Provide emotional support for patient/significant
other .
 Provide information about condition, prognosis,
and treatment.
 Educate the patient and relative regarding
hygiene practices

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 Complication
 Bacterial infection, which may lead to a bloodstream
infection (sepsis).
 Fluid loss, including low blood volume (hypovolemia).
 Dangerously low body temperature (hypothermia).
 Breathing problems from the intake of hot air or smoke.
 Scars or ridged areas caused by an overgrowth of scar
tissue (keloids).
 Bone and joint problems, such as when scar tissue causes
the shortening and tightening of skin, muscles or tendons
33 (contractures).