Reported by: Katrina Cassandra R.

Bulado
Burns Involves top of skin

Are tissue damage that resuls from heat, other radiation, and
chemical or electrical contact. It is one of the most common
household injuries, especially among children.

It is characterized by severe skin damage that causes the affected

skin cells to die. Burns can be minor medical problems or life-
threatening emergencies. Involves top of the skin and dermis

Burns are classified into six categories from first degree burn to Deep blistering
sixth degree burn.

Charred dermis and subcutaneous tissue

Types of Burns
Thermal Injury
- Scald -spillage of hot liquids
-Flame Burns
-Flash burns due to exposure of natural gas, alcohol, combustible liquids
-Contact burns -contact with hot metals/objects

Electrical injury
Chemical burns- Acid/alkali
Cold injury- frost bite
Sun burns
Classification of Burns
Depth Appearance Sensation Healing time

First Degree
Dry, redBlanches with
Superficial Painful 3 to 6 days
pressure
(epidermal)

Painful to
Second Degree BlistersMoist, red,
temperature
Superficial partial- weepingBlanches with 7 to 21 days
and air and
thickness pressure
touch

Blisters (easily unroofed)Wet

Second Degree or waxy dryVariable color >21 days, usually
Painful to
Deep partial- (patchy to cheesy white to requires surgical
pressure only
thickness red)Blanching with pressure treatment
may be sluggish

Waxy white to leathery gray

Third Degree to charred and blackDry and Deep pressure Rare, unless
Full-thickness inelasticNo blanching with only surgically treated
pressure

Fourth Degree Extends into fascia and/or Never, unless

Deep pressure
Deeper injury muscle surgically treated
Jackson’s thermal wound
theory
Zone Of Coagulation- Center area of wound, where all tissues are
damaged
Zone Of Stasis- Surrounds the coagulation area, where compromised
blood supply, inflammation and tissue injury
Zone Of Hyperemia- Surrounds the stasis, where sustaines least damage
 Assessment of Burns
There are two commonly used method in assessing the total percentage of body surface area (TBSA):
Rule of Nines - The quickest assessment of TBSA for adults
Lund-Browder - the most accurate method in measuring TBSA in both adult
and children. Children have proportionally larger heads and smaller lower
extremities, so the percentage TBSA is more accurately estimated.
Formula:
4ml x TBSA x Weigh (kg) = (TOTAL) fluid to be replaced
in succeeding 24hrs

Birth First 8hrs = TOTAL

1 to 4 5 to 9 10 to 14
Area* to 1 Adult 2
years years years
year TOTAL = succeeding 8hrs

Head 9.5 8.5 6.5 5.5 4.5

Neck 1 1 1 1 1
Trunk 13 13 13 13 13
Upper arm 2 2 2 2 2
Forearm 1.5 1.5 1.5 1.5 1.5
Hand 1.25 1.25 1.25 1.25 1.25
Thigh 2.75 3.25 4 4.25 4.5
The palmar surface or palm method - is used in
Leg 2.5 2.5 2.5 3 3.25
adults and children. It's helpful for estimating the
Foot 1.75 1.75 1.75 1.75 1.75
extent of smaller burn areas. With this method, the
Buttock 2.5 2.5 2.5 2.5 2.5
surface of a person's hand (palm and fingers) equals
Genitalia 1 1 1 1 1
about 1% of their total body surface area. For example,
* Values listed are for one surface area and each individual extremity. Anterior and posterior surface if you have a burn that appears to be the size of two of
area values are equivalent in estimating total body surface area (TBSA). For circumferential burns, your hands, the extent of the burn is about 2% of your
multiply surface area burned by two.
total body surface area.
Percentage of burns
Mild (minor) Major (Severe)
Partial thickness burns <15% in adult or Second degree burns more than 25% in
<10% in children adults and more than 20% in children
Full thickness burns <2% All third degree burns of 10% or more
Can be treated on outpatient basis Burns that involves the eyes, ears, feet,
hands, and perineum
Moderate Burns with fractures or major
Second degree of 15-25% burns (10- mechanical trauma
20% in children)
Third degree between 2-10% burns
Burns that does not involve the eyes,
ears, face, hand, feet, perineum
Signs and sytoms
First Degree Burns (Superficial burns) First Degree Burns (Superficial burns) S&S:
The least serious type Pain
Only affects the outer layer of skin, called dermis Redness
Ex. Sunburn mild swelling of the skin, but usually no blisters

Second Degree Burns (Partial thickness burns) Second Degree Burns (Partial thickness burns) S&S:
Superficial partial thickness burns - burns that Pain
involve the top part of the dermis Deep redness of the skin
Deep partial thickness burns- burns that go Blisters
deeper into the dermis Wet or glossy look from leaking fluid
possible loss of some skin

Third Degree Burns (Full-thickness burns)
Require emergency medical attention. It damage
or completely destroy the thickness of the skin.
Third Degree Burns (Full-thickness burns) S&S:
Loss of skin layers
No pain if nerves have been destroyed
Dry, leathery skin
Charred skin or patches that appear white,
brown, or black
Pathophysiology
Burn Injury Skin and underlying tissues become damaged

Causes cells to seperate

Certain chemicals tells
blood vessels to constrict
Increase capilarry permeability Triggers release of certain chemicals
Blood Vessels Leak
Decrease in sodium and
increase in potassium
Hematocrit levels will start to rise

Less fluid to organs = Less oxygen to organs

Edema Decrease fluid inside the
Severe Hypovolemia
blood vessels

Decreased organ prefusion

Decreased blood flow to skin, brain, kidneys and GI tract
Pathophysiology
Since less blood
goes to the organs

The heart is going to try

Blood Pressure and Cardiac output will decrease
to compensate

Systemic Inflammatory response syndrome (SIRS) Infection

Multiorgan dysfunction syndrome (MODS)

Treatment
Medical Treatment: Pharmacological Treatment:
Water-based treatment Analgesics (Opioids- Morphine, fentanyl,
Administer IV fluids methadone, etc. meds for severe burn pain)
Burn creams and ointment (NSAIDs drugs - ibuprofen (Advil, Motrin IB,
[Ex. bacitracin and silver sulfadiazine (Silvadene)] others), or acetaminophen (Tylenol, others), can
Dressings help relieve pain).
Tetanus shot
Antibiotics (such as oxacillin, mezlocillin, and
gentamicin) are used to treat infection.
Topical Antimicrobials [ Silver Sulfadiazine
Surgical Treatment:
(Silvadene), Mafenide Acetate (Sulfamylon) -
Surgical debridement
used to treat and prevent infections in burn
Skin Grafting
wounds]
(skin replacement & skin substitute)
Topical corticosteroids (Hydrocortisone cream-
Surgical reconstruction
used to reduce inflammation and itching in
superficial burns)
nursing intervention
1. Assess the burn injury for its extent, depth, location and any associated injuries.
2. Always keep airway clear
3. Provide oxygen as prescribed
4. Provide analgesics as prescribed to alleviate pain and/or non-pharmacological
techniques pain management such as distraction, and positioning.
5. Monitor vital signs
6. Start Fluid resuscitation and monitor for any fluid shifts and electrolyte changes
that can occur
7. Clean the wound using aseptic technique to prevent infection
 References:
Burns: Types, Symptoms, and Treatments. (2014). Healthline.
https://www.healthline.com/health/burns#outlookCherney, K. (2019, June 4).
4th Degree Burn and Other Degrees: Classification, Healing, More. Healthline.
https://www.healthline.com/health/4th-degree-burnEdison, D. (2015, November 14). Pathophysiology of burns.
Slideshare.net. https://www.slideshare.net/oswinissac1/pathophysiology-of-burnsUpToDate. (2019). Uptodate.com.
https://www.uptodate.com/contents/assessment-and-classification-of-burn-injury
Thank you!