BURN

By
DR. NICOLAUS JOSEPH, MD

06/07/24 1
 DEFINITION
• Burn injury can be defined as bodily injury resulting
from exposure to heat, cold, chemical, electricity or
radiation
• Burn causes coagulation necrosis of the skin and
underlying tissues

06/07/24 2
 EPIDEMIOLOGY
Incidence
• Burn injury constitutes a major health problem allover
the world affecting approximately 1% of the world
population each year
• In TZ burn injury is one of the commonest form of
trauma

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 Morbidity / mortality
• Burn injury contributes significantly to high
morbidity and mortality
• Patients with extensive burns frequently die, and for
those with less severe injuries, physical recovery is
slow and painful
• In addition to physical damage caused by burns,
patients also may suffer emotional and
psychological problem
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 Age
• Age incidence depends on the type of burn
• Scald is common in children < 5 year of age while
flame, electrical and chemical burn injuries are
common in adult

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 Sex
• Sex distribution depends on the place of burn
• Domestic burn injury is common in females while
occupational and recreational burns are common in
males

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 Race
• No racial predilection exists in burn injuries

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 Risk Factors
 Diseases e.g. epilepsy, diabetes
 Children< 5years; Elderly > 75 years
 Cold weather
 Occupational – electricians/industrial
 Alcoholism
 ??Low socioeconomic status
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 Anatomy of the Skin

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 ETIOLOGY
• Thermal injuries
– Scald
– Flame
– Contact
• Chemical injuries
• Electrical injuries
• Radiation injuries
• Cold injuries
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 Mechanism of injury
• Depends on the causes
– Thermal injuries
• Scald
• Flame
• Contact
– Chemical injuries
– Electrical injuries
– Radiation injuries
– Cold injuries
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 Thermal injuries
• Scalds
– About 70% of burns in children are caused by scalds
– They also often occur in elderly people
– The common mechanisms are spilling hot drinks or liquids
or being exposed to hot bathing water
– Scalds tend to cause superficial to superficial dermal burns

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• Flame
– Flame burns comprise 50% of adult burns
– They are often associated with inhalational injury and other
associated injuries
– Flame burns tend to be deep dermal or full thickness
• Contact
– In order to get a burn from direct contact, the object touched must
either have been extremely hot or the contact was abnormally long
– The latter is a more common reason, and these types of burns are
commonly seen in people with epilepsy or those who misuse alcohol
or drugs
– They are also seen in elderly people after a loss of consciousness
– Contact burns tend to be deep dermal or full thickness
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 Electrical injuries
• Account for 3-4% of burn admissions
• An electric current will travel through the body from one point to
another, creating "entry" and "exit" points
• The tissue between these two points can be damaged by the
current
• The amount of heat generated, and hence the level of tissue
damage, is equal to 0.24x(voltage)2xresistance
• The voltage is therefore the main determinant of the degree of
tissue damage
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• Electrocution injuries can be divided into two categories:-
– Low voltage injuries
• Considered to be anything <1000 volts
• This includes domestic electrical supply
– High voltage injuries
• Can be further divided into:-
– True high tension injuries
» Caused by high voltage current passing through the body
» > 1000V
» There is extensive tissue damage and often limb loss
» There is usually a large amount of soft and bony tissue necrosis
» Muscle damage gives rise to rhabdomyolysis, and renal failure may occur with these injuries
– Lighting injuries
» Caused by exposure to an extremely high voltage current
» Result from an ultra high tension
• A particular concern after an electrical injury is the need for cardiac
monitoring
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 Chemical injuries
• Chemical injuries are usually as a result of industrial
accidents but may occur with household chemical
products
• Chemical burn may also occur as a result of assault
• These burns tend to be deep, as the corrosive agent
continues to cause coagulative necrosis until completely
removed
• Alkalis tend to penetrate deeper and cause worse burns
than acids
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 Radiation injuries
• These burns are frequently caused by ultraviolet
rays from the sun and nuclear sources

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 Cold injuries
• Results from exposure to extremely cold →tissue
necrosis

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 CLASSIFICATION
• According to the type [causes] of burn
– Thermal burn
• Scald
• Flame burn
• Contact burn
– Electrical burn
– Chemical burn
– Radiation burn
– Cold burn
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• According to body site burned
– Facial burn
– Head & neck
– Trunk
– Limbs
– Perineal burn etc
• According to burn depth
– Superficial burn
• Epidemal
• Dermal
– Deep burn
• Dermal
• Full thickness
– Mixed burn
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• According to the degree of tissue injury
– First degree burn
– Second degree burn
– Third degree burn
– Fourth degree burn
• According to the Size/Extent of Burn Injury
– Total body surface area (TBSA) burned
• According to the severity of burn
– Minor burn
– Moderate burn
– Major burn

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 PATHOPHYSIOLOGY
• Burn injuries result in:-
– local response
– systemic response

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 A. Local responses
• Divided into three zones of a burn which were
described by Jackson in 1947 →Jackson’s zones of
burn wound
• These zones include:-
– Zone of coagulation
– Zone of stasis/ischaemia
– Zone of hyperamia
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 Jackson's burns zones

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 a. Zone of coagulation
• This occurs at the point of maximum damage
• In this zone there is irreversible tissue loss due to
coagulation of the constituent proteins

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 b. Zone of stasis /ischemia
• The zone of stasis is characterized by decreased tissue perfusion
• The tissue in this zone is potentially salvageable
• The main aim of burns resuscitation is to increase tissue
perfusion here and prevent any damage becoming irreversible
• Additional insults—such as prolonged hypotension, infection, or
edema—can convert this zone into an area of complete tissue
loss

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 c. Zone of hyperaemia
• In this outermost zone tissue perfusion is increased
• The tissue here will invariably recover unless there
is severe sepsis or prolonged hypoperfusion

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 B. Systemic response
• The release of cytokines and other inflammatory
mediators at the site of injury has a systemic effect
once the burn reaches 30% of total body surface
area

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 a. Cardiovascular changes
• Capillary permeability is increased, leading to loss of
intravascular proteins and fluids into the interstitial
compartment
• Peripheral and splanchnic vasoconstriction occurs
• Myocardial contractility is decreased, possibly due to
release of tumor necrosis factor

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 • Cardiac output decreases due to loss of
intravascular volume

• These changes, coupled with fluid loss from the

burn wound, result in systemic hypotension and
end organ hypoperfusion

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 b. Respiratory changes
• Inflammatory mediators cause bronchoconstriction, and
in severe burns adult respiratory distress syndrome can
occur
• Pulmonary dysfunction may occur as result of:-
– Inhalation injury
– Aspiration
– Shock
– Upper airway injury/edema
– Circumferential thoracic eschar → RLD
• Hypovolemia may cause V/Q mismatch
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 Inhalational injury
• It is caused by the minute particles within thick
smoke, which, because of their small size, are not
filtered by the upper airway, but are carried down
to the lung parenchyma.
• They stick to the moist lining, causing an intense
reaction in the alveoli.
 Inhalational injury cont..
• This chemical pneumonitis causes edema within
the alveolar sacs and decreasing gaseous exchange
over the ensuing 24 hours, and often gives rise to a
bacterial pneumonia.
• Its presence or absence has a very significant effect
on the mortality of any burn patient.
 c. Gastrointestinal changes
• Characterized by mucosal atrophy, changes in the
digestive absorption and  intestinal permiability
• Burn also causes reduced glucose, amino acids and
fatty acids
• Stress (curling’s) ulcer
• Acute pseudo-obstruction of the colon
– massive colonic dilation without organic cause
• Acalculous cholecystitis
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 d. Renal changes
• Uncommon, but can result from:
– prolonged hypotension due to hypovolemia
– myoglobin release from damaged muscle/tissue
– hemoglobinuria from heat-induced
•  BV & CO  RBF GFR:-
– Release of Angiotensin II, aldosterone, vasopresinfurther
reduction of RBF & GFRARF
– Oliguria ATN & ARF
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 e. CNS Changes
• CNS dysfunction in up to 14% of burn patients
– most had >50% BSA involvement
• Hypoxia most common etiology
– smoke inhalation, pulmonary edema, pneumonia

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 f. Haematological changes
• Mild thrombocytopenia (sequestration) early,
followed by thrombocytosis (2-4x normal) by end
of the first week
• Persistant thrombocytopenia associated with poor
prognosis--suspect sepsis
• DIC with generalized bleeding can occur
– shock, sepsis, hypoxia, reperfusion
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 g. Immunologic Changes
• Loss of Skin as an organ of host defense→:-
– Loss of keratin layers which act as physical barrier to
bacterial invasion →wound sepsis
– Loss of stratum corneum containing of unsaturated free fatty
acid film which is bacteriostatic and fungistatic
•  Cellular Immune Function
– Several circulating mediators in burn patient sera suppress
normal lymphocyte function
– CD4 count
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• Humoral Immune Function
– immunoglobulin levels decreased proportional to burn size
– leakage of IgG & IgA from the circulation, fibronectin
depletion, impaired opsonization
• Phagocyte Function
– early granulocytopenia common
– diminished chemotactic responsiveness
• diffuse endothelial cell activation, and adhesion molecule
overexpression
– decreased oxygen radical production, with impaired
bactericidal activity
– PMN margination/aggregation
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 h. Metabolic changes
• Metabolic changes in burn injury occur in 2
phases:-
– Ebb phase
– Flow phase
• Catabolic phase
• Anabolic [recovery phase]

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 Ebb phase

• Occurs during the 1st 24 hours

• Characterized by  MR, hypothermia, CO & 
oxygen consumption

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 Flow phase
• Subdivided into 3 phases:-
– Catabolic phase
– Anabolic phase

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 a. Catabolic phase
• Occurs after 24 hours after burn injury
• Characterized by:-
– ↑ Cardiac output
– ↑ Oxygen consumption
– ↑ Heat production [hyperthermia]
– ↑ BMR
– Hyperglycemia
– Proteolysis
– Peripheral lipolysis
• Mediated through release of catabolic hormones [ i.e.
catecholamines, glucocorticoids, glucagon etc ] and other chemical
mediators e.g. cytokines, lipid mediators etc
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 b. Anabolic phase
• Also called recovery phase
• Characterized by:-
– Slow re-accumulation of protein and fat
– This phase continues for weeks to months after injury

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 ASSESSMENT OF BURN INJURY

Remember
 Establish cause.
 Associated injuries
 During escape from fire.
 Explosions throw patient a distance causing internal injuries.
 Electrical muscular spasms can cause fractures.
 Burns in enclosed space suggest inhalational injury.
 Pre-existing disease states, medication, allergies, lung sensitivities.
 Establish tetanus immunization status.

Friday, June 7, 2024 45

 Clinical presentation
• History
• Physical examination
– General
– Systemic
– Local

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 History
• Patient characteristics
– Age
– Sex
• History of injury
– Time of burn
– Place of burn
– Nature of injury
• Intentional
• Unintentional
• Undetermined

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• Type of burn
– Thermal
– Chemical
– Electrical
– Radiation
– Cold
• Mechanism of injury
• Associated injuries
• Associated inhalation injuries
• Associated clothing iginition
• Whether first aid measures was done at the site of accident
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 Physical examination
• General
– Body weight
– Shock
– Level of consciousness
– Dyspnoea
– In pain
– Restless ± gasping
– Anaemic
– Dehydration
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 • Systemic examination
– Cardiovascular system
– Respiratory system
– PA
– CNS
• Local examination [assessment of burn wound]
– Body region burned
– Extent of burn
– Burn depth
– Severity of burn
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 a. Body region burned
• Head / neck
• Upper limbs
• Trunk
• Lower limbs
• Genitalia / Perineal areas

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 b. Extent of burn [%TBSA]
• Size of a Burn Injury
– Total Body Surface Area (TBSA) Burned
• Palmar Method
– A quick method to evaluate scattered or localized burns
– Client’s palm = 1 % TBSA
• Rule of Nines
– A quick method to evaluate the extent of burns
– Major body surface areas divided into multiples of nine
– Modified version for children and infants (Rule of Sevens )
• Lund-Browder Method
– Most Accurate; based on age (growth)
06/07/24 – Can be used for the adult, children & infants 52
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 c. Burn depth
• Superficial (First Degree)
• Partial Thickness
– Superficial ( Second Degree)
– Deep ( Second Degree)
• Full Thickness ( Third Degree)
• Deep-Full Thickness (4th degree)

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 i. Superficial (First Degree)
• Involves the epidermis
– Wound Appearance:
• Red to pink (light skin)
• Mild edema
• Dry and no blistering
• Pain / hypersensitivity to touch
– i.e. Classic sunburn
• Desquamation occurs 2-3 days
– Wound Healing
• Wound Healing spontaneous
• Duration 3 to 5 days
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 Superficial-1st Degree Burns

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 ii. Superficial - 2nd Degree Burns
• Involves upper 1/3 of dermis
– Wound Appearance:
• Red to pink
• Wet and weeping wounds
• Thin-walled, fluid-filled blisters
• Mild to moderate edema
• Extremely painful
– Wound Healing:
• In 2 weeks (spontaneous)
06/07/24 • Minimal scarring; minor pigment discoloration may occur 61
06/07/24 62
 Superficial - 2nd Degree Burns

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 iii. Deep 2nd Degree Burns
• Wound Appearance:
– Mottled: Red, pink, to white surface
– Moist
– No blisters
– Moderate edema
– Painful; usually less severe than superficial 2 nd Degree
• Wound Healing:
– May heal spontaneously 2-6 weeks
– If so Hypertrophic scarring / formation of contractures
• Wound Management:
– Treatment of choice: surgical excision & skin grafting
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 Deep 2nd Degree Burns
(10th day post-burn)

Deep 2nd Degree

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 iv. Full-Thickness Burns (3rd degree)
• Involves the entire epidermis and dermis
– Wound Appearance:
• Dry, leathery and rigid
• + Eschar (hard and in-elastic)
• Red, white, yellow, brown or black
• Severe edema ( ? Escharotomy in limbs, chest)
• Painless & insensitive to palpation
– Wound Healing:
• No spontaneous healing;
weeks to months with graft
– Wound Management:
06/07/24 • Surgical excision & skin grafting 66
06/07/24 67
 v. Deep Full-Thickness Burns
• Extends beyond the skin to include muscle, tendons &
possibly bone.
– Wound Appearance:
• Black (dry, dull and charred)
• Eschar tissue: hard, in-elastic
• No edema
• Painless & insensitive to palpation
– Wound Healing:
• No spontaneous healing; weeks to months with graft
– Wound Management:
• Surgical excision & skin grafting
06/07/24 • Frequently requires amputation if extremity involved 68
06/07/24 69
 d. Severity of burn
• Severity is determined by:
– Type of burn
– Depth of burn injury
– Total body surface (TBSA) burned
– Location of burn (face, hands, feet and perineum are considered severe !!)
– Patient’s Age
– Presences of other preexisting medical conditions
– Presence of associated injuries
– Complications (Inhalation , Hypothermia , Shock)
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 • Severity classified as follows:-
– Minor
– Moderate
– Major

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 i. Minor burn injury
• Characterized by:-
– <10% in adult
– < 5% <10 yo >50 yo
– < 2% full thickness
– No associated injuries, no complications, no pre-morbid
illness, no circumferential burns, not involving the hands,
face, perineum
• Minor burn needs outpatient management

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 ii. Moderate burns
• Moderate – admit
– 10 - 20 % in adult
– 5 - 10 % <10 yo >50 yo
– High voltage, suspected inhalation,
circumferential or susceptibility to infection

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 iii. Major burns
• Second and third-degree burns greater than 10% body surface
area (BSA) in patients under 10 or over 50 years of age
• Second and third-degree burns greater than 20% BSA in
patients between 10 and 50 years of age
• Second and third-degree burns with serious threat to functional
and cosmetic impairment that involve the face, hands, feet,
genitalia, perineum, and other major joints
• Third-degree burns greater than 5% BSA
• Specialized injuries such as electrical burns, including lightning
and chemical burns, with serious threat of functional or
cosmetic impairment

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• Significant inhalation injuries
• Circumferential burns of the extremities or the chest
• Pre-existing medical disorders that complicate
management, prolong recovery, or affect mortality
• Concomitant trauma in which the burn injury poses the
greatest risk of mortality

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 WORK UP
• Lab studies
 Serum electrolyte for checking levels of electrolytes
especially Na and K
 Serum creatinine for renal function
 Full Blood Picture for checking anemia and number of
WBCs
• Imaging studies
– CXR
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 management
• Objectives of management
• Burn team
• Criteria for admission
• Phases of management

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 Objectives of management
• To prevent fluid and electrolyte imbalance
• Rapid and painless healing
• To prevent complications
• Rehabilitation

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 Burn team
• Consists of multidisciplinary group whose individual skills are
complementary to each other
• Includes:-
– Surgeons –reconstructive (plastic), General or trauma surgeon, Paediatric
surgeon
– Nurses
– Anesthetist
– ICU team
– Physiotherapist
– Occupational therapist
– Social workers
– Psychologists
– Psychiatrist
–
06/07/24 Dietitians 79
 Criteria for admission
• Type of burn
– Electrical
– Chemical
– Lightening
• Complications- inhalation burn
• Circumferential burns of the limbs or chest
• 2nd and 3rd degree burns more than 15% BSA in adults or more than 10% of
BSA in children3rd degree burns over 2-5% of BSA in adults
• Burns to hands, face, feet, perineum and inner joint surfaces
• Associated carbon monoxide poisoning
• Severe underlying medical illness (diabetes, emphysema, coronary artery
disease, etc)
•06/07/24
Suspected battered child (intentionally inflicted injuries) 80
 Transfer to Burn Centre
• 2nd and 3rd degree burns more than 25% of BSA in adults or
more than 20% of BSA in children
• 3rd degree burns more than 10% of BSA
• 3rd degree burns to hands, feet, face and perineum
• Major chemical or electrical burns
• Respiratory tract injury
• Associated major trauma
• Circumferential burns
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 Phases of management
• As in all trauma patients the mgt of burn injury is
divided into 5 phases according to ATLS (Advanced
Trauma Life Support)
 Phase I: Primary survey phase
 Phase II: Resuscitation phase
 Phase III: Secondary survey phase
 Phase IV: Supportive care phase
 Phase V: Definitive treatment phase
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 Phase I: Primary survey phase
• Aim: to identify life threatening conditions
• The life threatening conditions include:
– A=Airway
– B=Breathing
– C=Circulation
– D=Disability- neurological status
– E=Exposure
• This should go hand in hand with the phase II
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 Phase II: Resuscitation phase
• Aim: to treat the immediately life threatening condition
 Airway –secure airway & Immobilize the cervical spine
 Breathing – optimize ventilation
 Circulation- establish i.v. access
 Disability- assess neurological deficit
 Expose the patient to avoid missed injury
 Fluid therapy

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 Airway
• A clear patent and functional airway should be
established
• This can be achieved by:-
– Use of airways
– Proper position of the patient
– Endotracheal intubation
– Ambubags
– Tracheostomy
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 Breathing / Ventilation
Make sure the patient is breathing properly
Achieved by:-
– Use of oxygen masks
– Mechanical ventilators

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 Disability: Neurological Status
• Establish level of consciousness
– A= Alert
– V= Response to Vocal stimuli
– P= Response to Painful stimuli
– U= Unresponsive
• Examine the pupillary response to light
• Be aware of hypoxemia and shock can cause  level of
consciousness
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 Exposure with Environment control
• Stop the burning process and relieve pain
• Remove victim`s clothes, rings and other jewellery.
• Immerse or cover the affected area in cool water.
• Keep the patient warm

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 Fluid Resuscitation
 Maintain tissue perfusion to the zone of stasis and so
prevent the burn from deepening

 Indication= ped 10%, adult 15%

 Fluid resuscitation formula

 not ideal
 guidelines
success relies on adjusting the amount of resuscitation fluid ↔
against monitored physiological parameters
 Insert intravenous cannula (16G or 14G) through unburned skin.

Friday, June 7, 2024 BURN 89

 Resuscitation cont…..
• Parkland formula
– Ringer Lactate 4mls x KgBwt x %TBSA1st 24hrs
– Crystalloid formula (R/L or NS)
– For burn >50% TBSA, use 50% for calculation (to prevent
fluid overload)
– ½ given in 1st 8 hrs & ½ next 16hrs.
– Maintenance fluid is required in addition to above for children
– If urine output is inadequate, increase infusion by 200ml
next hour
Friday, June 7, 2024 BURN 90
 Resuscitation cont….
After 1st 24 hrs, colloid infusion(Albumin or Dextran 70) is started at a rate of
0.5 ml× (%TBSA)×(Bwt in kg) and
• Maintenance crystalloid (usually DNS or 5% Dextrose in the 2nd 24 hours
to maintain urinary output) is continued at a rate of
1.5mls x %TBSA x Bwt
End point to aim is a urine output of:-
0.5-1.0 ml/kg/hr in adults
1.0-1.5 ml/kg/hr in children
• Hypertonic saline improves circulation, cardiac function faster and reduces
load

Friday, June 7, 2024 BURN 91

 Resuscitation cont…..
Colloid use is controversial:
• some units start colloid after 8 hrs (as the
capillary leak begins to shut down)
• whereas others wait until 24 hrs
FFP is often used in children,
albumin or synthetic high molecular weight in
adults.

Friday, June 7, 2024 BURN 92

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 Phase III :Secondary survey phase
Not started until phase I &II are complete
This include:-
 History
 Physical examination
 Investigations as above

06/07/24 94
 Secondary survey cont…
Baseline investigation for major burn.
 Blood
• Hb
• Grp & x-match
• CoHb
• Serum glucose
• Electrolytes
 X-rays
Friday, June 7, 2024 BURN 95
 Phase IV: Supportive care phase
• Analgesics- IM Pethidine 100mg
• Systemic antibiotics - IV Ampiclox 1gm TDS 5/7 or IV
Ceftriaxone 1 gm OD 5/7 AND IV Metronidazole 500 mg TDS
5/7
• Tetanus Prophylaxis
 Previous immunization <5 years: Nil
 Previous immunization > 5 years: booster
 No immunization or >10 years, 250-500 units of human anti
tetanus globulin then full course TT when patient is stable
06/07/24 96
 Supportive care phase
• Burns 20% or greater carry a high incidence of paralytic ileus and
Curling’s ulcer.
 A nasogastric tube should be inserted
 IV Pantoprazole 40 mg OD 3/7 or IV Ranitidine 50 mg 8hrly
• Elevate limbs to decrease oedema
• Monitor -Vital signs and Input /output
• Urethral catheterization for monitoring urine output to achieve (0.5-
1 mls/kg/hour)
• Nutrition support -Mainly carbohydrates, protein, vitamin A and C
rich diet
• Physiotherapy to avoid contractures
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 Phase V: Definitive treatment phase
(Wound care)
• Depends on the characteristics and size of the
wound
– Conservative treatment
– Surgical treatment

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 Conservative treatment
• Indicated for superficial 1st and 2nd degree burn
• Involves:-
– Wound dressing
– Topical antimicrobial agents

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 a. Wound dressing
• The dressing should serve the following fx:-
– Protect the damaged epithelium, minimizing bacterial ad
fungal colonization (protective fx)
– Provide splinting action to maintain the desired position of
function (splinting fx)
– Occlusive to reduce evaporative heat loss and minimize cold
tress
– Provide comfort over the painful wound
• The choice of dressing is based on the characteristics
of the wound
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• Sterile Dressing
• Several layers dressings
• Special Considerations:
– Joint area lightly wrapped to allow mobility
– Facial wounds maybe left open to air, kept moist
– Circumferential burns: wrap distal to proximal
– All fingers and toes should be wrapped separately
– Splints applied over dressings
– Functional positions maintained; not always comfortable

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 b. Antimicrobial Agent
• Apply an Antimicrobial Agent -Silver sulphadiazine-
0.5% (Silvadene or Silverex)
– Silverex
• Broad spectrum , Ideal choice.
– Silvadene
• Broad spectrum; the most common agent used
– Sulfamylon
• Penetrates eschar for invasive wound infections
• Painful burns for approximately 20 minutes after applied
– Acticoat (antimicrobal occlusive dressing)
• A silver impregnated gauze that can be left in place for 5 days
06/07/24
• Moist with sterile water only; remoisten every 3-4 hours 102
 Surgical treatment
• Escharotomy -Early eschar excision (escharotomy
and fasciotomy) and grafting
– Eschar is excised at 2-7 days .and grafted
immediately
– Grafting reduces evaporation, pain and protects
underlying tissue
• Skin grafting -2nd and 3rd degree burns that do not
heal at 3 weeks may require skin grafting
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 Complications
• Ca be classified as:
– Early Complications
– Late Complications

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 a. Early Complications
• Fluid/Electrolyte imbalance
• Hypovolaemic shock
• Thermoregulation dysfunction-Hypothermia
• Acute renal failure
• Inhalation injury
• Pneumonia - Bronchpnemonia (S.aureus or Gram-ve organisms)
• Burn wound sepsis/Systemic infection
• Anemia
• Acute endocarditis - thrombophlebitis
• Stress ulcers /Curling ulcers
• Acute gastric/colonic dilatation-Adynamic ileus
• Cardiopulmonary failure 105
06/07/24
 b. Late Complications
• Contractures
• Keloids
• Hypertrophic scars
• Hyperpigmentation
• Marjolin’s ulcer
• Corneal abrasions
• Cataracts
• Acalculous Cholecystitis
06/07/24 106
 Prognosis
• The prognostic factors for burns are classified as
follows:-
– Patient characteristics
– Circumstances of the injury
– Characteristics of burn wound
– Treatment parameters

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 Patient characteristics
• Age
• Sex
• Pre-existing illness
• HIV status

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 Circumstances of the injury
• Nature of the injury
• Type of burn
• Timing in seeking medical care
• Associated injuries
• Associated burning of clothes
• Inhalation injury
• First-aid measures taken at the site of accident
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 Clinical characteristics of burn wound
• Body regions burned
• % total surface area burnt (%TSAB)
• Burn depth
• Severity of burn
• Burn wound sepsis

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 Prevention
• 1st – risk factors
• 2nd – early treatment
• 3rd – rehabilitation

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 THANK YOU

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