ASRAT WOLDEYES HEALTH SCIENCE CAMPUS

DEPARTMENT OF PUBLIC HEALTH OFFICE

PREPARED BY : Bemihret Getachew and
Getahun

Modulator:DR.Selamawit Hassen
Sub DATE :1
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 OUTLINE

 Objective
 Anatomy & Physiology of skin
 Definition
 Epidemiology
 Etiology
 Pathophysiology burn
 risk factor
 Classification of burn
 Clinical assessment of burn
 Admission Criteria
 Management and Complication of burn
 Reference

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 OBJECTIVE
 To define burn
 To know different types of burn
 To express the pathophysiology of burn
 To explain classification of burn
 To assess burn wound
 To describe management of burn

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Anatomy and physiology
• The skin is also known as cutaneous membrane or integument covers the
external surface of the body
• The skin is a sensory organ whicht is the largest organ of the body.
• It has three main parts (Layers). These are:-
I. Epidermis (Epidermal layer) :- superfiial layer of the skin
-compose of epithelial tissue
II. Dermis (Dermal layer) :-the deeper layer of the skin
- primery composed of connective tissue
has two parts, papillary dermis and reticular dermis.
- it contains sebaceous gland, sweat gland, hair follicule, and neurovascular
structures.
III. Subcutaneous tissue
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ANATOMY AND PHYSIOLOGY

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 Functions include:
• protection from external environment
• maintenance of fluid/electrolyte homeostasis
• Thermoregulation
• immunologic function
• sensation
• Excretes toxic substances with sweat.
• Metabolic organ (i.e., Vit D synthesis)

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 BURN
BURN
• defined as a wound caused by exogenous agent leading to coagulatie necrosis of the
tissue.
• a type of injury to skin, or other tissues, caused by heat, cold, electricity, chemicals,
friction, or radiation. Most burns are due to heat from hot liquids, solids, or fire
ETIOLOGIES could be
• thermal
• Electict contact
• chemical
• ionizing radiation
• cold injuries
• inhalation injuries
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Epidemiology
 Burns are the 4th most common type of trauma worldwide
 265,000 deaths every year are caused by burns
 One of leading causes of disability-adjusted life-years (DALYs) lost in low-
and middle-income countries
 Ethiopian situation :-

 A community-based study (7309 pts in 390 households)

 Highest incidence was in children < 5yrs,

 Most common causes were :-

- Scald burn (59 %);

- Flame (34 %),

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 Etiology
Thermal burns
contact
Direct contact with hot object (i.e. pan or iron)
• Anything that sticks to skin (i.e. tar, grease or foods)
Scalding
• Direct contact with hot liquid / vapors (moist heat)
i.e. cooking, bathing or car radiator overheating
• Single most common injury in the pediatric client
• Flame
Direct contact with flame (dry heat)
• i.e. structural fires / clothing catching on fire
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Electrical
Electrical it is the result of direct contact with electricity or lighting
Effects of current depend on several factors
- type of circuit
- voltage
-resistance of body
-duration of contact
divided into
high voltage-greaterthan1000v
low voltage -less than 1000v

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Radiation
Prolonged exposure to ultraviolet rays of the sun
Other sources: occupational or medical therapies

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Cold Injuries
Frostbite
• Don’t forget all burns not from heat !!
• Injury due prolonged exposur to freezing &sub freezing temperatures.
• Ice crystals puncture the cells and destroy tissue
• Can result in amputation

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 chemical
• it reault from tissue injury and destruction from necrotizind substances
• Degree of tissue damage determined by
- Chemical nature of the agent
- Concentration of the agent
- Duration of skin contact
Acids- Eg- Formic acid,sulphuric acid
Alkalis- Eg. Lime, potassium hydroxide

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Inhalation injuries
• Result from inhalation of hot air or noxious chemicals 
• Cause damage to respiratory tract 
• Important determinant of mortality in fire victims
Eg :Carbon monoxide (CO) poisoning

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 Pathophysiology
 Although most affected organ in burn injury is the skin, Burn injury has both
local and systemic effect
i) Local Changes:
The local changes that occur consist in the formation of three zones:
(a)Zone of coagulation:
 Necrotic area of burn where cells are disrupted and Most severely injured
area

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cont...
(b) Zone of satsis:
Its area surrounding zone of coagulation where vessel leakage
& vessel damage present
(c)Zone of hyeremia It is area where
Vasodilation & inflammation is present.

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Systemic Effects
Significant burns cause release of inflammatory mediators which cause:
- Vasoconstriction and vasodilatation
- Capillary permeability and edema
Hypovolemia/burn shock /results from:
- Fluid shift
 - Insensible fluid loss
 - Increase in BMR
 - May progress to hypovolumic shock

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 Burn shock pathophysiology

• Increased capillary permeability

• Decreased plasma oncotic pressure
• Increased capillary hydrostatic pressure
• Reduced clearance of fluid and protein from interstitial space by lymphatic
ducts
• Intracellular fluid accumulation
• Increased evaporative water loss
• Depressed myocardial function and increased peripheral resistance.
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Cardiovascular effects

Hypovolemia Decreased CO
 Renal effects
- Hypovolemia
- Hemoconcentration
- Decreased renal blood flow
- Decreased GFR ->Tubular necrosis ->renal failure


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Electrolyte disturbance
Caused by changes in cellular permeability and fluid loss
- Hyponatremia due to fluid loss
- Hyperkalemia due to excessive tissue necrosis; serious
- Cardiologic and neurologic consequences

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RISK FACTOR
• occupations
• poverty
• lack of proper safety measures;
• alcohol abuse and smoking
• chemicals used for assault
• use of kerosene (paraffin)

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At great risks are
♦ The very young
♦The very old
♦ Those whose ability to protect themselves is impaired.
*Epilepsy
*Alcohol
*Drug abuse

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Classification of burn
FIRST DEGREE BURN(SUPERFICIAL PARTIAL THICKNESS)
- are one of the mildest forms of skin injuries,
- they usually don't require medical treatment.-tact epidermalbarrier
- do not result in scarring
involves only the epidermis tissue will blanch with pressure
 Tissue is erythematous and often painful
 Involves minimal tissue damage
 Sunburn

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Clinical features
• reddnes of skin Pain at burn site
• Involves only epidermis
• Blanch to touch
• Have an It's an injury that affects the first layer of your skin.

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SECOND DEGREE BURN
- Referred to as partial-thickness burns
- Involve the epidermis and portions of the dermis
- Often involve other structures such as sweat glands, hair follicles, etc. •
Blisters and very painful
- Edema and decreased blood flow in tissue can convert to a full-thickness burn.

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THIRD DEGREE BURNS
- Referred to as full-thickness burn
- Never heal spontaneously, and treatment involves excision of all injured tissue
- In these injuries, epidermis, dermis, and different depths of subcutaneous and
deep tissues have been damaged.
- The potential for infection if left nonexercised is very high.
- A dry, white, or charred appearance is common.

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FOURTH DEGREE BURN
- It damage the underlying bones, muscles, and tendons.
- There is no sensation in the area since the nerve endings are destroyed.

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DEPTH OF INJURY
-1- SUPERFICIAL PARTIAL THICKNESS
A first-degree burn is also called a superficial burn or wound. It's an injury
that affects the first layer of your skin. First- degree burns are one of the
mildest forms of skin injuries, and they usually don't require medical
treatment.

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Cont...
-2- FULL PARTIAL THICKNESS
A partial thickness burn (a lso known as a second degree burn) is a burn that
affects the top two layers of skin, called the epidermis and hypodermis Partial
thickness burns can continue to change over time and can evolve to a full
thicknessburn (or third degree burn), even after initial treatment.

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Cont...
-3- DEEP PARTIAL THICKNESS
• A burn is an injury to the tissue of the body, typically the skin. Burns can vary
in severity from mild to life-threatening. Most burns only affect the uppermost
layers of skin, but depending on the depth of the burn, underlying tissues can
also be affected.

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clinical ASSESSMENT OF BURN
There are three ways of estimation of
%TBSA :-

1,Palm method

rule of palm is another way to estimate the

size of a burn. The palm of the person who is
burned (not fingers or wrist area) is about 1%
of the body. Use the person's palm to measure
the body surface area burned. It can be hard
to estimate the size of a burn.

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 Cont...
2,RULES OF NINE
 The rule of nines assesses the percentage of burn and is used to help guide
treatment decisions including fluid resuscitation and becomes part of the
guidelines to determine transfer to a burn center

3, LUND AND BROWDER METHOD 

a method for estimating the extent of burns that allows for the varying
proportion of body surface in persons of different ages.It is used instead of the
RULE OF NINES for children, in whom the head occupi es a larger area and the
lower limbs a smaller area than in adults.

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Cont...
most accurate
because it compensates for the
variation in body shape with age.

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Cont...
1. 2nd degree 20% burn in adults
2. 2nd degree 10 % burn in extreme ages (Age < 3 years or > 60 years)
3. 3rd degree 5% burn
4. Inhalational , chemical , and electrical
5. Circumferential
6. Suicidal
7. Involvement areas and organs affect the function ( face and neck , perineum )
8. Trauma-associated
9. With comorbidities

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MANEGEMENT OF BURN

Burn care is typically categorized into three phases of care

1. Emergent / resuscitative phase

2. Acute / intermediate phase

3. Rehabilitative phase

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Cont...
Emergent / resuscitative phase
I. Assess burn severity
- Burn depth
- Burn size
- Burn location
- Age
- General health
- Mechanism of injury

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Cont...

II. Treat minor burns

- Run under cold water for about 10 minutes
- Do not use ice
- Pat dry the skin after washing
- Dressing or bandage over burn
- Regular changes to burn dressings or bandages
- Keep burn dressing clean and dry

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Cont...
III. Treat major burns
- Monitor airway and breathing
- Prevent burn shock
- Prevent aspiration
- Minimizing pain and anxiety
- Wound care
- Prevent tetanus
- Prevent tissue ischemia
- Transport to burn facility

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FLUID MANAGEMENT
- Start with RL in adults and Isolyte P in children 
- After 24 hours start with DNS 
- If not adequate,urine output in 12 hours start colloid FFP

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Parkland formula
The Parkland formula is mathematically expressed as:
V= 4*m*(A.100)
where mass (m) in kg, area (A) as a percentage of total body surface area,
and volume (V) in ml.
For example,
a person weighing 75 kg with burns to 20% of his or her body surface area
would require 4 x 75 x 20 = 6,000 mL of fluid replacement within 24 hours.
The first half of this amount is delivered within 8 hours from the burn
incident, and the remaining fluid is delivered in the next 16 hours.

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2. ACUTE /INTERMITTENT MANAGEMENT
MEDICAL MANAGEMENT
1. Prevent infection
- Asepsis
- Prophylactic antibiotics
- Immunization
- Environmental control
2. Provide metabolic support - Adequate Calorie intake

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Cont...
3. Minimizing pain
- Patient controlled analgesia devices
- Inhalation analgesics
- Oral analgesics, opioid analgesics, NSAIDs
- Hypnosis. Art and play therapy
- Guided imaginary, relaxation techniques
- Distraction therapy, Music therapy

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Cont...
4. Provide wound care
- Wound cleansing
- Wound debridement
- Topical antimicrobial treatment silver sulfadiazine 1% Mafenide acetate
5% Silver nitrate 0.5% Acticoat
- Wound dressing

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Cont...
5. Maximize function
- Splinting
- Positioning
- Exercise
- Ambulation performance of ADI
- Pressure therapy

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Cont...
6 .Prevention and treatment of scars
Abnormal wound healing
- Hypertrophic
- Keloid scars

- Pressure use of topical silicon

- Scar massage
- Steroid injections
- Application of pressure garments
- Cosmetic interventions

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 Surgical management
1. Escharotomy
an emergency surgical procedure involving incising the burnt skin areas to
release the eschar and its constrictive effects, restore distal circulation and
allow adequate ventilation.
2. Faciotomy or faciectomy
a procedure in which fascia is cut to relieve pressure in the muscle
compartment.
3. Wound grafting(composition)
.Split-thickness skin grafts (STSG) are composed of the epidermis and a
superficial part of the dermis.
.Full-thickness skin grafts (FTSG) contain both the full epidermis and dermis.
.Composite grafts contain skin and another type of tissue, usually cartilage.
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3. Rehabilitation
1. Minimizing functional loss
- exercise
- splinting
- positioning
2. Provide psychological support
- self image issues
- physical limitations
- reintegrate into society
- fear of rejection
- good communication
- encourage independence
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Cont...

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 COMPLICATIONS
1. Shock
2. Pulmonary complications
3. Wound infection
4. Scarring
5. Psychological trauma
6. Multiple organ failure
7.Death

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Minimizing complication

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Reference

 Schwartz's Principles of SurgeryTextbook by Seymour I.

Schwartz
 Manipal manual of surgery 4th Edition
 Bailey and love‘s short practice of surgery 27th edition
• Internet

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 THANK YOU

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