Burns

• Burn wound


  Injuries caused by an extreme of heat or cold or by another physical agent having a similar effect e.g. electricity, caustic agents or radiation
• Types of burns


  • Thermal
  • Chemical
  • Electrical
  • Radiation
• Burn classification


  • First degree (superficial burn)
  • Second degree (deep, partial thickness burns, possible progression to 3rd degree)
  • Third degree (full-thickness burns)
• Burn pathophysiology


  • Cellular destruction (reversible or irreversible)
  • Thrombosis of the blood (ischemia)
  • Vascular permeability changes (fluid volume shift, fluid, electrolyte & plasma protein loss)
• Systemic effects of burns

  • Burn shock (hypovolemic shock, multiorgan failure, hypoxia, death)
  • Respiratory Distress Syndrome (edema of larynx, bronchospasm, CO poisoning, bacterial pneumonia)
  • Impaired host defense mechanism (skin barrier, specific/non-specific immune)
• Initial burn wound evaluation

  1. Assess size and depth of burn wounds

  2. > 30 - 50 % (TBSA) full thickness skin burn: PTS

  3. > 30 % (TBSA) partial thickness, > 10 - 15 % full thickness: emergency support therapy/special care

  
• TBSA (Total Body Surface Area)

  Rule-of-nine: 9 % for each forelimb, 18 % each hind limb, 9 % for head and neck, 18 % each dorsal and ventral surface of abdomen and thorax region
• Initial burn wound treatment

  1. O2 therapy

  2. Tracheostomy

  3. Bronchodilator

  4. Local wound treatment

  5. Cold therapy

  6. Systemic therapy (fluid & therapy)

  7. Diuretic

  8. Analgesic

  9. Sedative

  10. Nutritional support
• Burn wound management


  1. Wound dressing/debridement

  2. Topical & systemic antibiotic therapy

  3. Nutritional support
• Burn wound surgery


  1. Burn eschar removal

  2. Wound closure

  3. Reconstructive procedure or 2nd intention wound healing
• Considerations in burn wound management include healing period and medical and cosmetic result