Burn Management

Posted by e-Medical PPT
Approx. one million burn patients/annually in the United States
3-5% cases are life-threatening
60,000 hospitalized / 5,000 die
Fires are the 5th most common cause of death from unintentional injury
Deaths are highest among children <5 yr. and adults >65 yr.

Skin is the largest organ of the body
Essential for:
   -  Thermoregulation
   -  Prevention of fluid loss by evaporation
   -  Barrier against infection
   -  Protection against environment provided by sensory information

Types of burn injuries
Thermal: direct contact with heat
    (flame, scald, contact)
 Electrical
    A.C. – alternating current (residential)
    D.C. – direct current (industrial/lightening)
 Chemical
 Frostbite

Burns are classified by depth, type and extent of injury
Every aspect of burn treatment depends on assessment of the depth and extent

First degree burn
Involves only the epidermis
Tissue will blanch with pressure
Tissue is erythematous and often painful
Involves minimal tissue damage
Sunburn

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

Third degree burn
Referred to as full-thickness burns
Charred skin or translucent white color
Coagulated vessels visible
Area insensate – patient still c/o pain from surrounding second degree burn area
Complete destruction of tissue and structures

Fourth degree burn
Involves subcutaneous tissue, tendons and bone

Criteria for burn center admission
Full-thickness  > 5% BSA
Partial-thickness > 10% BSA
Any full-thickness or partial-thickness burn involving critical areas (face, hands, feet, genitals, perineum, skin over major joint)
Children with severe burns
Circumferential burns of thorax or extremities
Significant chemical injury, electrical burns, lightening injury, co-existing major trauma or significant pre-existing medical conditions
Presence of inhalation injury

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