Burns

• Definition:
It is a coagulative necrosis of the skin and tissue that is initiated
due to one of the causes.
• Causes:
1. Heat. e.g: flame, hot objects.
2. Chemical agent. e.g: acid.
3. Electrical
4. Physical. e.g: fraction
5. Environmental. e.g: sun, radiation, frost.


• Classification:

1. Superficial burn:
It affects the epidermis with out affecting the basal layer

2. Partial Thickness burn:
It affects the epidermis and part of the dermis

3. Full Thickness burn:
It may affect all layers reaching to the subcutaneous tissue, muscles and even the bone


• Symptoms and Signs:

1. Superficial burns:
-Red, erythrematous and painful.
-Tactile sensation is good due to the vitality of the nerve endings.

2. Partial Thickness burns:
-Pale, wet, clustery, blistery.
-Tactile sensation is dull because the loss of some of the
nerve endings.

3. Full Thickness burns:
-Dry, leathery looking.
-Tactile sensation is completely lost due to complete loss
of the nerves.


• Factors affecting the depth of burns:

1. Strength:
Density of effectors that are applied on the tissue
e.g: more heat means more depth of the burn
high voltage increases the depth of the wound

2. Duration:
The longer the time of application of the effectors the
deeper the burn is.


• The Pathophysiology of burns:

1. Local:
- Burns is a trauma local acute inflammation.
-Local acute inflammation will cause:
1-vasodilation 2- increase permeability
-1 & 2 will cause:
Edema, loss of fluids (filtration of plasma proteins and electrolytes to the extra-vascular tissue).

2. General:
-Maintain normal Blood Pressure and Pulse by:
1-Increase Cardiac Out Put by:
Increase Heart rate & Heart contractility.
2-Genaralized peripheral & visceral Vasoconstriction
Except in the: brain, heart and muscles.
**But there is a limit for the body compensation, so we need to help the body by managing the case and monitoring it.
#How to Masseur the Burns?
We masseur it in relation to the total body surface in percentage
*The role of 9:
Which means we divide the body to 11 parts:
1) 9%: head & nick
2) 9%: each upper limb [2 limbs=18%]
3) 9%: chest
4) 9%: abdomen
5) 18%: lower limb (thigh, leg & foot),
[2 limbs=36%”]
6) 18%: back
7) 1%: genitalia

@Note: if the burn is 20% of the total body, the body can deal with it. But if it is more than 20%(>20%) the body can’t efficiently deal with it and the patient need to be managed and treated.

**This measurement is applied on adults.
It cant be used on Children because they body shape is changing
and different (the body is still developing).



• Management:
-We give the patient what he/she lost
Fluids with electrolytes (crystalloid) & fluids with plasma (colloid)
*The amount of colloid used depends on the surface area of the burn and the type of the burn.
#superficial small burns need very small amount of colloids.
#full thickness large burns need very large amount of colloids.




*daily total fluid loss= ~2.5 L/day
*urine = ~1.5 L/day sweet= ~ 300-500 ml/day
-Fluid administration:
give the calculated amount of fluid every 8hr,16hr,24hr,48hr till the patient get stabilized. Then continue on just maintenance fluid if there is no abnormal loss of fluids.
- We monitor the patient Vital Signs (Blood pressure, pulse, breathing and heart rate) to see how the body is adjusting (stabilization).
e.g: normal vital signs = the body is compensating and is doing well disturbance in vital signs = the body is having some problems
-The most accurate way to monitor how is the body dealing with the burn management is the Urine Out Put = 60 ml/hour OR 1 ml/min
** Normal Urine Out Put normal Filtration rate
normal Blood Pressure
** Decrease in urine out put Decrease in Filtration rate Decrease Blood Pressure
@Note: the given fluid is composed of: 1/3 colloid & 2/3 crystalloids.
** Decrease in Blood Pressure indicates that we need to add more colloid, because we need plasma proteins to increase the osmotic pressure in the vessels, which will attract the water from the interstitial tissue and raise hydrostatic pressure increase in Blood Pressure to the normal level



• Treatment:-Their are 2 types of healing:
1- Healing by Regeneration.
2- Healing by scar formation (fibrosis).
**Both of them can occur in the skin:
1. Superficial burns:
Regeneration is fast because the basal layer is still viable and can form new skin cells (3-7 days)
2. Partial Thickness burns:
-Both types will occur
-Regeneration is slow because part of the basal layer is partially damaged (takes 2-3 weeks)
3. Full Thickness burns:
May never heal by Regeneration (because of the loss of the basal layer).
It might heal by Scar formation Or we might use skin graft technique.

#How to mange the wound?
-2 methods:
1-Exposed wound: in face head and nick
2-Dressing: in the limbs, chest, abdomen…etc.
** It depends on your clinical point of view and the patient clinical situation. But each method have its advantages
and diadvantiges.
** Infection will delay healing by activating necrosis of tissue which will attract inflammatory factors.




-This is a summarized paper ……it is not enough. It is just a guideline to Burns.