A burn is a type of injury to flesh caused by heat, electricity, chemicals, light, radiation or friction

Introduction
The skin has an important role to play in the fluid and temperature regulation of the body. If enough skin area is injured, the ability to maintain that control can be lost. The skin also acts as a protective barrier against the bacteria and viruses that inhabit the world outside the body.

three layers: 1. Epidermis, the outer layer of the skin 2. Dermis, made up of collagen and elastic fibers and where nerves, blood vessels, sweat glands, and hair follicles reside. 3. Hypodermis or subcutaneous tissue, where larger blood vessels and nerves are located. This is the layer of tissue that is most important in temperature regulation. The amount of damage that a burn can cause depends upon its location, its depth, and how much body surface area that it involves.

Cause
Chemical Most chemicals that cause chemical burns are strong acids or bases.[8] Chemical burns can be caused by caustic chemical compounds such as sodium hydroxide or silver nitrate, and acids such as sulfuric acid Electrical Electrical burns are caused by either an electric shock or an uncontrolled short circuit Radiation burns are caused by protracted exposure to UV light (as from the sun), tanning booths, radiation therapy (in people undergoing cancer therapy), sunlamps, radioactive fallout, and X-rays.

Scalding Scalding (from the Latin word calidus, meaning hot[14]) is caused by hot liquids (water or oil) or gases (steam), most commonly occurring from exposure to high temperature tap water in baths or showers or spilled hot drinks Classification of burns

Names First degree

Layers involved Epidermis

Appearanc e Redness (erythema)

Textur e Dry

Sensatio n Painful

Time to healing 1wk or less

Complications Increased risk to develop skin cancer later in life Local infection/cellulit is

Example

Second degree (superfici al partial thickness) Second degree (deep partial thickness) Third degree (full thickness) Fourth degree

Extends into superficial (papillary) dermis

Extends into deep (reticular) dermis

Extends through entire dermis Extends through skin, subcutaneo us tissue and into underlying muscle and bone

Red with clear blister. Blanches with pressure Red-andwhite with bloody blisters. Less blanching. Stiff and white/brow n

Moist

Painful

2-3wks

Moist

Painful

Dry, leather y

Painless

Weeks may progres s to third degree Require s excision

Scarring, contractures (may require excision and skin grafting Scarring, contractures, amputation

Black; charred with eschar

Dry

Painless

Require Amputation, s significant excision functional impairment, possible gangrene, and in some cases death.

Extent of Body surface area injured *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 unit

An adult who has been burned, the percent of the body involved can be calculated as follows:

Head = 9% Chest (front) = 9% Abdomen (front) = 9% Upper/mid/low back and buttocks = 18% Each arm = 9% (front = 4.5%, back = 4.5%) Groin = 1% Each leg = 18% total (front = 9%, back = 9%)

*Lund and browder method -more precise method of estimating the extent of burn -dividing the body into a very small areas and providing an estimate proportion of TSBA accounted for each body part, *Palmar Method -used in patients with scattered burns -size of the patientss palm is approximately 1% of the TBSA, the patients palm without the fingers is equivalentto 0.5%TBSA and serve as a general measurement Pathophysiology

Management
The resuscitation and stabilization phase begins with the reassessment of the injured person's airway, breathing and circulatory state.
Management of Fluid loss and shock -Fluid replacement therapy

Children with >10% total body surface area burns, and adults with >15% total body surface area burns need formal fluid resuscitation and monitoring (blood pressure, pulse rate, temperature and urine output).[23] Once the burning process has been stopped, the injured person should be volume resuscitated according to the Parkland formula. This formula calculates the amount of Ringer's lactate required to be administered over the first 24 hours post-burn. Parkland formula: 4mL x (percentage of total body-surface-area sustaining non-superficial burns) x (person's weight in kgs).
Wound care Debridement cleaning and then dressings are important aspects of wound care. The wound should then be regularly re-evaluated until it is healed. Types of debridment: 1. Natural Debridement- the dead tissue separates from the underlying viable tissue spontaneously. 2. Mechanical Debridement- involves the use of surgical scissors, scalpels, and forceps to separate and remove the eschar. 3. Chemical Debridement- topical enzymatic debridement agents are available to promote debridement of the burn wounds. 4. Surgical Debridement- an operative procedure involving either primary excision (surgical removal of tissue) of the full thickness of the skin down to the fascia (tangential excision) or shaving of the burned skin layers gradually down to freely bleeding, viable tissue. Antibiotics Intravenous antibiotics may improve survival in those with large and severe burns. Analgesics A number of different options are used for pain management. These include simple analgesics (such as ibuprofen and acetaminophen) and narcotics Surgery

Wounds requiring surgical closure with skin grafts or flaps should be dealt with as early as possible.[3] Circumferential burns of digits, limbs or the chest may need urgent surgical release of the burnt skin (escharotomy) to prevent problems with distal circulation or ventilation.[3]

Complications

Infection is a major complication of burns Burn wounds are prone to tetanus.