BURNS

BURNS
▸ Types of Burns
▸ Jackson’s Model
▸ Classification of burns
▸ Wallace rule of nines and Lund and Browder Chart
▸ Parkland Formula
▸ Pathophysio
TYPES OF BURN
TYPES OF BURN
TYPES OF BURN
TYPES OF BURN
TYPES OF BURN
JACKSON’S MODE
 PATHOPHYSIOLOGY
DAMAGED KERATINOCYTES

MOIST
MAST CELLS, MACROPHAGE
WARMTH
Pro inflammatory CYTOKINES
BLANCHI
+ NG
ERYTHE
PAIN (NERVE MA
ENDINGS) + BLISTERS

VASCULAR
PERMEABILITY
FLUID
+
LEAKS OUT VASODILATION
(HYPOTENS
ION)
INTERSTITIAL
EDEMA
PATHOPHYSIOLOGY
LOSS OF
SENSATI
ON
DRY
BLANCHING
AREA
AND NOCICEPTORS
INELASTIC DESTROYE
D SENSORY
NERVE
ENDINGS

INCREASED
VASCULAR
DESTROYED PERMEABILITY
BLOOD VESSELS

INSTERSTITIAL
EDEMA
 ‣ Second-degree burn
< 15%(TBSA) = adults
< 10% TBSA = children

‣ Third-degree burn
< 2% TBSA
not involving special care areas
Minor Burn Injury (eyes, ears, face, hands, feet,
perineum, joints)

‣ Excludes electrical injury,

inhalation injury, concurrent
trauma, all poor-risk patients
(eg, extremes of age,
concurrent disease)
 ‣ Second-degree burns
15%–25% TBSA =adults
10%–20% in children

‣ Third-degree burns
<10% TBSA
Moderate, Uncomplicated
not involving special care areas
Burn injury
‣ Excludes electrical injury,
inhalation injury, concurrent
trauma, all poor-risk patients
(eg, extremes of age,
concurrent disease)
 ‣ Second-degree burns
exceeding 25% TBSA = adults
20% = children

‣ All third-degree burns

exceeding 10% TBSA
Major Burn Injury ‣ All burns involving eyes, ears,
face, hands, feet, perineum,
joints

‣ All inhalation injury, electrical

injury, concurrent trauma, all
poor-risk patients
PARKLAND FORMULA

WEIGHT
IN KG X TBSA X ml

1/2 FOR THE FIRST

8 HOURS
1/2 FOR THE NEXT
16 HOURS
EMERGENT
PHASE
24-48 HOURS

ACUTE
PHASE
48- 72
HOURS

REHABILITATIO
N PHASE
72 HOURS >
EMERGENT BURN SHOCK OR
PHASE CAPILLARY LEAK
24-48 HOURS SYNDROME
‣ K
‣ Hematocrit
‣ Kidney
‣ ABG
‣ HR
‣ BP
‣ CVP
‣ GI mucosa
‣ Airway
EMERGENT
PHASE ACUTE PHASE
24-48 HOURS PRIORITY: TO
PREVENT
INFECTION
‣ Diuresis
ACUTE ‣ Pain control
PHASE ‣ Debridement
48- 72 ‣ Grafting
‣ wound care management
HOURS ‣ nutritional support
Streptococci (Beta haemolytic—most
common), Pseudomonas, Staphylococci,
Other gram-negative organisms, Candida
albicans
EMERGENT
PHASE REHABILITATION
24-48 HOURS PHASE

‣ prevention of scars
ACUTE ‣ physical, occupational
PHASE rehabilitation
48- 72 ‣ functional and cosmetic
reconstruction
HOURS ‣ psychosocial counseling

REHABILITATIO
N PHASE
72 HOURS >
CAUSE OF DEATH
‣Hypovolemia (refractory and uncontrolled) and shock
‣ Renal failure
‣ Pulmonary edema
‣ Septicaemia
‣ Multiorgan failure
‣ Acute airway block in head and neck burns