BURN & SCALD

DEFINITION
PATHOPHYSIOLOGY
ASSESSMENT OF BURN WOUND
DEFINITION
BURN
Damage to the skin or other
body parts caused by exposure
to dry heat and has different
depth of injury.
SCALD
Damage to the skin or other
body parts caused by exposure
to moist heat and involve
superficial.

Fire
Hot objects
Electricity
VS Hot liquids
Gases(steam)

Sunburn
COMMON CAUSES
PATHOPHYSIOLOGY
Burns <25% TBSA primarily local response
Burns >25% TBSA both local and systemic response.
 Zone of coagulation In this zone there is
irreversible tissue loss due to coagulation
of the constituent proteins.

Zone of stasis The surrounding zone of

stasis is characterised by decreased tissue
perfusion. The tissue in this zone is
potentially salvageable. The main aim of
burns resuscitation is to increase tissue
perfusion here and prevent any damage
becoming irreversible.

Zone of hyperaemia In this outermost

zone tissue perfusion is increased. The
tissue here will invariably recover unless
there is severe sepsis or prolonged
hypoperfusion.
 Systemic changes that occur after a burn injury
The release of cytokines and other inflammatory mediators at the site of injury

Cardiovascular changes
Capillary permeability is increased, leading to loss of intravascular proteins and fluids
into the interstitial compartment.
Peripheral and splanchnic vasoconstriction occurs.
Myocardial contractility is decreased, possibly due to release of tumour necrosis factor
.
These changes, coupled with fluid loss from the burn wound, result in systemic
hypotension and end organ hypoperfusion.

Respiratory changes
Inflammatory mediators cause bronchoconstriction, and in severe burns adult
respiratory distress syndrome can occur.

Metabolic changes
The basal metabolic rate increases up to three times its original rate.

Immunological changes
Reduced immune response.
ASSESSMENT OF BURN WOUND
1. Depth of injury
a) Superficial partial-thickness burn
b) Deep partial-thickness burn
c) Full-thickness burn

2. Total Body Surface Area (TBSA)

a) Rules of 9
b) Palm method
c) Lund & Browder method
DEPTH OF INJURY
First indication of burn depth comes from the history
 Burning of human skin also depends on
1. Temperature
2. Time

Example of hot water at 65C

Exposure for 45 sec full-thickness burn
Exposure for 15 sec deep partial-thickness burn
Exposure for 7 secs superficial partial-thickness burn
 Superficial partial-thickness Deep partial-thickness Full-thickness burn
Involve epidermis. Epidermis lost Whole dermis is detroyed
Does not go deeper than Involve dermis Hard, leathery feel
papillary dermis. Blister covers large area. Appearance can vary from
Presence of blister Exposed dermis is not as that similar to patients
Underlying dermis is pink and moist as that in a superficial normal skin to charred
moist burn. black,depending upon the
intensity of heat.
Capillary return is clearly Does not blanch with
visible when blanched. pressure No capillary return
Little or no capillary staining Abundant fixed capillary Thrombosed vessel can be
staining after 48 hours seen under skin
Pinprick sensation is normal
Sensation is completely
Heal without residual scarring Sensation is reduced
absent
in 2 weeks Take 3 or more weeks to heal
without surgery Required skin grafting
Treatment is non-surgical.
Usually leads to hypertrophic
scaring
 RULES OF 9
Commonly used as a simple guideline

Each upper limb= 9%

Each lower limb = 18%
Torso ,each side = 18%
Head and neck = 9%
Genitalia = 1%
PALM METHOD
Used in the case of smaller burns or patches of
burns
Cut a piece of clean paper the size of the patients
whole hand 1%TBSA
LUND AND BROWDER
The most accurate way of
measuring the size of the
burns is to draw the burn
on a Lund and Browder
chart.
It takes into account
different proportional body
surface area in children
according to age.
 Minor : <10% in children, <15% in adult
Major : > 10% in children, >15% in adult
REFERENCE

Bailey& Love
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC421
790/