BURNS

Burns are injuries to body tissue caused

by excessive heat (heat greater than 104F
[40C]). Such injuries tend to be more
serious in children than in adults, because
the same size burn covers a larger surface
of child’s body.
 TYPES OF BURN
THERMAL BURN: exposure to flame or hot object
o SCALD BURN: most frequent in home injuries; hot water,

liquids and foods are most common causes

o FLAME BURN: due to gasoline, kerosene, LPG or

burning houses

CHEMICAL BURN :exposure to acid, alkali or organic

substances
ELECTRICAL BURN: worst than the other types; with
entrance and exit wounds; may stop the heart and depress
the respiratory system; may cause thrombosis and cataracts
RADIATION BURN: from x-ray, radioactive radiation being
transferred to the body resulting in production of cellular
toxins
 DEPTH OF BURN and take
only 2-3 days to heal after
 FIRST DEGREE BURN desquamation
Involves only the superficial Scarring is rare
epidermis Ex. scalds and sunburn
The area appears
erythematous
Painful to touch
Blanches on pressure
No blister
Heal by simple regeneration
 SECOND-DEGREE BURN
 Involves the entire epidermis

 Sweat glands and hair follicles are left intact

 The area appears very erythematous, blistered and moist from

exudate
 It is extremely painful

 Burns heal by regeneration of tissue but take 2-6 weeks to

heal
 THIRD DEGREE BURN
 Full thickness burn involving both skin layers,
epidermis and dermis
 It may also involve adipose tissue, fascia muscle and
bone
 Burn appears white, cherry red, brown or black

 Requires definitive surgical management

 Dry and often leathery

 Typically insensate because of superficial nerve injury

 Skin grafting is necessary

 Healing takes months

 Scar tissue will cover the final healed site

THIRD DEGREE BURN
 MODERN TERMINOLOGY
Depth of Burn
Superficial: involves only the outer epidermis; heals
without scarring
Superficial Partial-Thickness: involves epidermis &
the upper portion of the dermis; pain & blisters; heals
with minimum to no scarring
Deep-Partial Thickness: complete destruction of the
epidermis & the majority of the dermis; blisters,
edema; heals with hypertrophic scars & keloids
Full-Thickness: complete destruction of the
epidermis & dermis along with partial damage of the
subcutaneous fat layer; require grafts & susceptible to
infection
 ZONES OF INJURY
Zone of Coagulation: area of greatest
destruction, tissue necrosis, irreversible cell
damage
Zone of Stasis: damaged tissue, area of less
severe injury that possesses reversible
damage and surrounds the Zone of
Coagulation
Zone of Hyperemia: Pink, no cell death, the
area surrounding the Zone of Stasis that
presents with inflammation, but will fully
recover without any intervention or permanent
damage
 COMPLICATIONS
Complications of deep or widespread
burns can include:
Bacterial infection, which may lead to a
bloodstream infection (sepsis)
Fluid loss, including low blood volume
(hypovolemia)
Dangerously low body temperature
(hypothermia)
Breathing problems from the intake of
hot air or smoke
 COMPLICATIONS
 Scars or ridged areas caused by an
overgrowth of scar tissue (keloids)
 Bone and joint problems, such as when scar
tissue causes the shortening and tightening of
skin, muscles or tendons (contractures)
 MANAGEMENT
MINOR BURNS
 Immediately apply ice to cool the skin and
prevent further burning.
 Application of an analgesic-antibiotic
ointment and a gauze bandage to prevent
infection
 Child should have follow up visit in 2days to
have area inspected for secondary
inspection and dressing change
 Keep the dressing dry
MODERATE BURNS
 Do not rupture the blisters to prevent
infection
 Cover the burn with topical antibiotic such as
silver sulfadiazine and bulky dressing to
prevent damage to denuded skin
 Return in 24 hrs for check up to assess that
pain control is adequate and there is no s/s
of infection
SEVERE BURNS
The child with a severe burn is critically
injured and needs swift, sure care,
including fluid therapy, systemic antibiotic
therapy, pain management and physical
therapy to survive the injury without a
disability caused by scarring, infection or
contracture.
 THERAPY FOR BURNS
TOPICAL THERAPY
 Silver sulfadiazine is the drug of choice for burn
therapy to limit infection at the burn site for children. It
is applied as a paste to the burn, and the area is then
covered with a few layers of mesh gauze. It is soothing
when applied and tends to keep the burn eschar soft,
making debridement easier.
 Antiseptic solutions, such as povidone–iodine
(Betadine) may also be usedto inhibit bacterial and
fungal growth. Dressings must be kept continually wet
to keep them from clinging to and disrupting the
healing tissue.
ESCHAROTOMY
An escharotomy is an incision made completely through the
depth of the burn “eschar” that usually occurs within the first
day of the injury. The eschar is necrotic skin that has a
leathery consistency as a result of the burn injury.
The escharotomy or incision through the eschar serves to
release the constricting tissue and allows the nerves,
muscles, and organs to function as normal. Usually several
incisions are required to release the constricting tissue. This
procedure is usually done while the patient is sedated but not
under general anesthesia.
DEBRIDEMENT
 Is the removal of necrotic tissue from a burned area.
It reduces the possibility of infection because it
reduces the amount of dead tissue present on which
microorganisms could thrive.
GRAFTING
 Homografting- is the placement of skin (sterilized
or frozen) from cadavers or a donor on the cleaned
burn site. These grafts do not grow
but provide
protective
covering for
the area.
 Heterografts
Also called xenografts, used other sources such as porcine or
pig skin.

 Autografting
Is a process in which a layer of skin of both epidermis and a
part of the dermis (split-thickness graft) is removed from the
distal, unburned portion of the child’s body and placed at the
prepared burn site, where it will grow and replace the burned
skin.
REFERENCES
 https://www.mayoclinic.org/diseases-
conditions/burns/diagnosis-treatment/drc-
20370545

 Maternal and Child Health Nursing

 Vol 2 pp. 1566-1574