Burn Injury

Overview

Dr. Miguel Johnson MBBS MRCSEd

Plastic Surgery Resident
University of the West Indies
Jamaica
 Define a burn
 Outline the different types of burns
 Discuss the emergency management of
different types of burns
 Outline the indication for admission
 Discuss principles of management
 Controversies in management
 Thermal

 Non Thermal
 Scald  Flame
 About 70% of burn in  Comprise of 50% of adult
children are caused by burns.
scalds.
 Often associated with
 Due to spilling of hot inhalation injury and
liquid – drinks, tea other concomitant
trauma.
 Varied depth based on
temp and exposure  Varied depth based on
time. Example hot oil temp and exposure time.
 Contact

 from direct contact, of

extremely hot surface.

 abnormally long contact

time.
 How did the burn occur?

 Did the burn occur inside or outside?

 Did the clothes catch on fire?

 How long did it take to extinguish the flames?

 How were the flames extinguished?

 Was gasoline or another fuel involved?

 Was there an explosion?

 Did the patient get thrown?

 Was there a house fire?

 Was the patient found inside a smoke-filled
room?
 How did the patient escape?
 If the patient jumped out of a window, from
what floor?
 Were others killed at the scene?
 Was the patient unconscious at the scene?
 Was there a motor vehicle accident?

 How badly was the car damaged?

 Was there a car fire?

 Are there other injuries?

 Are the purported circumstances of the injury

consistent with the burn characteristics (i.e., is
abuse a possibility)
 Extent of Burn
▪ Rules of nine
▪ Lund & Browder chart
▪ Patient’s palm

 Depth of burn
▪ Temperature
▪ Duration of contact
▪ Thickness of the dermis
▪ Blood supply
• Rules of nines
• Lund & Browder
• More accurate

• Divides body into

small areas

• Estimates
proportion each
area contributes

• Takes more time

and effort to
calculate than Rule
of Nines method
SUPERFICIAL

PARTIAL THICKNESS
-SUPERFICIAL
-DEEP

FULL

THICKNESS
 Advanced Trauma Life Support Guidelines

 Airway maintenance with cervical spine

protection
 Breathing and ventilation
 Circulation with hemorrhage control
 Disability (access neurologic deficit)
 Exposure (completely undress the patient, but
maintain temperature)
 Detailed History

 Detailed Examination

 Supplemental Studies eg. Laboratory and

radiologic
 “Head to Toe” Examination

 Head  Perineum, genitalia

 Facial burns  Back and buttocks
 Singing of nasal hair  Musculoskeletal
 Carbonaceous sputum  Vascular
 Soot  Neurologic
 Pharyngeal oedema
 Stridor
 Hoarseness
 Cervical spine and neck
 Chest
 Abdomen
 Clinical findings:
 Facial burns (96%)
 Wheezing (47%)
 Carbonaceous sputum (39%)
 Rales (35%)
 Dyspnea (27%)
 Hoarsness (26%)
 Tachypnea (26%)
 Cough (26%)
 Cough and hypersecretion (26%)

DiVincenti et al. Journal of Trauma, 1971; 11:109-117