Burn : Classification, Management, First-Aid, Treatment

A burn is an injury to the skin or other organic tissue primarily caused by heat or due to radiation, radioactivity, electricity, friction or contact with chemicals. Skin injuries due to ultraviolet radiation, radioactivity, electricity or chemicals, as well as respiratory damage resulting from smoke inhalation, are also considered to be burns.

Causes of a burn:-

1. Thermal injury
   • Scald- spilling of hot liquids
   • Flame burns
   • Flash burns due to exposure of natural gas, alcohol, combustible iquids.
   • Contact burns- contact with hot metals/ objects/ materials.
2. Electrical Injury
3. Chemical burns- acid/ alkali
4. Cold injury- frost bite
5. Sun burns
6. Ionising radiation

Classification of Burns:-

[A]. Depending on the Percentage of a burn (Burns severity classification)-

• Mild (minor) – Partial thickness burns <15% in adults or 10% in children.
  • Full thickness burns less than 2% can be treated on outpatient basis.
• Moderate – 2nd degree of 15 -25% burns, 3rd degree between 2-10% burns.
  • Burns not involving eyes, ears, face, hand, feet, perineum
• Major (severe)- second degree burns, more than 25%
  • in children > 20%
  • All 3rd degree burns of 10% or more
  • Burns involving eyes, ears, feet, perineum
  • All electrical & inhalation burns
  • Burns with fractures/ mechanical trauma

[B]. Depending on thickness of skin involved-

1. I degree- epidermis- red and painful
   • No blisters
   • Heals rapidly in 5-7 days by epithelialisation without scarring
   • Shows capillary filling
2. II degree– Affected area mottled, red painful with blisters,
   • Heals by epithelialisation in 14-21 days
   • Superficial second degree burn
   • Deep second degree burn.
3. III degree- Affected area- charred, parchment like, painless and insensitive with thrombosis of superficial vessels.
   • Requires grafting
   • Charred, denatured, insensitive contracted full thickness burn is called as eschar.
4. IV degree- involves underlying tissues as well as deeper tissue, possibly involving muscle and bone.

[C]. Depending on thickness of skin-

• Partial thickness burn- either I / II degree burn
• Full thickness burn- III degree burn

Wallace’s rule of Nine (Rule of 9):-

	Adults	Children	Infants
Head and neck	9%	18%	20%
Front of chest and abdominal wall	9*2=18%	18%	20%
Back of chest and abdominal wall	9*2=18%	18%	20%
Lower limb	18*2=36%	13.5*2= 27%	20%
Upper limb	9*2=18%	18%	20%
Perineum	1%	1%	–

Assessment:-

• Wallace’s rule of 9
• Using the Lund and Browser chart

Clinical features-

• History
• Pain
• Burning
• Anxious status
• Tachycardia (Increased heart rate)
• Tachypnea
• Fluid loss

Sepsis in Burn patient-

Due to Streptococcus, Pseudomonas, Staphylococci, other gram negative organisms

Causes of death in Burns-

• Hypovalaemia & shock
• Renal failure
• Pulmonary oedema and ARDS
• Septicaemia
• Multiorgan failure
• Acute airway block in head & neck burns

Management of burns:-

1. Initial management-

• Clothing should be removed
• Cooling of the part by running water for 20 min.
• Cleaning the part to remove dust, mud etc.
• Chemoprophylaxis- tetanus toxoid, antibiotics
• Covering with dressing
• Comfortable with sedation and painkiller.

2. Definitive treatment-

• Admit the patient in burn unit
• Maintain ABC (Airway, Breathing and Circulation)
• Emergency endotracheal intubation
• Do not use succinylcholine

First Aid:

Basic guidance on first aid for burns is provided below.

What to do–

• Stop the burning process by removing clothing and irrigating the burns.
• Extinguish flames by allowing the patient to roll on the ground, or by applying a blanket, or by using water or other fire-extinguishing liquids.
• Use cool running water to reduce the temperature of the burn.
• In chemical burns, remove or dilute the chemical agent by irrigating with large volumes of water.
• Wrap the patient in a clean cloth or sheet and transport to the nearest appropriate facility for medical care.

What not to do-

• Do not start first aid before ensuring your own safety (switch off electrical current, wear gloves for chemicals etc.)
• Avoid prolonged cooling with water because it will lead to hypothermia.
• Do not apply ice because it deepens the injury.
• Don’t apply paste, oil, haldi (turmeric) or raw cotton to the burn.
• Do not open blisters until topical antimicrobials can be applied, such as by a health-care provider.
• Do not apply any material directly to the wound as it might become infected.
• Avoid application of topical medication until the patient has been placed under appropriate medical care.