Burn

BURN

BURNMeenakshi sharmaPharm.D Chitkara university

Burn is defined as a wound caused by an exogenous agent leading to coagulated necrosis of the tissue.

Types of burnsTHERMAL BURNS CHEMICAL BURNSELECTRICAL BURNSCOLD BURNSRADIATIONS

THERMAL BURNS Scald burn Most frequent in home injuries like hot water , liquids and food are most common cause.Temperature above than 136F causes burn.Temperature less than 111F tolerated for long periods

CHEMICAL BURN Common in industries and factories but can occur at homes also.Caused by concentrated acids or alkalis.Acids are more common than alkali.

ELECTRICAL BURNWorse than other types of burn with entry and exit wounds.May stop the heart and depress the respiratory system.May cause thrombosis and cataracts.

RADIATION BURNSCause due to radiationsRadioactive explosions.X-Rays.Nuclear bomb explosions.

PPHYSIOLOGYOF BURNSFLUID SHIFTPeriod of inflammatory response.Vessels adjacent to burn injury dilates inc. hydrostatic pressure and inc. capillary permeability.Continuous leak of plasma from intravascular space to interstitial space.Associated imbalances of fluids, electrolytes and acid-base occur.HemoconcentrationLasts 24-36 hours.

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Video representation of burns

PPHYSIOLOGYOF BURNSFLUID REMOBILIZATIONCapillary leak ceases and fluid shifts back into the circulation.Restores renal perfusion and fluid balance.Increase urine formation and diuresis.Continued electrolyte imbalances.HyponatremiaHypokalemiahemodilution

BODYS RESPONSE TO BURN.Emergent phase (STAGE 1)Pain responseCatecholamine responseTachycardia ,tachypnea , mild hypertension , mild anxiety

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BODYS RESPONSE TO BURN.FLUID SHIFT PHASE (STAGE 2)Length 18-24 hours.Begins after emergent phaseReaches peak level in 6-8 hours.Damaged cells initiate inflammatory response.Increased blood flow to cellsShift of fluid from intravascularto extravascular spaceMassive edema

BODYS RESPONSE TO BURN.HYPERMETABOLIC PHASE ( STAGE 3)Last for days to weeksLarge increase in bodys need for nutrients as it repairs itselfRESOLUTION PHASE (STAGE 4)Scar formationGeneral rehabilitation and progression to normal function.

CLASSIFICATION OF BURNSFIRST DEGREESUPERFICIAL SECOND DEGREEDEEP SECOND DEGREETHIRD DEGREEFOURTH DEGREE

1ST degree burnReddened skinPain at burn siteInvolves only epidermisBlanch to touchHave an intact epidermal barrierDo not result in scaringEG: sunburn , minor accidentTreatment with topical soothing agents or NSAIDS

2ND DEGREE BURNSIntense skinWhite to red skinBlistersInvolves dermis and papillary layers of dermisSpares hair follicles , sweat glands etc.Erythematous and blanch to touch.Very painful/sensitive.No or minimal scarringSpontaneously re-epithelize from retained epidermal structures in 7-14 days.

DEEP SECOND DEGREE BURNInjury to deeper layers of dermis-reticular dermisAppear pale and mottledDo not blanch to touchCapillary return sluggish or absent.Take 13 to 45 days to healRequires excision or skin grafting.

3rd degree burnDry, leathery skin (white , dark , brown or charred)Loss of sensation (little pain)All dermal layers/tissues may be involved.Always require surgery.

4TH DEGREE BURNInvolves structure beneath the skin-muscle , bone

ASSESEMENT OF BURNSRULE OF NINESBest used for large surface areasExpedient tool to measure extent of burnRULE OF PALMSBest used for burns