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BURNS - INITIAL MANAGEMENT
Thermal burns are burns due to external heat sources that raises skin and tissue temperature causing tissue cell death or charring. Flame is the most common type of burn. Inhalation injury is found in 30% of victims of major flame burns.
Chemical burns are due to strong acids, alkalis, detergents or solvents coming into contact with the skin. Tissues are damaged by protein coagulation or liquefaction rather than hyperthermic activity.
Electrical burns are due to electrical current or lightning coming in contact with the body.
First degree burns or superficial burns appears similar to sunburn that is painful, dry, swollen, erythematous without blisters and involves only the epidermis.
Second degree burns or partial-thickness burns has appearance of moist blebs, formation of vesicle and blister; underlying tissue is mottled pink and white with good capillary refill; this involves the entire epidermis and a variable portion of the dermal layer.
Third degree burns or full-thickness burns appears dry, leathery eschar, mixed white waxy, khaki, mahogany and soot stained. It involves the entire epidermis and dermis, leaving no residual epidermis cells, may include fat, subcutaneous tissue, fascia, muscle and bone.

Definition

Types of Burn Injury

Thermal burns are due to external heat sources that raises skin & tissue temperature causing tissue cell death or charring

  • Flame: Most common type of burn
  • Inhalational injury: Found in 30% of victims of major flame burns
    • History of flame burns or burns in an enclosed space
    • Full thickness or deep dermal burns to face, neck, or upper torso
    • Singed nasal hair
    • Carbonaceous sputum or carbon particles in oropharynx
    • Charred lips, carbonaceous secretions
    • Posterior pharynx edema
    • Hoarseness, cough or wheezing
  • Scald/contact: Usually found in skin that comes in contact with hot objects

Chemical Burns are due to strong acids, alkalis, detergents or solvents coming into contact with the skin

  • Tissues are damaged by protein coagulation or liquefaction rather than hyperthermic activity

Electrical Burns are due to electrical current or lightning coming in contact with the body

  • The extent of injury correlates with the voltage of the electric shock, & although not initially apparent, is often extensive, involving skeletal muscles & other tissues

Signs and Symptoms

Alarm Signs

  • The following are alarm signs & necessitate admission
    • Burns >10-15% of the total body surface area (BSA)
    • Burns associated with smoke inhalation
    • Burns involving hands, feet, face, perineum & joint surfaces
    • Burns resulting from high-tension electrical injuries
    • Circumferential, full-thickness burns
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