1. Evaluation and Management of Burns
Geoffrey Lee
Plastics Intern

2. Physiology

3. Anatomy

4. Types Thermal Cold exposure Chemical Electrical current Inhalation
Radiation

5. Severity
Size
Depth
Site

6. Size Percentage of body surface area estimates Palm method = 1%
Rules of Nines
Each leg represents 9 x 2 = 18%
Each arm 9%
Anterior and posterior trunk each 9 x 2 = 18%
Head 9%
Lund-Browder chart

8. Depth
Colour
Moist vs dry
Blanching
Blisters
Pain

9. Superficial Only epidermal layer Painful Dry Red Blanch with pressure
Do not blister
Heal 5-7 days
No scarring

10. Superficial Partial Thickness
Epidermis and superficial part of dermis
Painful
Red
Weeping
Blanches with pressure
Heal in 7-21 days
Unlikely scarring, pigment changes may occur

11. Deep Partial Thickness
Epidermis and deeper dermis
Painful to pressure only
Blister
Wet or waxy dry
Mottled colorisation
Do not blanch with pressure
Heal in 3-9 weeks
Hypertrophic scarring likely

12. Full Thickness Extend through all layers of dermis
Anaesthetic or reduced sensation
Appearance varies
Dry
Do not blanch with pressure
No vesicles
Severe scarring with contractures
Usually require grafting

13. Forth Degree
Deep and extend through skin into underlying tissues such as fascia, muscle and/or bone

14. Dangerous Sites Face Ears Eyes Hands Feet Genitalia Perineum
Major joints

15. Management Major vs moderate/minor
Major burns should be transferred to specialized burns centres
Victoria:
Victorian Adult Burns Service (VABS) at the Alfred
Burns Unit at RCH

16. Victorian State Burns Service Referral Criteria
Burns with associated inhalation injury
Burns greater than 10% total body surface area
Burns to special areas – face, hands, major joints, feet and genitals
Full thickness burns greater than 5% total body surface area
Electrical burns
Chemical burns
Circumferential burns of limbs or chest
Burns with associated trauma
Burns in the very young or elderly people
Burn injury in patients with pre-existing illness or disability that could adversely affect patient care and outcomes
Suspected non-accidental injury in children or the elderly
Burns in children under the age of 12 months
Small area burns - in patients with social problems, including children at risk
Burns occurring in pregnant women

17. Major burns Primary survey Assess extent of burns
Beware of circumferential full thickness burns
Analgesia
NGT insertion
Tetanus
Prevent hypothermia
Fluid resus

18. Fluid Resus Parkland formula
Amount required in 24hrs = 4 x wt(kg) x BSA(%)
Half in first 8hrs
Half in next 16hrs
Maintenance fluids in addition for children weighing less than 30kg
Guided clinically and by urine output

19. Minor Burns First aid Cleaning burns Blister management Dressings
Analgesia
Tetanus
Follow up
Post burn skin care

20. Electrical Burns Low voltage (<1000V) High voltage (>1000V)
First aid
Turn power off
Ensure own safety
Dysrhythmias
Compartment syndrome
Fluid resus
Full thickness exit wound to armpit post high voltage electrical burn injury

21. Chemical Burns History First aid Type of agent
Strength and concentration
Site of contact, swallowed or inhaled
Manner and duration of contact
Mechanism of action of chemical
First aid
Prolonged irrigation of water
Remove contaminated clothing
Brush off metals and powders
Do not attempt neutralising without specialist advice
Full thickness burns to the legs caused by kneeling in cement

22. Questions?