BURNS - RULE OF 9 IN BURNS,LATE COMPLICATION AND MANAGEMENT

 BURNS

• BURN is a wound in which there is coagulative necrosis of the tissue 
• Burns never occur at temperature less than 44 degree celsius 
• Scald is a burn but caused by moist heat 

TYPES:

1)THERMAL :-Flame burns,scald burn 

2)ELECTRICAL

3)CHEMICAL

RULE OF 9 IN BURNS :

• Pathology of burns are divided into :

1)Local changes:

2)Systemic changes 

1)Local changes :

1. Severity of burn
2. Extent of burn
3. Vascular changes
4. Infection

SEVERITY OF BURN:

• Microscopic destruction of the superficial layers of the epidermis
• Desquamated within few days 
• No scarring

EXTENT OF BURN :

• Length and width of burn is expressed by percentage of total surface area displaying either 2nd or 3rd degree burn,extent estimated by WALLACE RULE OF NINES 

ANATOMIC AREA                                               PERCENTAGE OF BODY SURFACE 

Head ,face and neck                                                    9% 

right upper extremity                                                 9%

left upper extremity                                                   9%

right lower extremity (thigh -9%,leg,foot-9%)         18%

left lower extremity                                                  18%

anterior trunk 

(chest -9%,abdomen-9%)                                           18%

posterior trunk 

(upper half-9%,lower half-9%)                             18%

external genitalia                                                  1%

• Rule of nines is applicable only to the adults 
• It does not apply strictly to infants and children cause the surface area of the head and neck of children is significantly larger than 9%)
• Example; 1 year child ,surface area associated with head -19% -compared to only 7% in adults 
• In contrast ,

Each lower extremity represent only 13% of total body surface area 

VASCULAR CHANGES:

1)DILATATION OF SMALL VESSEL - due to direct injury to vessel wall

2)CAPILLARY PERMEABILITY INCREASED- plasma rich in protein pours out -exudate collects in blister

INFECTION:

• 1st degree burn -epidermis act as barrier against infection
• Deep burn -severe infection 

COMPLICATION:

• Hypovolemic shock
• Septic shock
• Smoke inhalation syndrome
• Neurogenic shock 
• Renal failure
• Electrolyte imbalance
• Gastric ulcer
• Malnutrition (protein loss)
• Hypertrophic scars
• Marjolin's ulcer
• Hematemesis 

MANAGEMENT :

FIRST AID MEASURES:

• Remove patient from burning agent 
• Pour water on body to extinguish fire
• Put off electricity if electric current is involved
• In case of indoor fire ,remove patient from smoke filled room 
• Apply cold /lukewarm water on burnt area

Advantages of pouring water :

• Extinguishes fire
• Easily available
• Less fluid evaporation from surface
• Reduces pain

Wrap the patient in clean dry sheet and shift to hospital 

A)AIRWAY:

• History of  flame burns suffered in closed space- smoke inhalation therefore sign of airway obstruction must be looked 
• Burns of mouth,lip,neck -soft tissue swelling ,within hours of injury -sudden airway obstruction -tracheostomy may be required 

B)BREATHING:

• Smoke inhalation is major cause of mortality in burns 
• Heat causes damage to upper airway (oral cavity,nasopharynx,larynx)
• Patient requires humidified oxygen

C)CIRCULATION:

• The patient needs rapid intravenous fluid replacement to compensate fluid lost from burn surface area
• If burn area in adult >15%,child->10% then they require intravenous fluid replacement 

FLUID RESUSCITATION

PARKLAND REGIME :

• 4ml /%burn/kg body weight /24 hours ,first 8 hours ,half the volume is infused ,rest given in 16 hours 

MUIR AND BARCLAY REGIME:

%Burns*body weight in kg /2= 1 ration 

• 3 rations in 1st 12 hours
• 2 ration in 2nd 12 hours
• 1 ration in 3rd 12 hours 

FLUIDS USED :

• Normal saline 
• Ringer lactate 
• Plasma 

LOCAL MANAGEMENT:

• Dressing at regular interval under general anesthesia using paraffin gauze ,hydrocolloids
• Slough excision is done regularly 
• After cleaning with povidone iodine silver sulfadiazine ointment is used 

AIM OF THIS POST:

Today we started with a small introduction about what burns are , the types of burns,rule of  9 in burns ,late complication and finally about its management .hope this post would have been informative if this post helped you learn then do let me know in the comment section below as this would motivate me to post more such content ,do stay  connected through instagram as well to receive instant post notification ,for product review kindly contact email id .

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