How does the Rule of 9s help in burn assessment. What is the Wallace rule of nines chart. Why is accurate burn measurement crucial for patient care. How can healthcare professionals effectively use the Rule of 9s in emergency situations. What are the key components of a thorough burn assessment.

The Importance of Accurate Burn Assessment in Emergency Care

Accurate burn assessment is a critical component of emergency care for burn victims. It plays a pivotal role in determining the severity of the injury, guiding treatment decisions, and potentially saving lives. One of the most widely used methods for assessing burns in adults is the Rule of 9s, also known as the Wallace rule of nines chart.

This systematic approach to burn assessment allows healthcare professionals to quickly estimate the percentage of total body surface area (TBSA) affected by burns. By understanding and correctly applying the Rule of 9s, medical practitioners can ensure that patients receive appropriate care and resources are allocated efficiently.

Why is precise burn measurement crucial?

• Determines fluid resuscitation requirements
• Aids in assessing the severity of the injury
• Helps decide if transfer to a specialist facility is necessary
• Guides treatment planning and wound management

Understanding the Wallace Rule of Nines Chart

The Wallace rule of nines chart is a tool designed to simplify the process of estimating burn surface area in adults. It divides the body into sections, each representing approximately 9% of the total body surface area, hence the name “Rule of 9s”.

How is the body divided according to the Rule of 9s?

• Head and neck: 9%
• Each arm: 9%
• Chest: 18% (9% front, 9% back)
• Abdomen: 18% (9% front, 9% back)
• Each leg: 18% (9% front, 9% back)
• Genitals: 1%

By using this chart, healthcare professionals can quickly add up the affected areas to get a total percentage of TBSA burned. This information is crucial for determining the severity of the burn and initiating appropriate treatment protocols.

Conducting a Thorough Burn Assessment

A comprehensive burn assessment involves more than just calculating the TBSA. It requires a systematic approach that includes gathering patient history, performing a head-to-toe examination, and documenting findings accurately.

What information should be collected during the initial assessment?

The AMPLE acronym serves as a useful guide for gathering essential information:

• Allergies
• Medications
• Past medical history (including tetanus status)
• Last meal
• Events leading to injury

Additionally, it’s important to note any first aid measures that have already been administered to the patient.

Head-to-Toe Examination: Beyond Burn Assessment

While burn assessment is crucial, a thorough head-to-toe examination is necessary to identify any additional injuries or complications that may have occurred alongside the burn.

What areas should be examined during a head-to-toe assessment?

1. Head and face
2. Neck
3. Chest
4. Abdomen
5. Extremities
6. Back (via log roll)

During this examination, healthcare professionals should look for signs of other injuries, such as lacerations, bruising, fractures, or signs of inhalation injury. All findings should be accurately documented and appropriate treatment initiated for non-life-threatening injuries.

Assessing Burn Depth: A Critical Component

In addition to calculating the TBSA, assessing burn depth is essential for determining the appropriate course of treatment. Burns are typically classified into three categories based on their depth.

How are burns classified by depth?

• First-degree (superficial) burns: Affect only the epidermis
• Second-degree (partial thickness) burns: Involve the epidermis and part of the dermis
• Third-degree (full thickness) burns: Extend through all layers of the skin and may affect underlying tissues

Accurately assessing burn depth requires careful examination of the wound’s appearance, sensation, and capillary refill. This information, combined with the TBSA calculation, provides a comprehensive picture of the burn’s severity.

The Role of Fluid Resuscitation in Burn Management

One of the primary reasons for accurately calculating TBSA is to determine fluid resuscitation requirements. Severe burns can lead to significant fluid loss and shock, making proper fluid management crucial for patient survival.

How is fluid resuscitation calculated for burn patients?

The Parkland formula is commonly used to estimate fluid requirements:

• 4 mL x patient’s weight in kg x % TBSA burned = total fluid in first 24 hours
• Half of this volume is given in the first 8 hours, and the remainder over the next 16 hours

It’s important to note that this formula provides an estimate, and actual fluid requirements may vary based on individual patient factors and response to treatment.

Special Considerations in Burn Assessment

While the Rule of 9s is a valuable tool, there are certain situations where it may need to be modified or used in conjunction with other assessment methods.

When might the Rule of 9s need modification?

• Pediatric patients: Children have proportionally larger heads and smaller legs compared to adults
• Obese patients: Body proportions may differ significantly from the standard chart
• Patchy or irregular burns: May require more detailed estimation methods

In these cases, healthcare professionals may use alternative methods such as the Lund and Browder chart or the palm method (patient’s palm represents approximately 1% of their TBSA) to supplement the Rule of 9s assessment.

Documentation and Communication in Burn Care

Accurate documentation of burn assessment findings is crucial for ensuring continuity of care, particularly when patients are transferred between facilities or care teams. Clear communication of burn extent, depth, and associated injuries helps guide treatment decisions and improve patient outcomes.

What should be included in burn assessment documentation?

• Detailed description of burn location and extent
• Estimated TBSA percentage
• Assessment of burn depth
• Presence of any inhalation injury or other associated trauma
• Initial fluid resuscitation calculations and patient response
• Any interventions performed during the initial assessment

Many burn centers use standardized burn diagrams to visually represent the extent and location of burns, which can be invaluable for tracking progress and planning treatment.

In conclusion, the Rule of 9s and the Wallace rule of nines chart are essential tools in the assessment and management of burn patients. By providing a quick and relatively accurate method for estimating burn surface area, these tools enable healthcare professionals to make timely decisions regarding fluid resuscitation, wound care, and potential transfer to specialized burn units. However, it’s important to remember that burn assessment is just one part of a comprehensive evaluation that includes detailed patient history, thorough physical examination, and ongoing monitoring of the patient’s condition. With proper training and application of these assessment techniques, healthcare providers can significantly improve outcomes for burn victims and ensure they receive the most appropriate and effective care possible.

Burns-Secondary Survey | Trauma Victoria

The secondary survey is only to be commenced once the primary survey has been completed and any life-threatening injuries have been treated. If during the examination any deterioration is detected, go back and reassess the primary survey.

History

Taking an adequate history from the patient, bystanders or emergency personnel of the events surrounding the injury can assist with understanding the extent of the injury, the likelihood of inhalation burns and any possible other injuries. 

Use the AMPLE acronym⁸ to assist with gathering pertinent information:
Allergies
Medication
Past medical history (including tetanus status)
Last meal
Events leading to injury

Note what first aid has already been given to the patient.

Head-to-toe examination

During this examination, any injuries detected should be accurately documented and any required treatment should occur, such as covering wounds, managing non-life-threatening bleeding and splinting of fractures.
 

Measuring burns

Assessing burn depth and calculating the percentage of the total body surface area burnt is important during the head-to-toe examination. This will allow fluid resuscitation requirements to be calculated and the severity of the injury to be determined to assess if transfer to a specialist facility is required.

The extent of the burn is measured as the percentage of TBSA. It is important to accurately document the location and area of the burn. The recommended tool for assisting in calculating this in adults is the Wallace rule of nines chart. While examining the patient it is helpful to have another staff member documenting the location and extent of the injuries as they are called out by the assessing clinician.
CLICK ON IMAGE TO ENLARGE
 

Used with permission from: Victorian Burns Unit 

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CLICK ON IMAGE TO ENLARGE

Used with permission from:  Victorian Burns Unit 

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Head-to-toe examination

During this examination, any injuries detected should be accurately documented and any required treatment should occur, such as covering wounds, managing non-life-threatening bleeding and splinting of fractures.

Measuring burns

Assessing burn depth and calculating the percentage of the total body surface area burnt is important during the head-to-toe examination. This will allow fluid resuscitation requirements to be calculated and the severity of the injury to be determined to assess if transfer to a specialist facility is required.
The extent of the burn is measured as the percentage of TBSA. It is important to accurately document the location and area of the burn. The recommended tool for assisting in calculating this in adults is the Wallace rule of nines chart. While examining the patient it is helpful to have another staff member documenting the location and extent of the injuries as they are called out by the assessing clinician.

Head and face

Inspect the face and scalp. Look for any lacerations and bruising as well as mastoid or periorbital bruising, which is indicative of a base of skull fracture. Gently palpate for any depressions or irregularities in the skull. Check the eyelashes and eyebrows for singeing.
Look in the eyes for any burn injury, foreign body, subconjunctival haemorrhage, hyphaema, irregular iris, penetrating injury or contact lenses.
Assess the ears for any signs of cerebrospinal fluid leak, bleeding or blood behind the tympanic membrane.
Check the nose for any deformities, bleeding, nasal septal haematoma, cerebrospinal fluid leak or presence of any soot/ash as well as singeing of nasal hairs.
Look in the mouth for any lacerations to the gums, lips, tongue or palate. Note any swelling, which may indicate inhalation injury. Inspect the teeth, noting if any are loose, fractured or missing.
Test eye movements, pupillary reflexes, vision and hearing.
Palpate the bony margins of the orbit, maxilla, nose and jaw.
Inspect the jaw for any pain or trismus.

Neck

The cervical collar should be opened, the head supported with manual in-line stabilisation and the neck inspected.
Gently palpate the cervical vertebrae. Note any cervical spine pain, tenderness or deformity.
Check the soft tissues for bruising, pain and tenderness.
Complete the neck examination by observing the neck veins for distension and palpating the trachea and the carotid pulse. Note any tracheal deviation or crepitus.
The patient will need to be log rolled to complete the full examination. This can be combined with the back examination.

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Chest

The chest should be palpated for rib tenderness and subcutaneous emphysema. The entire thorax must be palpated including the supraclavicular fossae, right and left ribs and both axillae. A hand can be slid posteriorly along a supine patient to check for occult blood loss; however, a formal examination of the back of the chest occurs when the patient is log rolled.
Palpate for clavicle or rib tenderness.
Auscultate the lung fields; note any percussion, altered/reduced breath sounds, wheezing or crepitations.
Check the heart sounds: apex beat and presence and quality of heart sounds.

Abdomen

Inspect the abdomen. Palpate for areas of tenderness, especially over the liver, spleen, kidneys and bladder. Look for any bruising, lacerations or penetrating injuries.
Check the pelvis. Perform a pelvic x-ray if there is any suspicion of injury. Gently palpate for any tenderness. Do not spring the pelvis..⁹ Any additional manipulation may exacerbate haemorrhage. Apply a binder if a pelvic fracture is suspected.
Auscultate bowel sounds.
Inspect the perineum and external genitalia.

Limbs

Full thickness burns to feet
_{Image used with permission from the Alfred Hospital}

Inspect all the limbs and joints, palpate for bony and soft-tissue tenderness and check joint movements, stability and muscular power. Note any bruising, lacerations or muscle, nerve or tendon damage. Look for any deformities, penetrating injuries or open fractures.
In electrical burns, look for any entry and exit wounds as well as signs indicating the development of compartment syndrome. These may be found centrally, not just on the limbs (check the head and chest).
Examine the sensory and motor function of any nerve roots or peripheral nerves that may have been injured.
Assess for circumferential burns that may constrict blood flow to all limbs or digits. Assess colour, warmth, movement, sensation and capillary refill distally.

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Back

Log roll the patient. Maintain in-line stabilisation throughout. Inspect the entire length of the back and buttocks noting any bruising and lacerations.
Palpate the spine for any tenderness or steps between the vertebrae. Include a cervical examination at this stage.
Digital rectal examination should be performed in a trauma patient only if a spinal injury is suspected. This is unlikely following isolated burn injury unless there is concomitant multitrauma spinal injuries. Note any loss of tone or sensation.

Buttocks and perineum

Look for any soft-tissue injury such as bruising or lacerations.

Genitalia

Inspect for soft-tissue injury such as bruising, lacerations or burns. Note any priapism that may indicate spinal injury.
 
The priorities for further investigation and treatment may now be considered and a plan for definitive care established.

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Burns • LITFL • CCC Trauma

Reviewed and revised 2 September 2014

OVERVIEW

Burns are injuries to tissues caused by heat, friction, electricity, radiation, or chemicals

• Burn injury is characterised by a hypermetabolic response with physiologic, catabolic and immune effects
• extent of burns and fluid resuscitation is often over-estimated in the ED

EPIDEMIOLOGY

• In adults the usual mechanism is exposure to fire, in child scalding is most common
• maybe associated with alcohol, abuse, epilepsy or psychiatric problem
• mortality is related to age (>50yrs), TBSA (40%) burnt and burn depth
• increased mortality if post-burn resuscitation is delayed >2h

CLASSIFICATION OF BURNS

• Superficial – epidermis only
• Partial – superficial (epidermis and upper layer of dermis), deep (extends to deeper layer of dermis)
• Full – all layers of dermis and may involve underlying tissue

ASSESSING EXTENT OF BURNS

Methods

• Rules of 9’s
• Palm of patient = 1% TBSA burn
• Lund-Browder Chart

OTHER IMPORTANT ASPECTS

• Resuscitation – airway patency, breathing, circulation, LOC
• Adequacy of resuscitation to date – HR, BP, urine output, fluid received
• Associated trauma
• Airway burn or inhalational injury – stridor, burns to face, nose and mouth, carbonaceous sputum
• Facial and/or corneal burns, perineal burns
• Circumferential burns – extremities -> compartment syndrome, ventilator inadequacy -> escharotomy
• Rhabdomyolysis
• Inhalation of toxic gases – CO
• Temperature
• Adequacy of analgesia
• Problems with vascular access
• Evidence of drug/alcohol ingestion
• Co-morbid conditions

MANAGEMENT

Key points

• EMST/ATLS protocol – primary and secondary survey
• Burn assessment and management – debridement by 48 hours
• Transfer to definitive care facility

PRIMARY SURVEY

Airway with C-spine control

• may need ETT urgently (use an uncut tube + wire to maxilla)
• warning signs include = singed nasal hairs, horse voice, productive brassy cough, soot in sputum, stridor, facial burns, breathed fire, voice change
• maximum wound oedema takes place at 12-36hrs after injury
• FOB or nasoendoscopy
• Bronchoscopy – soot, charring, mucosal erythema, necrosis, airway oedema
• RSI
• sux ok for 24-48h then none for 2 days -> 2 yrs
• may need AFOI or surgical airway

Breathing with O2

• 15L/min + reservior bag
• may require ETT + IPPV because of other injuries, major resusication, sedation, ARDS & analgesia, decreased pulmonary compliance
• protective lung injury
• NAC & heparin nebulisers used in some centers
• suction

Circulation with haemorrhage control

• >25% -> SIRS with oedema
• IV access through intact skin where possible
• IVF for >15% in adults & >10% in children
• Hartmans is preferred
• x-match units
• may have to stop surgery to catch up
• aim for PCV 0. 3

Disability with assessment of neurological function

• CHI
• CO poisoning
• ETOH poisoning
• analgesia

Exposure with temperature control

• remove all clothes
• if stuck to patient, cut around adherent areas
• keep warm
• assess %TBSA and depth
• warm theatre (32 C)
• humidify (70-80%)

SECONDARY SURVEY

• cool with running cold water (20min)
• bronchoscopy for evidence of an inhalational injury (nebulized heparin and NAC)
• watch for hypothermia
• cover with clingfilm (limits evaporation, heats loss & pain)
• IV morphine
• escharotomy – limbs & chest wall
• have lots of blood ready
• watch for COHb -> will need 100% O2 or hyperbaric O2

ICU MANAGEMENT

Fluid replacement

• required in adult > 15%, children >10%
• Modified Parklands Formula (original Parkland’s formula included colloids)

-> Adults – 4mL/kg/%
-> Children – 3-4mL/kg/%

• give 1/2 in first 8h since the time of injury
• give 1/2 in next 16h
• + maintenance fluid for children <30 kg

• aim for urine output of 0. 5mL/kg/hr and normal cardiovascular parameters (HR, BP)
• then albumin after first 24 hours (keep albumin > 20)
• more fluid is typically required if: inhalational injury, electrical burns or delayed resuscitation
• permissive hypovolaemia with non-invasive haemodynamic monitoring is a promising approach
• test for myoglobinuria -> if +ve then rhabdomyolysis is present:

(1) aim 2-3mL/kg/hr
(2) consider: alkalinise urine with 25mmol of HCO3- for each litre of Hartmans
(3) consider: promote diuresis with 12.5g mannitol to each litre of Hartmans

Dressings

• biobrane: superficial
• acticoat: partial
• subcut infusions: hypertonic saline + acetic acid (anti-pseudomonal)

Other issues

• NJ tube -> feed
• strict asepsis
• vigilance for nosocomial infections: line changes every 7 days
• tetanus
• antibiotics in initial period if dirty (frequently cooled at scene with dirty water)
• family discussion
• prognosis: age + TBSA burn should be less than 100.
• monitor for post burn leukopenia (cease silver sulfadiazine and use mafenide acetate, stop cimetidine, consider G-CSF if doesn’t improve in 3 days)

Chemical Burns

• protect self with gloves, apron & facemask
• remove contaminated clothing
• neutralize or dilute with h3O (1hr)

• Hydrofluoric acid – topical calcium gluconate burn gel + Biers block with 10-15mL of 10% calcium gluconate + 5000U of heparin in 40mL 5 % dextrose
• Phosphorus – copper sulphate solution
• Bitumen – cool with h3O, remove with vegetable or paraffin oil

Electrical Burns

• low voltage (<1000V) -> local contact burn
• high voltage (>1000V) -> entrance & exit wound -> may require fasciotomy
  -> side flash = nearby lightening strike -> superficial burns, entry & exit burns +/- respiratory arrest
• direct lightning strike -> often fatal

INDICATIONS FOR REFERRAL TO BURNS CENTRE

Early discussion with your regional burns centre is advised if there is any doubt/concern regarding the management of any burns patient.

• Burns > 10 % TBSA in an Adult
• Burns > 5 % TBSA in a Child
• Full thickness burns > 5% TBSA
• Burns of face, hands, feet, perineum, genitalia, and major joints
• Circumferential burns
• Chemical or electrical burns
• Burns in the presence of major trauma or significant co-morbidity
• Burns in the very young patient, or the elderly patient
• Burns in a pregnant patient
• Suspicion of Non-Accidental Injury

FLUID CREEP

• excess fluid loading is also termed ‘fluid creep’
• fluid creep is common in burns patients
• possible reasons for fluid creep:
  • inaccurate fluid requirement calculations
  • lack of vigilance in reducing unnecessary fluid infusions
  • increased use of sedation and analgesic agents
  • excess crystalloid over colloid replacement
  • inappropriate use of parameters for monitoring adequacy of fluid replacement

References and links

LITFL

• Trauma Tribulation 032 – Trauma! Major Burns
• Toxicology Conundrum 038 — Smoke inhalation with Carbon Monoxide and Cyanide Toxicity
• Trauma Tribulation 005 — Escharotomy

Journals and Textbooks

• Benson A, Dickson WA, Boyce DE. Burns. BMJ. 2006 Mar 18;332(7542):649-52. Review. Erratum in: BMJ. 2006 Apr 1;332(7544):755. PMID: 16543335; PMCID: PMC1403274.
• Coban YK. Infection control in severely burned patients. World J Crit Care Med. 2012 Aug 4;1(4):94-101. PMC3953869.
• Hall KL, Shahrokhi S, Jeschke MG. Enteral nutrition support in burn care: a review of current recommendations as instituted in the Ross Tilley Burn Centre. Nutrients. 2012 Oct 29;4(11):1554-65. PMC3509506.
• Hettiaratchy S, Dziewulski P. ABC of burns: pathophysiology and types of burns. BMJ. 2004 Jun 12;328(7453):1427-9. Review. Erratum in: BMJ. 2004 Jul 17;329(7458):148. PMC421790.
• Norman AT, Judkins KC. Pain in the patient with burns. Contin Educ Anaesth Crit Care Pain 2004;4(2):57-61 [Free Full Text]
• Peck M. Respiratory burn injuries: An overview. Indian J Burns [serial online] 2013 [cited 2014 Sep 2];21:17-23. Available from: http://www.ijburns.com/text.asp?2013/21/1/17/121876
• Snell JA, Loh NH, Mahambrey T, Shokrollahi K. Clinical review: the critical care management of the burn patient. Crit Care. 2013 Oct 7;17(5):241. PMC4057496.
• Williams FN, Branski LK, Jeschke MG, Herndon DN. What, how, and how much should patients with burns be fed? Surg Clin North Am. 2011 Jun;91(3):609-29. PMC3255093.

FOAM and web resources

• DirtMed — Burn Resuscitation Part 1 and Part 2 (2012)
• ICN — Burns and Fluids by Lewis Macken (smaccGOLD, 2014)
• ICU Rounds Podcast 12 — Burns: Fluid Creep (2007)
• ICU Rounds Podcast 28 — Pediatric Burns (2008)
• Maryland CCP — N-acetylcysteine for Inhalational Burn Injury (2014)
• Maryland CCP — Managing the Burn Patient in the ICU (2013)
• Victoria Burn Management Guidelines (a comprehensive resource covering all aspects of burns assessment and management and a great place to download Burns Surface Area charts and Information Posters for clinical areas)

Chris Nickson

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of three amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

article Oxford Medical clinic Kyiv

The information in the article is provided for review and is not a guide to self-diagnosis and treatment. If symptoms of the disease appear, you should consult a doctor.

Contents:

1. Symptoms of burns of varying degrees

2. First aid for skin burns

3. 90 013 What can not be done with burns?

4. How do burn injuries develop?

5. Types and degrees of burns

6. How are burns treated?

7. Why are burns dangerous?

A burn is damage to the skin and subcutaneous tissues caused by prolonged exposure to the sun, contact with fire or hot objects, contact with the skin with boiling water or aggressive chemicals, as well as exposure to electric current or radioactive radiation.

Almost everyone experiences minor burns. They often occur in domestic settings, for example, when cooking. Superficial burns quickly pass due to the regenerative properties of the skin and rarely cause complications.

Deep or extensive injuries, on the contrary, are dangerous to the health and even life of the victim. In such cases, it is important to properly provide first aid and quickly contact a doctor.

Symptoms of burns of varying degrees

Symptoms of burns may vary depending on the depth of damage to the skin.

First degree burns occur:

Second degree burns are also accompanied by:

• exfoliation of the outer layer of the skin;

• blistering filled with liquid;

• fever.

Third degree burns:

• skin becomes grayish;

• blisters and spots of brown, rarely black color form on it;

• develops necrosis and rejection of damaged tissues.

IV degree burns occur:

First aid for skin burns

The first step is to stop contact with the source of the burn and make sure that the victim is safe.

Further recommend:

• for mild burns, cool the burnt skin area with cool running water, this is especially important for chemical burns;

• remove clothing or accessories that are near the affected area of ​​the skin;

• in case of a wound, if possible, treat it with an antiseptic agent and cover it with a light sterile dressing;

• give the victim water to drink to reduce intoxication and prevent dehydration;

• in case of III-IV degree burns, call an ambulance or immediately take the patient to the hospital.

What should not be done in case of burns?

Oxford Medical specialists warn that various methods of treating burns are common among the people, but many are not only ineffective, but also increase the risk of complications.

Not recommended in particular:

• keep the burned area under cold water for more than 10 minutes as this may lead to hypothermia;

• use ice for cooling, as this may aggravate skin damage;

• apply oil or fat cream to the skin – this contributes to the formation of an impenetrable film, which impairs healing;

• independently separate from the skin items of clothing or other things that have stuck to the wound;

• independently open papules and remove accumulated fluid – an infection can get into the wound.

How do burn injuries develop?

Thermal and chemical stimuli cause destruction and death of skin cells. With light burns, only the epidermis is damaged, while with prolonged or too strong exposure, all layers of the skin, as well as muscles, ligaments, blood vessels, and even internal organs.

Destruction of the protective layer of the skin leads to loss of fluid due to increased permeability of the walls of small vessels, disruption of local thermoregulation and the risk of infection.

With severe damage, burn shock may develop, accompanied by loss of consciousness, circulatory disorders and general intoxication of the body.

Types and degrees of burns

Depending on the depth and intensity of damage, 4 degrees of burns are distinguished:

1. Burn of the 1st degree is accompanied by damage to the epidermis, the upper layer of the skin. Pain and redness may persist for 2-3 days, after which the healing process begins. If the affected area is small, such burns do not require a visit to a doctor and respond well to treatment at home.

2. Second degree burn – accompanied by damage to the epidermis and dermis. Symptoms may persist for up to 2 weeks. Without proper treatment, there is a risk of scarring and scarring.

3. Third degree burn – (A) accompanied by partial destruction of all layers of the skin and (B) – complete;

4. IV degree burn – accompanied by damage to the subcutaneous tissue, muscles, ligaments, tendons, bone tissues and internal organs.

For II and III (A) degree burns, a doctor’s consultation is mandatory, but treatment can be carried out by conservative methods at home. For deeper injuries, an ambulance call and hospitalization of the patient is required.

In addition to the degree of damage, burns are also classified according to the source of exposure. Allocate solar, thermal, chemical, electrical, radiation and radiation burns.

How are burns treated?

Many people experience small, superficial burns in the home. Due to the regenerative properties of the skin, sometimes they heal even without the use of drugs. Wound healing creams and ointments may be recommended to relieve pain and speed up healing.

In case of burns of the second degree or more, it is imperative to consult a doctor. The specialist will assess the degree of damage and draw up a treatment plan.

Superficial burns are treated on an outpatient basis. As a rule, the damaged surface is first decontaminated, after which the drug is applied and, if necessary, a bandage is applied. Anti-inflammatory, antibacterial and wound-healing agents are used.

III(B) and IV degree burns require hospitalization. First, the patient is given emergency medical care to relieve an acute condition. Treatment of deep burns is carried out using conservative and surgical methods. In particular, necrotic tissues are surgically removed and plastic surgery of the skin is performed.

Depending on the patient’s condition, necrectomy may be done immediately, a few days after a burn occurs, or if pus has formed. Skin plastic surgery is also performed immediately or when the healing process begins. It allows you to speed up recovery and reduce cosmetic defects.

In addition, patients are given systemic therapy to reduce pain, intoxication of the body, treat or prevent complications.

Why are burns dangerous?

With burns of I – III (A) degree, the risk of complications is low. The main thing is to follow the doctor’s prescriptions and take care of maintaining the sterility of the wound.

The likelihood of serious complications occurs with deep burns and damage to more than 40% of the body area. In a special risk group are patients over 60 years of age and with chronic diseases.

Both local and systemic complications can develop against the background of burns. Local include:

• formation of keloid scars;

• appearance of age spots;

• development of trophic ulcers;

• muscle atrophy and limitation of joint mobility.

Systemic complications are:

• secondary bacterial infection;

• blood poisoning;

• hypothermia – decrease in body temperature;

• hypovolemia – decrease in blood volume;

• respiratory dysfunction;

• disturbance of metabolic processes;

• liver failure, etc.

Modern medicine makes it possible to effectively provide care to patients even with extensive deep burns, and aesthetic and plastic surgery methods eliminate scars, scars and other defects, making them almost invisible.

Sources:

National Library of Medicine

Springer Nature

Science Direct

Published: 12/23/2022

Updated: 24. 05.2023

( Rating: 5.00, votes: 2 )

Primary burn toilet wounds: necessary preparation, course of administration and contraindications

This is a set of measures aimed at preventing the spread of infection in the burn site and its speedy healing.

Primary care for burn wounds should not be confused with first aid for burns . Although both of these events have some similarities. However, first aid is provided in the order of self-help or mutual assistance, i.e., independently or by unauthorized persons, as a rule, not related to medicine.

And the primary toilet for burn wounds is already a qualified assistance measure. This assistance in a medical institution is provided by a surgeon. In large medical centers, this is done by a highly specialized surgeon specializing in the treatment of burns, combustiologist (from Latin combustio – burn).

Before proceeding with the treatment of the wound, the doctor finds out the circumstances of the burn, determines the depth and degree of burn lesions. In clinical practice, one often has to deal with household thermal burns with steam or boiling water. Burns with boiling water often get small children left unattended. Much less common are industrial thermal (voltage arc, hot metal), chemical (caustic acids and alkalis) and electrical burns.

To accurately determine the area of ​​burns, many devices have been developed, the use of which in real conditions is not always advisable. An experienced doctor will determine the area of ​​the burn visually. Small areas are calculated by the rule of the palm – the palm of the victim corresponds to 1% of the area of ​​\u200b\u200bhis body. And for extensive burns, the rule of nines is used (the percentage of the area of ​​\u200b\u200bthe anatomical zones corresponds to numbers that are multiples of 9).

Determining the area of ​​burns is also not difficult. There are four degrees of burns in total. Although in fact there are five of them:

I. Redness of the skin.

II. Blisters filled with serous fluid.

IIIA. The blisters burst, exposing the deep germ layer of the skin, which remains intact.

IIIB. The entire thickness of the skin with the germ layer is damaged, which, under bursting blisters, takes on the appearance of boiled meat.

IV. The burn extends to the hypodermis (subcutaneous fatty tissue), as well as to muscles, bones, ligaments, acquiring a characteristic appearance of charring.

I, II and IIIA degree are superficial burns, and IIIB and IV degree are deep burns. With superficial burns, epithelialization and complete restoration of the skin are possible. With deep burns, this does not happen, and healing is accompanied by scarring.

During the examination, the doctor not only determines the depth and degree of the burn, but also assesses the general condition of the patient. With extensive burns, burn disease develops with burn shock, dysfunction of vital organs and subsequent purulent-septic complications. After all, a burn wound is not only damage, but also an entrance gate for pyogenic bacteria.

But in young children, in elderly debilitated patients , burn shock develops even with a relatively small area of ​​damage. All patients with symptoms of burn shock are subject to intensive care in a hospital setting.

The rest of the victims are treated on an outpatient basis. First of all, you need to wash the wound with antiseptic solutions (furatsilin, chlorhexidine, rivanol). At the prehospital stage, it is forbidden to free the burn wound from foreign bodies (pieces of clothing, pieces of dirt, etc.). But in a medical institution, the doctor is obliged to do this. After all, foreign bodies are a source of infection.

Formed bullae , large serous blisters, open. At the same time, the skin remaining after opening is not removed, but the blisters are cut with scissors at the base, and the liquid is released. However, the doctor must remove the necrotic tissues formed during deep IV degree burns – this is also a source of infection. It is important that all instruments used during processing are sterile.

Treatment of burn wounds with alcohol and alcohol-containing agents is not allowed. In the same way, ointments and other fat-based preparations are not allowed, as well as numerous pseudo-folk remedies like goose or pork fat. The fact is that after a burn, an elevated temperature remains in the tissues, and by applying fat, we create thermal insulation and prevent the wound from cooling.

chemical burns may also have errors. So, some argue that acid burns should be treated with a solution of soda, and alkaline burns with a solution of acetic acid. Allegedly, in this case, mutual neutralization of substances occurs. This is also unacceptable, and chemical burns are treated with neutral antiseptics.

After treatment, the burn surface is fixed with a sterile bandage with a gauze pad moistened with an antiseptic solution. The bandage is applied not too tight, so as not to further injure the burn area and not increase pain. After all, burns are accompanied by pain, and the treatment only exacerbates it. The most painful are not deep, but superficial burns II-IIIA degree. To eliminate pain, analgesics are administered intramuscularly. With an intense pain syndrome, it may even be necessary to administer analgesics of the narcotic series.

The specifics of applying a dressing for various types of burns

The dressing technique is very simple:

1. Open the protective packaging.
2. Disinfect the wound.
3. Cover the burn with a sterile dressing.

Therapy of burn wounds I-II degree

Post-burn dressings with a small amount of damaged areas can be carried out at home. Medical manipulations in such conditions are based on high-quality treatment of the affected area, after which it is closed with a sterile bandage. To avoid injury, the burn is gently washed from exudate and skin particles, then disinfected with antiseptics, in particular, chlorhexidine.

It is important to eliminate bursting blisters, remove the contents from the remaining intact blisters by puncture, in this case it is not advisable to remove the outer layer. Small bubbles do not need to be removed. In the future, it is important to treat the burn with a special ointment and antibiotic. These simple procedures help to eliminate suppuration, as well as soften the boundaries of wound damage. After treating the damaged area, the wound is closed with an anti-burn dressing designed to protect the surface of the lesion from infection and environmental exposure.

Therapy for third degree burns

In the presence of third degree burns, treatment should be adjusted according to the complexity of the wound process. Typically, such manipulations are carried out in stationary conditions. In pharmacies, you can buy special anti-burn plasters. They completely close the wound, soften its edges, provide tissue regeneration, do not undergo adhesion, and are freely removed.

Rules for dressing burns

Bandages for the treatment of burns should be applied sparingly to the wound so as not to accidentally injure the delicate ball of the overgrown epithelium, in particular in the treatment of chemical and thermal burns of the 2nd degree.

It is very important to constantly monitor the condition of the affected areas in order to change the treatment tactics in a timely manner, if necessary. To avoid infection, the surface of the burn should only be covered with an aseptic dry dressing.

When treating a wound and applying a bandage to the affected area, it is forbidden:

• touch the side of the dressing that is in contact with the wound;
• remove clothing stuck to the burnt body, remove blisters;
• remove foreign bodies from the wound cavity, clean it with water;
• self-adjust protruding internal organs.