HURUTA PRIMARY HOSPITAL

PROTOCOL ON MANAGEMENT OF
BURN

Prepared by Dr

February 2015 E.C

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BURN
 A burn is defined as a traumatic injury to the skin or other organic tissue
primarily caused by thermal or other acute exposures.

 It is a type of coagulative necrosis caused by

*Thermal

*Chemical

*Electrical

*Radiation energies or combinations

 Frost bite occurs in cold countries is also a coagulative necrosis but it is

caused by high degrees of cold.

 The majority of burns in children are scalds

 Among adolescent patients, experimenting with matches and flammable

liquids (young males)

 In adults, scalds are not uncommon, but are less frequent than flame
burns.

 Most electrical and chemical injuries occur in adults.

 Cold and radiation are very rare causes of burns.

 At great risks are

♦ The very young

♦The very old

♦ 80% of patients with burns admitted to hospital

*Epilepsy

*Alcohol

*Drug abuse

Estimation of surface area of burn injury

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 Rules of 9

 Lund & Browder charts-most accurate

 Palm method-used In smaller burns or patches of burn,

the best measurement ,using piece of clean paper the
size of the patient’s whole hand (digits and palm),
which represents 1 per cent TBSA, and match this to
the area

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Classification of burns based on its depth

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Depth Appearance Sensation Healingtime
First degree Dry (no blister) Painful 3-6days
(Superficial) Erythematous
Blanches with pressure
Second degree Blisters 7 to 21 day
(partial-thickness)- Moist, red, weeping Painful (even
superficial Blanches with pressur to air)
Second degree Blisters (easily Senses Perceptive
(partial-thickness)- unroofed) pressure only >21
deep Wet or waxy dry daysrequires
Variable color (cheesy surgical
white to red) treatment
Does not blanch with
Pressure
Waxy white to gray or Deep pressure Rare, unless
Third degree(full black only surgically
thickness) Dry and inelastic treate
No blanching with
Pressure
Extends into fascia Deep pressure N ever,
Fourth degree and/or only unless
(extending beyond Muscle surgically
the skin) treated

Burn injury severity grading (modified

from the American Burn Association burn
injury severity grading system
Burn type Criteria Disposition
Minor <10% TBSA burn in adults Outpatient
<5%TBSA burn in young or
old
<2% full-thickness burn

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Moderate 10-20%TBSA burn in adults admit
5-10% TBSA burn in young or
old
2-5% full-thickness burn
High voltage injury
Suspected inhalation injury
Circumferential burn
Medical problem
predisposing to infection
(eg, diabetes mellitus)
Major >20% TBSA burn in adults Refer after
>10% TBSA burn in young or emergency
old management
>5 %full-thickness burn (Make sure the
High voltage burn referral center
Known inhalation injury provides burn
Any significant burn to face, services)
eyes, ears, genitalia, or joints
Significant associated
injuries
(fracture or other major
trauma)

Principles in Management of Burn Patients

 Management of burn patient can start before
they arrive to the hospital.
Pre-hospital Care
 Remove the patient from the source of heat
 extinguishing the victim on fire, to drop down to
the ground and roll on the floor(stop, drop and
roll)
 Victims cloth on fire must be extinguished and
removed

 Remove clothing and jewelry

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  Turn off electric supply before rescuer
touches the victim
 Check for other injuries

Management at the Hospital

 primary survey and resuscitation is 1 st step (ABCDEF
rules)
 Maintain airway
 give 100% oxygen in suspected CO
poisoning
 intubate those with inhalational respiratory
tract injury
 Analgesics
 Tetanus prophylaxis
 escharotomy of predicted area-
 chest,
 limbs
 Routine labs (HCT, Blood G, electrolyte, blood
gas analysis)

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 Acute resuscitation
 Replace fluid lost with large amount of
crystalloid
 using the Parkland formula
 (4ml R L/kg per % of burned SA in
the 1st 24 hrs.)
 -50 % of fluid in the 1st 8hrs.
 -50 % of fluid in the next 16 hrs.
 provide the daily maintenance
requirement of 2-3lt on top of the
calculated amount
 Keep urine out put in the range of 0.5-
1ml/kg/hr
 Monitor the following while giving fluid
 PR,BP ,capillary refill,skin turgor

Wound management
Minorburns
 Treated in an outpatient setting
 Debride all loose skin. Blisters are better not excised
 Cleanse with mild soap and irrigate with isotonic saline.
 The wound is then covered with Silver sulfadiazine and
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 properly dressed.
 The first dressing change and dressing evaluations are
performed 24-48 hrs after injury
 Silver sulfadiazine cream1%,apply daily with sterile
applicator (not on the face or in patients with a sulfa
allergy)
OR
 Fusidic acid,thin films of 2% cream applied to skin 3-4
times daily.
Moderate and severe burns
 Do all recommended for minor burns
 Apply local antibiotic or Vaseline coated dressing
Antibiotic prophylaxis is not recommended unless
there is obvious infection

Prevention of stress ulcer–for severe burns

only
Firstline for patients who are able to take oral
medications
 Omeprazole,40mg,oral,daily
 Firstline for patients who are unable to take oral
medications
 Cimetidine,200mg-400mgIV,every12hours
Tetanusprophylaxis
 Tetanus immunization should be updated for any
burns deeper than superficial-thickness.
Pain management:
First line use depending on pain severity and response
in stepwise fashion
 Paracetamol,500-1000mgP.O.,4-6timesaday
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OR
 Tramadol 50-100mg,Slow IV or P.O,3-4times daily
(maximum400mg/day)
OR
 Morphine hydrochloride injection(for severe
pain only), 10-20mg IM OR SC,repeat every 4hours
PRN.
OR
 Pethidine 50mg IM every 4hrs(depending on the
need) or 5-10mg IV 5minutes
Systemicantibiotics
 Not indicated for prophylaxis
 When there is evidence of infection (e.g. persistent
fever, leukocytosis) take specimens for culture and
start empiric antibiotics based on suspected site of
infection.
 If wound infection is the suspected source of infection
empiric antibiotics should cover Pseudomonas
aeruginosa,other gram-negative bacteria’s and
Staphylococcus aureus
Prevention,management and follow
up of complications
 Electrolytes-Hyperkalemia,
hyponatremia/hypernatremia
 Acute Kidney Injury-Correction fluid deficit, avoidance
of nephrotoxic medication
 Malnutrition-burn patients require high calorie and high
protein diet
 Deep vein thrombosis-Prophylaxis with heparin if
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 patient is immobilized
 Joint Contractures-proper wound care and
physiotherapy
 Psychiatric attention
 Urine output should be strictly followed with goal of 1-
2ml/kg/hr, do urinalysis to check for rhabdomyolysis
 Always suspect and report burns mainly in children and
the elderly as abuse especially hand and glove type of
pattern

APPROVED BY SIGN

 DR
 DR
 Dr
 Dr

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