Burns: Classification of burn injury

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Classification of burn injury
  • Depth of burn
  • Extent of burn calculated in percent of total body surface area (TBSA)
  • Location of burn
  • Patient risk factors

1. Depth of burn
  • Superficial/ First degree burns: First-degree burns are limited to the epidermis, or upper layers of skin.
Characteristics of Burns According to Depth
DEPTH OF BURN AND CAUSES
SKIN INVOLVEMENT
SYMPTOMS
WOUND APPEARANCE
RECUPERATIVE COURSE
Superficial Partial-Thickness (Similar to First Degree)
Sunburn Low-intensity flash

Epidermis; possibly a portion of dermis
Tingling Hyperesthesia
(supersensitivity)
Pain that is soothed by cooling
Reddened; blanches with pressure; dry
Minimal or no edema Possible blisters

Complete recovery within a week; no scarring
Peeling

Deep Partial-Thickness (Similar to Second Degree)
Scalds Flash flame
Epidermis, upper dermis, portion of deeper dermis
Pain Hyperesthesia Sensitive to cold air
Blistered, mottled red base; broken epidermis; weeping surface
Edema
Recovery in 2 to 4 weeks Some scarring and depig-
mentation contractures Infection may convert it
to full thickness
Full-Thickness (Similar to Third Degree)
Flame
Prolonged exposure to hot liquids
Electric current Chemical
Epidermis, entire dermis, and sometimes subcutaneous tissue; may involve connective tissue, muscle, and bone
Pain free
Shock
Hematuria (blood in the urine)
and possibly hemolysis (blood cell destruction)
Possible entrance and exit wounds (electrical burn)
Dry; pale white, leathery, or charred
Broken skin with fat exposed
Edema
Eschar sloughs
Grafting necessary Scarring and loss of con
tour and function; contractures
Loss of digits or extremity possible

SUPERFICIAL BURN
  • Skin depth- Epidermis
  • Cause- Flash flame, UV light, sunburn
  • Appearance- Dry, no blisters, minimal or no edema, blanches with fingertip pressure.
  • Colour - Increased redness
  • Sensation- Painful
  • Healing time - 2-5 days with peeling, no scaring, may discolor.

Superficial Partial-Thickness second degree burns
PARTIAL THICKNESS BURN
  • Skin depth- epidermis, partial dermis, sweat glands, hair follicles.
  • Cause- hot liquids or solids, flash flame, chemicals, UV rays
  • Appearance- blisters, blanches with fingertip, moist.
  • Colour- pink
  • Sensation- very painful
  • Healing time - 5 - 21 days. Grafting may be required
FULL THICKNESS BURN / third degree burns
  • Skin depth- extends to subcutaneous tissue, possibly muscle and bone.
  • Cause- hot liquids, chemicals, electrical contact.
Appearance-dry with leathery eschar, charred vessels, blisters are rare, no blanching.
Colour- white, charred, dark tan, black, dark red.
Sensation-little or no pain, deep throbbing, nerve endings dead.
  • Healing time - no healing potential, requires excision and grafting
Fourth degree burn
  • Involves subcutaneous tissue, tendons and bone



Classification On the basis of Extent of Burn Injury
  • Determine the total body surface area (BSA) affected or the extent of a burn wound.
a.Rule of nines
b.Lund- Browder chart
c.Sage burn diagram
d.Palmar method
  • Note: first degree burns, equivalent to a sunburn, are not included when calculating BSA

a. RULE OF NINE
  • For the adults the " RULE OF NINE " is a quick tool for determining the size of a bum
  • The percentage of total body surface area burned is estimated with the use of charts  that depict anterior and posterior drawings of the body. The body is divided into multiples of 9%.
  • [RULE OF 9'S ]

b.Lund - Browder method
  • Head -7%
  • Lt. lower arm - 3%
  • Neck- 2%
  • Rt. palm-2.5%
  • Anterior trunk- 13%
  • Lt. palm 2.5%
  • Posterior trunk -13%
  • Rt. thigh -9.5%
  • Rt buttock -2.5%
  • Lt. thigh -9.5%
  • Lt buttock- 2.5%
  • Right leg 7%
  • Genitalia -1%
  • Left leg -7%
  • Rt upper arm -4%
  • Rt foot -3.5%
  • Lt. upper arm -4%
  • Rt. lower arm- 3%
  • Lt foot – 3.5%

c.Palmar method
  • In this method size of patient palm is considered as 1%.
  • For irregular and odd shaped burns


d. Sage burn diagram
  • newer computerized burn estimation tool
  • available at www.sagediagram.com
  • the tool also calculates fluid resuscitation requirements

3.Classification on the basis of  Location of burn
  • Severity of the burn Injury is related to the location of the burn wound

Face , neck and circumferential burns to the chest/back
Inhibit respiratory function due to mechanical obstruction
Hands, feet, joints and eyes

Make self care very difficult and may  jeopardize future
function
Difficult to manage because of superficial vascular and nerve supply systems

Ears and nose
Susceptible to infection, poor blood supply to the cartilage
Buttocks or genitalia
Highly susceptible to infection

Extremities
Circulatory compromise distal to the bum with subsequent neurologic impairment, compartment syndrome



4.Patient risk factors:

  • Older adults - heals slowly, difficulty with rehabilitation
  • Preexisting cardiovascular, respiratory, or renal disease- poor prognosis
  • Diabetes and peripheral vascular disease
  • General physical debilitation - chronic disease, alcoholism, drug abuse, malnutrition
  • Additional injuries- fractures, head injury, other trauma.

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notes.nursium.com: Burns: Classification of burn injury
Burns: Classification of burn injury
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