Burns Shock Overview: Types, Classification, and Management
Types of Burns
➢ Thermal Injury from fire, flash, or contact with hot objects
o Most common type of burn injury
o Extent depends on temp. & length of contact
➢ Chemical Injury from contact with acids, alkali, or organic
compounds
o Alkali burns is more difficult because they adhere to
skin
o Many of these chemicals are readily available in
household products
➢ Electrical Injury from heat generated from electrical current
o Tissue density offers resistance, i.e. bones & fat
o Current that passes thru vital organs
➢ Smoke/inhalation Injury from hot air or noxious fumes
o Metabolic asphyxiation (carboxyhemoglobin concentration > 20% interferes with oxygen
delivery), upper (mouth, oropharynx, &/or larynx- burn eschar & mechanical obstruction can
occur) – edema can be massive & fast & lower airway (caused by breathing in smoke or fumes)
o These injuries major predictor of mortality
❖ Rapid assessment crucial
Symptoms of airway burns:
• Singed nasal hair
• Hoarseness
• Sooty sputum
• Hx of burned in enclosed space
• Burns around face, chest & neck
CLASSIFICATION OF BURN DEPTH
First degree burn (superficial)
• affects the epidermis, causing erythema and pain
• area is reddened & blanches with pressure
• no edema present
• have the least damage because epidermis is only part of skin that is injured
• are usually caused by prolonged exposure to low intensity heat (eg. sunburn or short flash)
• redness with mild edema and pain
• peeling of dead skin (desquamation) occurs for 2-3 days after the burn
• heal within 7 to 10 days without scarring
Second degree burn (partial thickness)
• affects both dermis & epidermis
• involves entire epidermis & varying depths of dermis
• superficial partial thickness wounds caused by heat injury to upper 3rd of
dermis leaving a good blood supply
• wounds are red, moist & blanch when pressure applied
• heat destroyed epidermis will blister that will increase in size as cell &
protein breakdown occurs
• increases pain sensation since nerve endings are now exposed
• any stimulation (touch or temp.) causes intense pain
• can heal in 10 to 21 days with no scar
Deep Partial thickness
• extends deeper into the skin dermis, and few healthy cells remain
Burns Shock Overview: Types, Classification, and Management
, Burns Shock Overview: Types, Classification, and Management
• blister formation does not occur because dead tissue layer is so thick & sticks
to underlying viable dermis that it does not readily lift off surface
• pain is present to a lesser degree
Third degree burn (full thickness)
• occurs with destruction of entire epidermis & dermis leaving no residual
epidermal cells to repopulate
• does not re-epithelialize and whatever area of the wound is not closed by
wound
contraction will require grafting
• hard dry, leathery eschar (burn, crust) that forms from coagulated particles
of the destroyed dermis
• eschar must slough off or be removed healing can occur
• edema is pronounced under the eschar in a full-thickness
wound
• escharotomies (incision through eschar) or fasciotomies
(incision through eschar & fascia) may
be needed to relieve pressure & allow normal blood flow &
breathing
Deep full thickness (4th degree)
• extend beyond skin into underlying fascia & tissues
• damage to muscle, bone, and tendons and leave them exposed
• occur with flame, electrical and chemical burns
• wound is blacken, depressed & sensation is COMPLETELY absent
• All full thickness wounds need early excision and grafting
• grafting decreases pain and length of stay and accelerates recovery
• amputation may be needed when an extremity is involved
Vascular Changes in Body
– circulatory disruption occurs at the burn site immediately after a burn
– blood flow decreases or ceases
Emergent phase
Management- primary goal is to prevent
Begins at time of injury, 36-48 hours
hypovolemia causing edema & shock
Begins when pt. hemodynamically AcuMteanpahgaesme ent- goal is to prevent infection,
stable, capillary permeability restored, provide metabolic support, wound care &
diuresis has begun, 48-72 hrs restorative therapy, continues till wound closure
Repair represents final care of buRrenhabilitativMe apnhaagseement- goal is to reach maximal
function & emotional recovery (i.e. wound
injury, overlaps acute phase & beyond
healing, increase physical strength, &
hospitalization
provide emotional support
Assessment
Cardiopulmonary: Assess for maintenance & treat or prevent complications such as pneumonia that can
progress to respiratory failure & mechanical ventilation. At risk for infections and sepsis, perform interventions
from emergent phase for these problems
Burns Shock Overview: Types, Classification, and Management
Types of Burns
➢ Thermal Injury from fire, flash, or contact with hot objects
o Most common type of burn injury
o Extent depends on temp. & length of contact
➢ Chemical Injury from contact with acids, alkali, or organic
compounds
o Alkali burns is more difficult because they adhere to
skin
o Many of these chemicals are readily available in
household products
➢ Electrical Injury from heat generated from electrical current
o Tissue density offers resistance, i.e. bones & fat
o Current that passes thru vital organs
➢ Smoke/inhalation Injury from hot air or noxious fumes
o Metabolic asphyxiation (carboxyhemoglobin concentration > 20% interferes with oxygen
delivery), upper (mouth, oropharynx, &/or larynx- burn eschar & mechanical obstruction can
occur) – edema can be massive & fast & lower airway (caused by breathing in smoke or fumes)
o These injuries major predictor of mortality
❖ Rapid assessment crucial
Symptoms of airway burns:
• Singed nasal hair
• Hoarseness
• Sooty sputum
• Hx of burned in enclosed space
• Burns around face, chest & neck
CLASSIFICATION OF BURN DEPTH
First degree burn (superficial)
• affects the epidermis, causing erythema and pain
• area is reddened & blanches with pressure
• no edema present
• have the least damage because epidermis is only part of skin that is injured
• are usually caused by prolonged exposure to low intensity heat (eg. sunburn or short flash)
• redness with mild edema and pain
• peeling of dead skin (desquamation) occurs for 2-3 days after the burn
• heal within 7 to 10 days without scarring
Second degree burn (partial thickness)
• affects both dermis & epidermis
• involves entire epidermis & varying depths of dermis
• superficial partial thickness wounds caused by heat injury to upper 3rd of
dermis leaving a good blood supply
• wounds are red, moist & blanch when pressure applied
• heat destroyed epidermis will blister that will increase in size as cell &
protein breakdown occurs
• increases pain sensation since nerve endings are now exposed
• any stimulation (touch or temp.) causes intense pain
• can heal in 10 to 21 days with no scar
Deep Partial thickness
• extends deeper into the skin dermis, and few healthy cells remain
Burns Shock Overview: Types, Classification, and Management
, Burns Shock Overview: Types, Classification, and Management
• blister formation does not occur because dead tissue layer is so thick & sticks
to underlying viable dermis that it does not readily lift off surface
• pain is present to a lesser degree
Third degree burn (full thickness)
• occurs with destruction of entire epidermis & dermis leaving no residual
epidermal cells to repopulate
• does not re-epithelialize and whatever area of the wound is not closed by
wound
contraction will require grafting
• hard dry, leathery eschar (burn, crust) that forms from coagulated particles
of the destroyed dermis
• eschar must slough off or be removed healing can occur
• edema is pronounced under the eschar in a full-thickness
wound
• escharotomies (incision through eschar) or fasciotomies
(incision through eschar & fascia) may
be needed to relieve pressure & allow normal blood flow &
breathing
Deep full thickness (4th degree)
• extend beyond skin into underlying fascia & tissues
• damage to muscle, bone, and tendons and leave them exposed
• occur with flame, electrical and chemical burns
• wound is blacken, depressed & sensation is COMPLETELY absent
• All full thickness wounds need early excision and grafting
• grafting decreases pain and length of stay and accelerates recovery
• amputation may be needed when an extremity is involved
Vascular Changes in Body
– circulatory disruption occurs at the burn site immediately after a burn
– blood flow decreases or ceases
Emergent phase
Management- primary goal is to prevent
Begins at time of injury, 36-48 hours
hypovolemia causing edema & shock
Begins when pt. hemodynamically AcuMteanpahgaesme ent- goal is to prevent infection,
stable, capillary permeability restored, provide metabolic support, wound care &
diuresis has begun, 48-72 hrs restorative therapy, continues till wound closure
Repair represents final care of buRrenhabilitativMe apnhaagseement- goal is to reach maximal
function & emotional recovery (i.e. wound
injury, overlaps acute phase & beyond
healing, increase physical strength, &
hospitalization
provide emotional support
Assessment
Cardiopulmonary: Assess for maintenance & treat or prevent complications such as pneumonia that can
progress to respiratory failure & mechanical ventilation. At risk for infections and sepsis, perform interventions
from emergent phase for these problems
Burns Shock Overview: Types, Classification, and Management
