‫بنام خداوند جان آفرین‬
‫دکتر بهشتی متخصص بیماریهای پوست و مو‬
‫عضو هیئت علمی دانشگاه‬
‫سوختگی پوست‬
‫تعریف‪ :‬سوختگی عبارتست از آسیب پوستی ناشی از یک‬
‫انرژی پاتولو ژیک که این انرژی می تواند ناشی از حرارت یا الکتریسیته‬
‫یا مواد شیمیایی و یا اشعه آفتاب ورادیاسیون باشد‪.‬‬
‫سوختگی پوست‬
‫پوست اولین عضو در اغلب سوختگیهاست‪.‬‬
‫وسعت زیاد پوست بدن و سوختگی آن میتواند آسیب های جدی برای‬
‫بیمار ایجاد کند‪.‬‬
‫مساحت پوست‪:‬‬
‫‪0.25‬متر مربع در بچه ها و‪1.8‬متر مربع در بزرگساالن‪.‬‬
‫وظائف پوست‬
‫‪)1‬اولین سد دفاعی بدن‬
‫‪)2‬کنترل دمای بدن‬
‫‪)3‬عضو حسی‬
‫‪)4‬تولید ویتامین‬
‫‪)5‬زیبائی ظاهری ونقش آن در مسائل جنسی‬
‫‪)6‬نقش پوست در ایمنی بدن‬
‫ِ‬
‫شیوع‬
‫با توجه به متفاوت بودن شدت سوختگی و عدم مراجعه بسیاری از موارد‬
‫سوختگی های سطحی به مراکز بیمارستانی آمار دقیق در دست نیست‪.‬‬
‫در امریکا در سال ‪ 2‬میلیون نفر مبتال به سوختگی به مراکز درمانی‬
‫مراجعه می کنند‪.‬‬
‫در انگلستان در سال ‪ 5000-6000‬مورد به علت سوختگی شدیدتر در‬
‫بیمارستان بستری می شوند‪.‬‬
‫شیوع‬
‫در امریکا ‪ 14000‬مورد مرگ در سال به علت سوختگی گزارش میشود‪.‬‬
‫علت مرگ اغلب ناشی از آسیب های ریوی ناشی از استنشاق دوده میباشد‪.‬‬
‫‪%50‬علت مرگ ناشی از سوختگی آتش سوزی منازل گزارش میشود‪.‬‬
‫تعینی شدت سوختگی‬
‫‪)1‬وسعت سوختگی‬
‫‪)2‬عمق سوختگی‬
‫‪)3‬سن بیمار‬
‫‪)4‬وضعیت جسمانی قبلی بیمار‬
‫‪)5‬محل سوختگی‬
‫‪)6‬شدت جراحات و صدمات همراه با سوختگی در بیمار‬
‫ارزایبی بیمار‬
‫‪Objective:‬‬
‫‪)1‬تعیین علت سوختگی‬
‫‪(2‬زمان سوختگی‬
‫‪)3‬مدت زمان سوختگی‬
‫‪)4‬نوع ماده ای که منجر به سوختگی شده است‬
‫سوختگی‬
‫عمق‬
‫تعیین عمق سوختگی در مراحل اولیه سوختگی مشکل است‪.‬‬
‫گاه تا مرحله ترمیم سوختگی نمیتوان عمق سوختگی را مشخص کرد‬
‫دقیق ترین راه تشخیص بیوپسی پوستی است‬
‫‪Wound excision until fine punctate bleeding occurs‬‬
Depth of burn
Partial thickness burn
involves epiderm
Deep partial thickness
involves derm
Full thickness
involves all of ski
‫‪Partial thickness superficial‬‬
‫سوختگی محدود به اپیدرم است‬
‫معموال بهبودی سریع و خودبخودی اتفاق میافتد‬
Partial thickness burns
Sunburn is a very superficial burn.
Expect blistering and peeling in a few days.
Maintain hydration orally.
Heals in 3-6 days- generally no scaring
Topical creams provide relief.
No need for antibiotics
•
•
•
•
•
•
‫‪Partial thickness deep‬‬
‫سوختگی در تمام اپیدرم و قسمت هایی از درم است‬
‫بهبودی خودبخودی امکان پذیر است‬
‫در برخی موارد میتواند منجر به تشکیل اسکار شود‬
Mixed partial and full thickness
Central yellow area might be full thickness. 
Outer edges are probably partial thickness. 
Initial management is the same. 
Later will need skin grafts for the full thickness areas. 
Deeper partial thickness
Blisters are typical of partial thickness burns.
Don’t be in a hurry to break the blisters.
Heals in 14-21 days
Blisters provide biologic dressing and comfort.
Once blisters break, red raw surface will be very painful.
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



‫‪Full thickness‬‬
‫شامل تخریب اپیدرم و درم و هیپودرم و گاها عضالت و استخوان هاست‬
‫ترمیم بافت های از دست رفته مشکل است‬
‫برای ترمیم پوست نیاز به گرافت پوست می باشد‬
Full thickness burn
Yellow, “leathery” appearance; or charred
Often have no sensation (nerve endings destroyed)
Outer edges might be partial thickness.
Initial management same as partial thickness.
Later will need skin grafts.





‫‪Subjective:‬‬
‫‪)1‬مشکالت وبیماری های قبلی بیمار‬
‫‪)2‬سایز و عمق سوختگی‬
‫‪)3‬سن بیمار‬
‫‪)4‬ناحیه ای از بدن که دچار سوختگی شده است‬
‫‪)5‬علت سوختگی‬
Estimate the size of the burn
The patient’s own palm is about 1% of his body surface 
area.
“Rule of Nines” 
Rule of 9s
ABA
Burn size in small children
The head accounts for about 18% (instead of 9%). 
The legs account for about 13% (instead of 18%). 
Minor burn
15 percent TBSA or less in adults
10 percent TBSA or less in children and older adults 
2 percent TBSA or less full-thickness burn in children 
or adults without cosmetic or functional risk to eyes,
ear, face, hands, feet, or perineum
The two commonly used methods of assessing
TBSA:
in adults are the Lund-Browder chart and "Rule of
Nines,“
whereas in children, the Lund-Browder chart 
is the recommended method because it takes into
account the relative percentage of body surface area
affected by growth.
Moderate burn
15 to 25 percent TBSA in adults with less than 10 percent 
full-thickness burn
10 to 20 percent TBSA partial-thickness burn in children 
under 10 and adults over 40 years of age with less than 10
percent full-thickness burn
10 percent TBSA or less full-thickness burn in children or 
adults without cosmetic or functional risk to eyes, ears,
face, hands, feet, or perineum
Major burn
25 percent TBSA or greater 
20 percent TBSA or greater in children under 10 and adults over 40 years 
of age
10 percent TBSA or greater full-thickness burn 
All burns involving eyes, ears, face, hands, feet, or perineum that are 
likely to result in cosmetic or functional impairment
All high-voltage electrical burns 
All burn injury complicated by major trauma or inhalation injury 
All poor-risk patients with burn injury 
‫تشخیص های افرتاقی‬
‫زرد زخم‬
‫کاپینگ‬
‫گزش حشرات‬
‫نورواپتی دایبتی و ‪.......‬‬
‫درمان‬
‫اقدامات اولیه‬
‫‪)1‬باز کردن راه هوائی‬
‫‪)2‬کنترل تنفس بیمار‬
‫‪)3‬بررسی نبض وفشار خون و جریان خون بیمار‬
‫‪)4‬تسکین درد‬
Care of small burns
Clean entire limb with 
soap and water (also under nails).
Apply antibiotic cream 
(no PO or IV antibiotic).
Dress limb in position of function,
and 
elevate it.
No hurry to remove blisters unless infection occurs. 
Give pain meds as needed (PO, IM, or IV) 

Rinse daily in clean water; in shower is very practical. 
Gently wipe off with clean gauze. 
Blisters break on their own
Upper arm burn day 1
day 2
Burn “looks worse” the next day because of
blisters breaking and oozing
Blisters
In the pre-hospital setting, there is no hurry to 
remove blisters.
Leaving the blister intact initially is less painful 
and requires fewer dressing changes.
The blister will either break on its own,
or 
the fluid will be resorbed.
American Burn Assoc says send these to a
burn center
•
Partial thickness burns >10% BSA
Burns involving the face, hands, feet, genitalia, •
perineum, or major joints
•
full thickness/3 degree burn
Electrical, Chemical, and Inhalation burns •
In combat, all but the most superficial burn should be
evacuated
•
Airway?
“Flash” burns may refer to those 
that suddenly flare up,
then die down quickly.
Patients may have burnt facial 
hair and carbon on lips.
Patients with this kind of facial 
burn will probably NOT need
an artificial airway.
Give humidified oxygen while 
under close observation.
Causes of death in burn patients
Circulation:
“failure of resuscitation”
Cardiovascular collapse, or acute MI
Acute renal failure
Other end organ failure
Missed non-thermal injury
Escharotomy - indications
Circulation to distal limb is in danger 
due to swelling. Progressive loss of
sensation / motion in hand / foot.
Progressive loss of pulses in the distal
extremity by palpation or doppler.
In circumferential chest burn, patient 
might not be able to expand his chest
enough to ventilate,
and
might need escharotomy of the skin of
the chest.
Neuro status
The burn itself does not alter the level of consciousness. 
If patient is not alert, think of other causes: 
hypovolemia 
carbon monoxide 
head injury 
Don’t allow swollen eyelids to prevent you from 
examining the pupils.
Test sensation and motion in burned extremities. 
Circulation
Record vital signs.
Check distal pulses and nail beds.
Keep him warm!
Loss of skin impairs ability to retain heat and
fluids.
Being cold will cause vasoconstriction.
Monitor urine output (in larger burns, insert 
Foley catheter for hourly urine output).
30/50cc/hr
Monitor at least HCT and urine specific gravity.
When available, monitor electrolytes.
Amount of edema can be 
immense (even without facial
burns)
Edema Formation
Depression of mental status can 
worsen problem
Edema peaks at 12 to 24 hours
Pediatric patients even more 
concerning
Upper arm burn
121
Blisters show probable partial thickness burn.
Area without blister might be deeper partial 
thickness.
Arm burn 4 days
Arm burn 7 days – note the exudate
After debridement
Debride blister using simple instruments
Causes of death in burn patients
Airway 
Facial edema, and/or airway edema
Breathing
Toxic inhalation (CO, +/- CN)
Respiratory failure due to smoke injury or ARDS
Circumferential burn
Burn requiring escharotomy
Electrical burn
Chemical burn
Face 
Mouth
Neck
Hands and feet
Genitalia
Genitalia
Shower daily, rinse off old cream, apply new cream. 
Insert Foley catheter if unable to urinate due to swelling.
Circumferential burn
Limb is burned all the way around.
Soft tissues under the skin always swell with 
burns
(due to capillary leak of fluids in first day or so).
There is a loss of skin expansion due to the loss of 
turgor/elasticity in burned tissue
Pressure inside limb gradually increases.
Eventually, pressure inside limb exceeds arterial 
pressure.
This requires escharotomy to relieve the pressure.
Hands and feet
Fingers might develop
contractures if active
measures are not taken to
prevent them.
Hands and feet
Allow use of the hands in dressings by 
day.
Splint in functional position by night.
Keep elevated to reduce swelling.
Face
Be VERY concerned for the airway!!
Eyelids, lips and ears often swell alarmingly.
In fact, they look even worse the next day.
But they will start to improve daily after that.
Cleanse eyes with warm water or saline.
Apply antibiotic ointment or liquid tears until
lids are no longer swollen shut.
Bacitracin cream/ointment will serve
‫سوختگی انشی از مواد اسیدی‬
Phosphorus
Particles of phosphorus 
must be removed from
under the skin.
Pick them off with 
forceps.
Must apply wet dressing 
to prevent re-igniting.
Electrical burn
Outer skin might not appear 
too bad.
But heat was conducted 
along the bone.
Causes the most damage. 
Burns from inside out. 
Usually requires fasciotomy 
QUESTIONS?
SUMMARY
Describe how to estimate the body surface 
area of burn.
Describe how to calculate initial fluid 
requirements in a patient with a large burn.
Describe intial management of a patient with 
a large burn.
Discuss indications and complications of 
escharotomy.