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Local and Systemic Response to Burns secondary o circumferential full thickness chest

burns caused this deteoriation
Burns that do not exceed 25% TBSA produce a •
primarily local response Pulmonary, upper airway injury results from

direct heat or edema,
Burns that exceed 25% TBSA may produce both
a local and systemic
by mechanical obstruction of the upper airway
response and are considered major burn injuries •
Cardiovascular Response Carbon monoxide, the pathophysiologic effects

due to tissue hypoxia, a result of carbon
Hypovolemia is tha immediate consequence of
monoxide combining with hemoglobin to form
fluid loss resulting in
carboxyhemoglobin, which competes with
oxygene for available hemoglobin binding sites
decreased perfusion and oxygen delivery Other Systemic Response

• Renal fxn may be altered as a result of decreased

Cardiac output decrease before any significant blood volume, destruction of
change in blood volume is red blood cells at the injury site results in free
evident hemoglobin in the urine
• •
The greatest volume of fluid leak occurs in the Significant impairment of the production and
first 24-36 hours after the burn, release of granulocytes and
peaking by 6-8 hours macrophages from bone marrow after burn
Burn Edema injury. The resulting immunosup

resion places the burn patient at high risk of
Edema maximal after 24 hours
• sepsis

It begins to resolve 1-2 days post burs and
Loss of skin also results in an ability to regulate
usually is completely resolved in 7-
body temperature. Burn
10 days post injury
• patients may therefore exhibits low body temp.
Edema increase in circumferential burns, in the early hours after injury

pressure on small blood vessels and nerve in
Two potential gastrointestinal complications may
distal extremities cause and obstruction of blood
occur, paralytic ileus and
flow and consequent ischemia
Curling ulcer, gastric distention and nausea my
Effects on Fluids and Electrolytes and Blood
lead to vomiting unless gastric
• decompression is initiated.
Evaporative fluid loss through the burn wound Emergency Medical Management

may reach 3 to 5 L or more
Transport to the nearest emergency department
over a 24 hour period until the burn surfaces are •
covered Priorities the airway, breathing, and circulation
• •
Hyponatremia is most common during the first Administer humidification, bronchodilator,
week of the acute phase, as mucolytic agents
water shifts from the interstitial to the vascular •

space Continuous + airway pressure and mechanical

• ventilation may also be required to
Immediately after burn injury, hyperkalemia achieve adequate oxygenation
(excessive potassium) results •

from massive cell destruction. Hypokelamia Asses for cervical spinal injuries

(potassium depletion) may occur Asses for burn and wound
later with fluid shifts from the interstitial to the •

vascular space Insert IVP and NGT, and suction the pt. to
Pulmonary Response prevent vomiting

Inhalation, bronchoconstriction caused by Practice aseptic technique to prevent infection

release of histamine, serotonin Asses for TBSA
and thrombaxane a powerfull vasoconstrictor, as •

well as chest constriction Fluid replacement

Asses for Acute Respiratory and Renal Failure To remove tissue contaminated by bacteria and

foreign bodies, thereby protecting
Transfer to a burn center
• the pt. from invasion of bacteria

Management of fluid loss and shock
To remove devitalized tissue or burn eschar in
Acute or Intermediate Phase of Burn Care
preparation for grafting and wound
Infection prevention
• healing

Phase occur 48-72 hours after burn injury
• Natural debridement

Asses for electrolytes imbalance, and
Mechanical debridement
gastrointestinal fxn •

Surgical debridement
Infection prevention wound cleaning, topical
antibacterial therapy, wound dressing,
wound debridement, and wound grafting

Pain management and nutritional support

Asses for airway obstruction caused by upper
airway edema

Asses for capillaries integrity

Monitor fever for the signs of infection

Monitor for infection like staphylococcus,

proteus, pseudomonas,
Escherichia coli, kliebsuella, candida
Wound Cleaning


Use tap water

Tub baths
Topical Antibacterial Therapy

Silver sulfadiazine (silvadene)

Mafenide acetate (sulfamylon)

Silver nitrate

Wound Dressing

1st topical agent is applied then covered by a
several layers of dressing

A light dressing is also applied areas for which a
splint has been designed to
conform to the body contour the proper
Dressing Change

Dressings are changed in the pt. units
hydrotherapy room, or tx approximately 20
min after and analgesics agent administered

They may also changed in the OR after the pt.
administered anesthesia
Wound Debridement