BURNS

BURN
Is a form of traumatic injury caused by

thermal, electrical, chemical or radioactive agents.

Are caused by transfer of energy from a heat

source to the body

Cell destruction of the layers of the skin and

the resultant depletion of fluids and electrolytes.

TYPES OF BURNS
A. Thermal caused by exposure to flames, B. C.

D.

hot liquids, steam or hot objects Chemical caused by tissue contact with strong acids, alkalis or organic compounds Electrical caused by heat generated by an electrical energy as it passes through the body; it results in internal tissue damage Radiation caused by exposure to ultraviolet, x-rays or a radioactive source

Signs and Symptoms

Blisters Charred mouth, burned lips, burns on the neck, head or

face Wheezing Change in voice Difficulty in breathing/ coughing Singed nose hairs and eyebrows Dark carbon-stained mucus Edema Pain Peeling skin or red skin Signs of shock White or charred skin

DIAGNOSTIC TESTS

1. URINALYSIS - myoglubinuria, hemoglobinuria 2. ABG - hypoxia 3. FIBER-OPTIC BRONCHOSCOPY - inhalation injury 4. CBC - elevated WBC 5. BUN - elevated 6. CREATININE - elevated

SUPERFICIAL THICKNESS (1st Burn)

BURN DEPTH

PARTIAL THICKNESS (2nd Burn)

FULL DEEP FULLTHICKNESS THICKNESS (3rd Burn) (4th Burn) Subcutaneous and Muscles and fascia bone Edema

Epidermis

Epidermis and dermis Blister

No edema With Eschar Most painful Little or no pain Painless Minimal pain Heals weeks to months Heals weeks to Heals 3 to 7 days Heals 2 to 4 weeks months

Erythema

SUPERFICIAL THICKNESS (1st Burn) Skin grafts not required

PARTIAL THICKNESS (2nd Burn)

FULL DEEP FULLTHICKNESS THICKNESS (3rd Burn) (4th Burn) Grafts required

Grafts may be Grafts required used if healing is prolonged Ex. - scald

Ex. - sunburn

Ex. Burn from a Ex. Burn from a flame and electric flame and electric current current

METHODS TO ESTIMATE EXTENT OF BURN INJURY

I.
- an estimation of the total body surface area (BSA) burned by assigning percentages in multiples of nine to major body surfaces Adult: - head and neck: 9% - anterior trunk: 18% - posterior trunk: 18% - anterior arm: 9% - posterior arm: 9% - anterior legs: 18% - posterior legs: 18% - perineum: 1%

RULES OF NINES

II.

LUND AND BROWDER METHOD

- a more precise method of estimating the extent of the burn; takes into account that the percentage of the surface area represented by various anatomic parts (head and legs) changes with growth.

III.

PALM METHOD

- used to estimate percentage of scattered burns, using the size of the patients palm (about 1% of body surface area) to assess the extent of burn injury

FLUID AND ELECTROLYTE CHANGES

EMERGENT
> 24 48 hours > Fluid shift:
Vascular to Interstitial

ACUTE
> 2 5 days > Fluid shift:
Interstitial to Vascular

> blood volume > Hemoconcentration Hct. GFR oliguria > O2 Metabolic Acidosis > Na, K arrhythmia

> blood volume > Hemodilution Hct. GFR - diuresis > O2 Metabolic Acidosis > Na, K

R E H A B I L I T A T I O N

REHABILITATION
Tissue Repair Prone to infection

- Prevent and control infection a. Reverse Isolation b. Prophylaxis Tetanus Toxoid Maintain patent airway esp. burns on the neck, face, chest laryngeal edema Give pain medications Narcotics-Analgesics a. Demerol b. Morphine Sulfate S/E : Respiratory Depression Restore and maintain adequate fluid volume

 Monitor urine output

- 30 to 60 ml/hour Maintain adequate nutrition - 1st 24 hours NPO Prone to Paralytic Ileus Curlings Ulcer * To prevent, give H2 Antagonist. a. Ranitidine b. Cimetidine c. Famotidine (+) Flatus High caloric, CHON, Vitamin

 Monitor hematocrit

- decreasing Monitor CVP - to determine if hypervolemic/hypovolemic Hydrotherapy (Hubbard tank) - tubbing, tanking or showering > is the bathing of the burn patient in a tub of water or with a water shower to facilitate cleansing and debridement of the burned area Advantage: fast healing and easy dressing Disadvantage: evaporative fluid loss (chills)

> Debridement

MECHANICAL

ENZYMATIC

SURGICAL

> Use of scissors > Application of > Excision of eschar and and forceps to lift prepared proteolytic coverage of wound and trim away loose and fibrinolytic A. TANGENTIAL eschar topical enzymes that - Shaving of thin layers digest necrotic tissue, of eschar until viable which facilitates tissue eschar removal B. FASCIAL
- Used for deep burns and removal of burn tissue and underlying fat down to the fascia

> Antibiotic :
SILVER SULFADIAZENE
Description: - a white, crystalline, highly insoluble compound in an opaque, odorless, water-miscible cream - exerts antimicrobial effect at the level of cell membrane and cell wall against gram-negative and gram-positive bacteria and yeast

> Assist for SKIN GRAFTING * In full thickness burn: immobilize the area and never touch to prevent disruption of granulation tissue 1. Autografts grafts done with tissue transplanted from the patients own skin. 2. Allografts involve the transplant of tissue from one individual of the same species; these grafts are also called Allogenic or Homografts. 3. Xenografts or Heterografts - involve the transfer of tissue from another species.

> Assist in Physical Therapy

1. Individualized program for splinting, positioning and activities of daily living. 2. Perform range of motion exercises. 3. Ambulate the client.

TRIAGE CRITERIA FOR DETERMINING WHEN IT IS ADVISABLE TO TRANSFER PATIENT TO A BURN CENTER
1. Burned area second degree and third degree (age <10 or >50) : 10% 2. Burned area second degree and third degree (age >10 or <50) : 20% 3. Burned area third degree : 5% at any age 4. Chemical burn 5. Electrical injury 6. Burn of face, hands, feet or perineum 7. Burn accompanied by airway or inhalation injury

POTENTIAL COMPLICATIONS
1. RESPIRATORY FAILURE S/Sx : increasing dyspnea stridor changes in respiratory pattern cerebral hypoxia 2. DISTRIBUTIVE SHOCK S/Sx : urine output cardiac output blood pressure increasing pulse progressive edema

3.

ACUTE RENAL FAILURE S/Sx : abnormal urine output BUN Creatinine level 4. COMPARTMENT SYNDROME S/Sx : extremity pain capillary refill absence of sensation loss of peripheral pulses 5. PARALYTIC ILEUS S/Sx : absence of bowel sounds 6. CURLINGS ULCER