Burn lecture, burn management and burn ppt

BURN INJURIES & ITS
MANAGEMENT
Prepared by
Saeeda Tariq
1

GENERAL OVERVIEW OF SKIN
 The skin has an important role to play in the fluid and
temperature regulation of the body. If enough skin area is
injured, the ability to maintain that control can be lost. The
skin also acts as a protective barrier against the bacteria
and viruses that inhabit the world outside the body.
 The anatomy of the skin is complex, and there are many
structures within the layers of the skin. There are three
layers:
 Epidermis, the outer layer of the skin
 Dermis, made up of collagen and elastic fibers and where
nerves, blood vessels, sweat glands, and hair follicles
reside. 2

 Hypodermis or subcutaneous tissue, where larger
blood vessels and nerves are located. This is the
layer of tissue that is most important in temperature
regulation.
3

BURN
 Burn: Damage to the skin or other body parts
caused by extreme heat, flame, contact with heated
objects, or chemicals.
 Burn depth is generally categorized as first, second,
or third degree.
 The treatment of burns depends on the depth, area,
and location of the burn, as well as additional
factors, such as material that may be burned onto
or into the skin.
 Treatment options range from simply applying a
cold pack to emergency treatment.
4

BURNS
 Wounds caused by exposure to:
 1. excessive heat
 2. Chemicals
 3. fire/steam
 4. radiation
 5. electricity
 Results in 10-20 thousand deaths annually
20/10/2018 5

TYPES OF BURNS
 Thermal
exposure to flame or a hot object
 Chemical
exposure to acid, alkali or organic substances
 Electrical
result from the conversion of electrical energy into heat.
Extent of injury depends on the type of current, the pathway of
flow, local tissue resistance, and duration of contact
 Radiation
result from radiant energy being transferred to the body
resulting in production of cellular toxins
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CHEMICAL BURN ELECTRICAL BURN
20/10/2018 7

THERMAL BURN RADIATIONAL BURN
8

BURN WOUND ASSESSMENT
 Classified according to depth of injury and
extent of body surface area involved
 Burn wounds differentiated depending on
the level of dermis and subcutaneous tissue
involved
1. superficial (first-degree)
2. deep (second-degree)
3. full thickness (third and fourth degree)
20/10/2018 9

SUPERFICIAL BURNS
(FIRST DEGREE)
 Epidermal tissue only affected
 Erythema, blanching on pressure, mild swelling
no vesicles or blister initially
 Not serious unless large areas involved
 i.e. sunburn
20/10/2018 12

DEEP (SECOND DEGREE)
*Involves the epidermis and deep layer of the dermis
Fluid-filled vesicles –red, shiny, wet, severe pain
Hospitalization required if over 25% of body surface
involved
i.e flame
20/10/2018 13

FULL THICKNESS (THIRD/FOURTH
DEGREE)
 Destruction of all skin layers
 Requires immediate hospitalization
 Dry, waxy white, or hard skin, no pain
 Exposure to flames, electricity or chemicals can
cause 3rd degree burns
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CALCULATION OF BURNED BODY SURFACE
AREA
Calculation of Burned Body
Surface Area
20/10/2018 16

RULES OF NINES
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Head & Neck = 9%
Each upper extremity (Arms) = 9%
Each lower extremity (Legs) = 18%
Anterior trunk= 18%
Posterior trunk = 18%
Genitalia (perineum) = 1%

VASCULAR CHANGES RESULTING
FROM BURN INJURIES
Circulatory disruption occurs at the
burn site immediately after a burn
injury
Blood flow decreases or cease due
to occluded blood vessels
Blood vessel thrombosis may occur
causing necrosis
20/10/2018 18

FLUID SHIFT
 Occurs after initial vasoconstriction, then
dilation
 Blood vessels dilate and leak fluid into the
interstitial space
 Known as third spacing or capillary leak
syndrome
 Causes decreased blood volume and blood
pressure
 Occurs within the first 12 hours after the
burn and can continue to up to 36 hours
20/10/2018 19

FLUID IMBALANCES
 Occur as a result of fluid shift and cell
damage
 Hypovolemia
 Metabolic acidosis
 Hyperkalemia
 Hyponatremia
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FLUID REMOBILIZATION
 Occurs after 24 hours
 Capillary leak stops
 See diuretic stage where edema fluid shifts
from the interstitial spaces into the vascular
space
 Blood volume increases leading to
increased renal blood flow and diuresis
 Body weight returns to normal
 See Hypokalemia
20/10/2018 21

PHASES OF BURN INJURIES
Emergent (24-48 hrs.)
Acute (12 to 14 days)
Rehabilitative
22

EMERGENT PHASE
*Immediate problem is fluid loss, edema,
reduced blood flow (fluid and electrolyte
shifts)
 Goals:
1. secure airway
2. support circulation by fluid replacement
3. keep the client comfortable with
analgesics
4. prevent infection through wound care
5. maintain body temperature
6. provide emotional support
23

ACUTE PHASE
 The acute phase of burns is defined as a
period extending from the onset of burns
with shock to the time taken for wound
epithelialization which normally takes about
12 to 14 days, if management of burns is
adequate.
24

REHABILITATION PHASE
 Rehabilitation from a burn injury is a lengthy
process, which starts on day one and
involves a continuum of care through to scar
maturation and beyond. It involves a
dedicated multidisciplinary team of
professionals and the full participation of the
patient.
27

COMMON FLUIDS
Protenate or 5% albumin in isotonic
saline (1/2 given in first 8 hr; ½ given
in next 16 hr)
LR (Lactate Ringer) without dextrose
(1/2 given in first 8 hr; ½ given in next
16 hr)
Crystalloid (hypertonic saline) adjust to
maintain urine output at 30 mL/hr
Crystalloid only (lactated ringers)
20/10/2018 29

DRESSING THE BURN WOUND
 After burn wounds are cleaned and
debrided, topical antibiotics are reapplied to
prevent infection
 Standard wound dressings are multiple
layers of gauze applied over the topical
agents on the burn wound
 Nonsurgical management: removal of
exudates and necrotic tissue, cleaning the
area, stimulating granulation and
revascularization and applying dressings.
Debridement may be needed 30

DIET
 Initially NPO
 Begin oral fluids after bowel sounds return
 Do not give ice chips or free water lead to
electrolyte imbalance
 In general, patients get a high-protein diet that also
includes fat, plus vitamin and mineral supplements.
 Protein. Patients need a lot of protein while healing
because the body will lose protein through the burn
wounds and muscles will break down trying to
produce extra energy for the healing process. ...
 Carbohydrates. Fat.
20/10/2018 31

GOALS
 Prevent complications (contractures)
 Vital signs hourly
 Assess respiratory function
 Tetanus booster
 Anti-infective
 Analgesics
 No aspirin
 Strict surgical asepsis
 Turn q2h to prevent contractures
 Emotional support
20/10/2018 32

DEBRIDEMENT
 To allow healthy tissue to heal and to prevent more
damage or infection, burned tissue is removed in a
procedure called burn debridement. Burn debridement
can be done by several different methods. They include
surgical, chemical, mechanical removal.
 Done with forceps and curved scissor or through
hydrotherapy (application of water for treatment)
20/10/2018 33

SKIN GRAFTS
 Done during the acute phase
 Used for full-thickness and deep partial-thickness
wounds
 POST CARE OF SKIN GRAFTS
 Maintain dressing
 Use aseptic technique
 Graft should look pink if it has taken after 5 days
20/10/2018 34

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