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BURNS.ppt
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- 2. Injuries that resultfrom direct contact or exposure to any thermal, chemical, electrical or radiation source are termed as BURNS Burn injuries occur when energy from a heat source is transferred to the tissues of the body.
- 4. Thermal burn arecaused by exposure to or contact with flame, hot liquids, semi liquids or steam. a). Flame: e.g. clothing ignite (catch fire) with fire b).Flash(Spark): Explosion of combustible fuels c).Scald(injury/blister): e.g. Hot bath water Hot grease or liquids from cooking ,Steam burns, microwave food
- 6. Specific examples ofthermal burn are those sustained in residential fires, explosives, scald injuries, clothing ignition and ignition of poorly stored flame able liquid petrol
- 8. Chemical burnare result of tissue injury and destruction from necrotizing substance Chemical burns are caused by tissue contact with strong acids, alkalies or organic compounds Chemical injuries to eyes and inhalation of chemical fumes are particularly serious
- 9. Cont.. • Chemical burnsare mostly caused by acids , however alkali burns also occur • Alkali are more dangerous than acids because alkali substance are neutralized by tissue fluids Alkali adhere (stick) to tissues, causing protein hydrolic and liquefaction thus damage continues until alkali neutralized
- 10. Cont.. • Chemicals canproduce respiratory and systemic symptoms as well as skin or eyes injuries • For example when chlorine is inhaled toxic gas produce respiratory distress. • By products of burning substances e.g. carbon are toxic to the sensitive respiratory mucosa. Tissue destruction may continue for up to 72 hours after chemical injury
- 12. • Electrical injuriesresult from coagulation necrosis that is caused by intense heat generated by the electrical energy as it passes through the body. • These injuries can result from contact with exposure or faulty electrical wiring or high voltage power lines. • It can also result from direct damage to nerves and vessels causing tissues anoxia (absence of oxygen) and death • Electrical contact with voltage greater than 40 is potentially dangerous
- 14. • Radiation burnare caused by exposure to the radioactive service • These types of injuries have been associated with nuclear accidents, the use of ionizing radiation in industry. • A sun burn solar radiation from prolonged exposure to ultraviolet rays is also considered to be a type of radiation burn.
- 16. The treatment ofburn is related to the severity of burn injury. The severity of burn injury is determined by: Burn depth Burn size Burn location Age of burn victim General health of burn victim Mechanism of injury
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- 18. Burn injuries areclassified as a partial or full thickness A). Partial Thickness Partial thickness burn injuries are classified as first and second degree burns or superficial and deep burn.
- 19. Cont.. Causes of Superficial(1st deg) Burn i.Sunburn ii.Quick heat flash In superficial burn pain sensation is intact Sign and Symptoms a). Mild swelling b). Erythaemia c). Blenching on pressure
- 21. Causes of DeepBurn (2nd deg) Burn The causes of deep burns / 2nd degree are a). Flame b). Flash c). Scald d). Contact burns In deep burn the epidermis and dermis involved
- 23. Sign and Symptomsof deep burn 1. Fluid filled vesicles that are red shinny. if, vesicles are ruptured 2. Severe pain caused by nerve injury 3. Mild to moderate edema Superficial burns heal in less than 21 days and deep burns require more than 21 days Healing rates vary with burn depth and presence of infection
- 24. B). Full Thickness Fullthickness burn injuries are classified as THIRD and Fourth Degree burn Causes of burn Flame Scald Chemical Electric current
- 25. Cont… Here all skinelements and nerve endings are destroyed Clinical appearance will be: Dry Waxy White Leathery (Rubbery) Hard skin
- 26. Cont… 1. Visible thrombosesvessel 2. Insensitivity to pain and pressure because of nerve destruction 3. There will be possible involvement of muscles, tendons and bones 4. 3rd degree require auto grafting and 4th degree require auto grafting and amputation of extremity
- 28. Burn Size Extent Thesize of a burn (percentage of injured skin, excluding first degree burn) is determined by following techniques The Rule of Nine (9) The rule of nine was introduced in the late 1940 as a quick assessment tool for estimating burn size. The basis of this rule is that the body divided into anatomic sections, each of which represents 9% or a multiple of 9% of the TBSA.
- 30. Head and Neck9% Arms 9% Anterior trunk 18% Posterior trunk 18% Legs 18% Perineum 1% 100%
- 31. • The locationof burn wound has a direct relationship to the severity of the burn injury. Burn of the head, face, neck and circumferential burns of the chest are frequently associated with pulmonary complications it may inhibit respiratory functions by virtue of mechanical obstruction secondary to edema. • These injuries may also indicate the possibility of inhalation injury or respiratory mucosal damage
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- 33. Cont… • Burns ofhands, feet, joints and eyes are of concern because they make them self –care impossible. • Hands and feet are difficult to manage medically because of superficial vascular and nerve supply system • Burn involving the perinea area are prone to infection due to auto contamination by urine • The burn of the buttock and genital are susceptible to infection and may be source of emotional conflict because of the pain involved possible disfigurement.
- 35. The client’s ageaffects the severity and outcome of the burn. Mortality rate are higher for children younger than 4 years and for client older than 65 years Because of an immature immune system and generally poor host defense mechanism an infant is less able to cope with burn injuries The older adult heals more slowly and has more difficulty with rehabilitation than a child or younger adult.
- 36. Any patient withpre-existing cardiovascular, pulmonary or renal disease has poorer prognosis for recovery because of the tremendous demands placed on the body by a burn injury The patient with diabetes mellitus or peripheral vascular disease is at high risk for gangrene and poor healing , especially with foot and leg burns. Patients who concurrently sustained fractures, head injuries or other trauma has poorer prognosis for recovery from the burn injury
- 37. Mechanism of burninjury is an important factor used to determine severity. As stated earlier, in electrical injuries heat is generated as the electricity travels through the body resulting internal tissue damage. Here, the voltage, type of current, AC or DC, contact site and the duration of contact are important consideration because they affect morbidity. AC is worst than DC because it is associated with cardiopulmonary arrest, ventricular fibrillation and vertebral compression fractures
- 38. Nursing care ofminor wounds include: 1. Wound assessment and initial care of wound 2. Tetanus immunization 3. Pain management 4. Health education
- 39. Burn management canbe classified in three phases 1. Emergent phase (Resuscitation) 2. The acute phase 3. The rehabilitative phase
- 40. The emergent phasebegins at the time of injury, with the pre hospital care and concludes when capillary integrity is restored, typically at 48 to 72 hours following injury. The primary goals during the emergent phase of recovery are directed towards sustaining life through prevention of hypovolemia burn.
- 41. The intermittent /acutephase begins 48-72 hours after the burn injury In this phase continues attention is directed towards continues assessment and maintenance of respiratory and circulatory status, fluid and electrolyte balance and GI function, infection prevention, burn wound care, pain management , nutritional support are priorities in this stage of burn. Cautious administration of fluid and electrolyte continues during this phase of burn care b/c of shift in the fluid from interstitial to intravascular compartment, loss of fluid from large burn wound Blood component are administered as needed
- 42. Central venous, peripheralarterial, or pulmonary artery thermo dilution catheter may be required for monitoring venous and arterial pressure, pulmonary artery pressure and cardiac output. However, invasive lines are avoided unless essential because they provide an additional port for infection in an already greatly compromised patient. Infection progressing to septic shock is the major cause of death in patient who has survived the first few days after the a major burn The infection that begins within the burn site may spread to the blood stream
- 43. 1. The rehabilitationphase begins immediately after the burn has occurred-often extend years after injury 2. Patient increasingly focus on alternations in self image & life style that may occur 3. Wound healing, psychological support and restoring maximum functional activity remain priorities 4. Reconstructive surgery to improve body appearance and functions may be needed 5. Family members also need support and guidance in assisting the patient to return to optimal health
- 44. Impaired gas exchangerelated to carbon mono oxide poisoning, smoke inhalation and upper airway obstruction secondary to Burn Ineffective airway clearance related to edema and effect of smoke inhalation Fluid volume deficit related to increase capillary permeability & evaporative losses from the burn wound Hypothermia related to loss of skin microcirculation & open wound Pain related to tissue and nerve injury Anxiety related to fear and emotional impact of burn injury