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B U R N S

B U R N S. BURNS. wounds caused by excessive exposure to the following agents or causes: Causes of Burns: Thermal [moist or dry heat] Electrical Chemical [strong acids and strong alkali Radiation [UV, x-rays, radium, sunburns]. B U R N S. CLASSIFICATION OF BURNS

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B U R N S

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  1. B U R N S BURNS • wounds caused by excessive exposure to the following agents or causes: • Causes of Burns: • Thermal [moist or dry heat] • Electrical • Chemical [strong acids and strong alkali • Radiation [UV, x-rays, radium, sunburns]

  2. B U R N S • CLASSIFICATION OF BURNS • Superficial Partial thickness (1st degree) • Outer layer of dermis • Erythema, pain up to 48 hrs • Healing 1-2 wks [sunburn] • Deep Partial thickness (2nd degree) • Epidermis & dermis • Blisters & edema, frequently quite painful • Healing 14-21 days • Full thickness (3rd degree) • Epidermis, dermis, subcutaneous fat • Dry, pearly white or charred in appearance • Not painful • Eschar must be removed; may need grafting

  3. B U R N S • STAGES OF BURNS • 1st: Shock/Fluid Accumulation Phase • 1st 48 hrs • IVC  ISC • Generalized DHN [fluid shifting] • Hypovolemia [plasma loss],  BP,  C.O. • Hemoconcentration,  Hct [liquid blood component  ISC] • Oliguria [ renal perfusion], ADH release & aldosterone • HyperK, hypoNa • Metabolic acidosis

  4. B U R N S • STAGES OF BURNS • 2nd: Diuretic/Fluid Remobilization Phase • After 48 hrs • ISC  IVC • Hypervolemia, • Hemodilution,  Hct • Diuresis [ renal perfusion],  ADH & aldosterone secretion • HypoK, hypoNa [K moves back into the cells, Na+ still trapped in the edema fluids • Metabolic acidosis

  5. B U R N S • STAGES OF BURNS • 3rd: Recovery Phase • 5th day onwards • Hypocalcemia • Ca is lost on the exudates • Ca is utilized in the granulation tissue formation • Negative nitrogen balance • Due to stress response •  protein catabolism • Protein intake is lesser than the demand • HypoK

  6. B U R N S • ASSESSMENT • Assess extent of body surface burned • Greater morbidity & mortality for burns affecting face, hands & perineum • Assess for dyspnea, stridor, hoarseness • Assess extent of burn injury • Rule of nine – immediate appraisal • Lund-Browder chart – more accurate • Berkow’s method – based on client’s age & changes that occur in proportion of head & legs to the rest of the body as one grows

  7. B U R N S 9% Front=18% 9% 9% Back=18% 1% 18% 18% ASSESSMENT Burn Evaluation Chart

  8. B U R N S • ASSESSMENT • 3. Assess depth of burn • Major burns – 2nd degree over 30% of body • Hospitalization - eyes, face, neck, hands, perineum, genitalia • 4. Assess unique contributing factors • Age of client • Health history • Diabetes, preexisting ulcers • Tetanus immunization

  9. B U R N S • EMERGENCY MANAGEMENT • Stop the burning process • Remove patient from source of injury • Advise client to roll on the ground if clothing is in flame [STOP-DROP-ROLL] • Throw a blanket over the client to smother the flame • Remove clothing only if hot or for scald burn • Immerse affected part in cold water [10 min] • Irrigate copiuosly w/ large amount of running water w/ chemical burns [except w/ phosphorus] • Interrupt power source w/ electrical burn

  10. B U R N S • MANAGEMENT • Maintenance of adequate airway • Promoting comfort: relieve pain • Promoting fluid-electrolyte, acid-base balance • Preventing infection • Maintaining adequate nutrition • Wound care

  11. B U R N S • METHODS OF TREATING BURNS • Open method or Exposure method • Face, neck, perineum, trunk • Allowing exudate to dry in 3 days • Occlusive • Less pain, absorption of secretion, comfort, transportability, accelerated debridement • Aesthetic considerations • Semi-open method • Covering of wound w/ topical antimicrobials: • Silver sulfadiazine 1% (Flamazine) • Silver nitrate 0.5% sol’n • Mafenide acetate (sulfamylon acetate)

  12. B U R N S • BIOLOGIC DRESSING (Skin Graft) • Allograft • Skin taken from other person [cadaver] • Autograft • Same person • Heterograft • Different species • Xenograft [segment of skin from animal such as pig or dog]

  13. B U R N S • FLUID REPLACEMENT • Types of fluids: • Colloids • Blood • Plasma & plasma expanders • Electrolytes • Lactated Ringers • Non-electrolyte • D5W

  14. B U R N S • FLUID REPLACEMENT • EVAN’S Formula: • C – 1ml x % burns x kgBW • E - 1ml x % burns x kgBW • Glucose 5% for insensible loss – 2,000ml D5W • Administer sol’n 1st 24 hrs – ½ [1st 8hrs], ½ [16hrs] • BROOKE Formula: [Administer as in Evan’s] • C – 0.5ml x % burn x kgBW • E - 1.5ml x % burns x kgBW • Water – 1000ml D5W

  15. B U R N S • FLUID REPLACEMENT • MOORES BURN BUDGET: • 75 ml of plasma, 75 ml of electrolyte-cont’g fluid for q 1%TBSA plus 2000 D5W • HYPERTONIC RESUSCITATION Formula: • Hypertonic salt containing 300mEq of Na+, 100mEq of Cl-, 200mEq lactate • Administered to maintain urinary output of 30-40 ml/hr

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