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Burns. Mechanism of Injury. Thermal burns can be caused by flames, flash, scalds, and contact with burning substances or objects. Chemical burns can be caused from acid and alkali materials, both dry and wet.
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Mechanism of Injury Thermal burns can be caused by flames, flash, scalds, and contact with burning substances or objects. Chemical burns can be caused from acid and alkali materials, both dry and wet. Electrical burns are caused by electrical sources of AC/DC power, including lightening. Radiation burns can occur from ultraviolet or ionizing radiation.
Inhalation Injury • In burn patients, the skin is usually the first injury observed, but the potential for injury to the pulmonary system requires immediate assessment and observation. • To treat an inhalation injury: • High flow O2, open and support airway • Intubate
Pathophysiology of Burns A burn injury will cause a release of vasoactive inflammatory mediators. These mediators alter capillary permeability. The smaller the burn the more local the trauma and edema. A burn >20-25% TBSA will result in a systemic response and generalized edema. The burned skin is divided into three zones: zone of coagulation, zone of stasis and zone of hyperemia.
Assessment of Burn Mechanism of Injury, Depth, Extent, and Location The severity of a burn injury is dependent upon the total burn surface area, TBSA, the depth of the burn injury and accompanying inhalation injury. Minor factors that effect the severity of the burn injury are age of the patient, associated trauma and co-morbid conditions such as diabetes and renal failure, and the location of the burn. The Rule of Nines is a quick way to assign percentage of body surface area affected.
Resuscitation Phase • The initial phase of burn injury requires early interventions to ensure adequate fluid resuscitation. • The goal of fluid resuscitation is early restoration of intravascular volume to ensure adequate organ and tissue perfusion. • Determine fluid resuscitation volumes: Calculate 2 to 4 ml/kg × % of TBSA burned and give within the first 24 hours • Give 1/2 of the total amount in the first 8 hours postburn and the remainder over the next 16 hours
Acute Phase IVF should be a crystalloid solution-Normal Saline or Lactated Ringer’s-warmed. Urine out put is the key measurement in monitoring for adequacy of fluid intake. The output goal for an adults is 30cc/hr . Maintain normothermia. Cover burns with clean sterile dressings and dry blankets .(no application of topical agents- burn center will treat the wounds) . Insert a foley and NGT if indicated Remove all clothing and jewelry