Advanced Burn Life Support CourseGeneral Course Objectives and Describtion Dr. Aidad Abu Elsoud Alkaisi BA law, RN, BSc, MSc, PhD Specialist in Intensive Care Nursing, Anaesthetic Nursing & Nursing Education
GENERAL COURSE OBJECTIVES: • The quality of care during the first hours after a burn injury has a major impact on long-term outcome. • Yet most initial burn care is provided outside of the burn center environment.
The Advanced Burn Life Support (ABLS) Pre-Hospital Course is a course designed to provide paramedics, transport teams and emergency care personnel with the skills and information that will enable them to assess and stabilize the burn patient at the scene of an emergency in preparation for transport to the nearest appropriate emergency facility.
The course addresses: • Scene Management (medical control, • scene safety, and multiple casualties; • the Psychophysiology of Burns; • Initial Assessment and Management (general patient care and stabilization and transportation); • Burn Injury Types (inhale- don, chemical, and electrical); • Pediatric Burn Patients; and • Special Burn Situations: • pregnancy, • hypothermia, and • radiation injury.
The objectives of the course are to provide the student with the knowledge and information required to: • Identify potential danger to the pre-hospital provider, patient or bystanders at the emergency scene. • Identify the role of medical control in managing the burn patient in the pre-hospital setting.
The objectives of the course are to provide the student with the knowledge and information required to: • Determine the magnitude and severity of a burn injury. • Identify and establish priorities of emergency care in the pre-hospital setting. • Identify criteria to be used in establishing priorities of care and evacuation in multiple casualty or disaster situations. • Provide initial pre-hospital treatment and stabilization for a burn victim.
COURSE DESCRIPTION • Burn injuries occur in the home, in industry and in recreational environments. • The physiologic response to burn injury is complex. • Smoke injuries presenta challenge requiring early identification. • Threatened airway and pulmonary function demand appropriate resuscitative measures. • Chemical and electric injuries present unique challenges to the entire medical team.
Summary • The management of a seriously burned patient in the first few hours post-injury can of significantly affect the long-term outcome. • Therefore, it is important that the patient be managed properly in the early hours after injury. • All aspects of the Pre-Hospital ABI.S Course have been designed to provide pre-hospital personnel and transport team with sufficient knowledge to meet the challenges of immediate care of patients with burn injuries. • Local medical protocols should be followed and medical control consulted by all pre-hospital providers, in any burn injury.
Advanced Burn Life Support CoursePathphysiology of Burns Dr. Aidad Abu Elsoud Alkaisi BA law, RN, BSc, MSc, PhD Specialist in Intensive Care Nursing, Anaesthetic Nursing & Nursing Education
Objectives: • Upon completion of this topic, the participants did be able to: • Discuss the pathphysiology of burn injures. • describe the hemodynamic changes that occur in the patient with burn injuries. • Describe signs and symptoms of the compromised circulatory system. • Determine severity of burn injuries
Introductions • The treatment of other life- and limb - threatening injuries always takes precedence (status established in order of importance or urgency) over the treatment of the burn wound per se. • Attention is directed to the burn wound only after -saving support of other organ systems has begun. • the burn patient's outcome depends on the effective treatment and ultimate healing of the burn wound.
Furthermore , the severity of the patient's multiple-system response to injury the likelihood of complication and the ultimate outcome are all intimately linked to the extent of the burn wound and to its successful management.
II. ANATOMY AND physiology oF THE SKIN: • A. Skin structure • Skin the largest organ of the body, is composed of two layers: • Epidermis • Dermis:
1. Epidermis • The outermost layer; serves as the body's first line of defense against injury and infection. • The outer layer of the epidermis is a non-viable, hardened cell layer, which is continuously shedding. • The deeper layers of the epidermis are living cells which are constantly undergoing change leading to desquamation or shedding. تقشر أو ذرف
2. Dermis: • The dermal (deep) layer of the skin is a highly elastic structure made of connective tissue which supports nerve and is blood vessels, sweat glands, hair follicles and sebaceous glands. • The nerve endings in the dermis provide a sense of touch temperature, pressure and pain.
2. Dermis: • The blood vessels transport oxygen and nutrients to the skin and remove carbon dioxide and metabolic waste products. • The sweat glands produce a secretion which contains water and electrolytes and participates in temperature regulation. • The dermis is supported by underling subcutaneous tissue, which is a layer of fatty tissue sparsely supplied by blood vessels
B. skin Function • The skin functions to protect the underlying tissue from injures caused by temperature fluctuation, Physical impact, chemical or thermal Injuries, and infection. • l. Enhances heat loss when core body temperature rises • 2. Reduces heat loss when core body temperature falls • 3. Prevents excessive water loss that may lead to dehydration • 4. Serves as a sensory organ guarding against damage from heat or cold
II. Physiologic Impact or BURN INJURIES: • The physiologic response to burn injuries is largely determined by the depth and extent of the burn. Age is also an important factor in the severity of the burn. • factors, including associated injuries preexisting medical illness, and burns involving special areas of the body, such as the face, hands, feet, major joints or genitalia, influence treatment needs and may have an adverse influence on patient outcome.
The severity of the injury is determined by the extent of the body surface involved and the depth of the burn. • The depth of the injury is a function of the temperature and the length of exposure
A. Depth of Tissue Injury • 1. A “first-degree” burn (Surface burn) : • A first degree- burn is any injury that is limited to the epidermis. • It is frequently a result of exposure to sunlight. • These burns are typically red and hypersensitive.
2. Second dgree burn ( partial thickness burn): • A “second-degree” burn involves the epidermis and a varying depth of the dermis as result of exposure to heat from scald (means to heat a liquid) , flame or chemical it is manifested by blister formation redness and pain.
3 Third-degree Burn (full thickness burn) • A “third degree” burn is an injury that destroys both layers of the skin epidermis and dermis. • The injury may extend into the underlying subcutaneous tissues muscle, bone and adjacent structures. The skin may appear charred (having been burned so as to affect color or taste ) and leathery, or may be dry and pale. • Pains typically absent since nerve endings are destroyed .
B. Extent of the Burn • The Rule of Nines is a convenient means of estimating the extent or body surface injury the adult. • Specific nontoxic areas represent 9% or two times 9% of the total body surface (e.g.), • the head and neck = 9%, • each arm = 9%, • each, Leg = 18%. • The front and back of the trunk =18% each). • In the infant and child, these calculations vary from the adult (e.g. the infant's head represents twice the fraction of the body surface area represented by the head of the adult).
Scattered (occurring or distributed over widely spaced) burns are conveniently equated by reference to the palmer surface of the patient's hand, which represents 1% of the patient's body surface. • Calculation of the body surface area (BSA) is most difficult in the pre-hospital setting therefore, the most expedient and accurate method of reporting the patien´s condition is to inform Medical Control of the anatomical area of the burn (e.g. right hand, left leg from knee to ankle).
III. PATHOPHYSIOLOGY OF BURN EDEMA FORMATION: • In edition to cellular damage, the classic inflammatory reaction is generated by : • thermal injury, with early and rapid accumulation of fluid (edema formation) in the burn wound. • Following the burn, capillaries in the burn wound become highly permeable. • Tlis results in leakage of fluid electrolytes and proteins into the area of the wound.
In patients with large burns, edema formation accrues in unburned tissues as well. • This plasma loss into both burned and unburned issues causes hypovolemia, and is the primary cause of shock in burn patients. • At the same time edema formation can cause deceased blood flow to the extremities and/or impaired chest movement during breathing.
Fluid migration occurs early following a burn injury and continues throughout the first 24 hours postburn. • The greatest fluid shift occurs in the first eight hours following the injury
As edema formation occurs in the issues, the total blood volume is decreased and cardiac output is significantly reduced. • The magnitude and duration of the systemic responses are proportional to the extent of the body surface area (BSA) burned.
Third-degree burns result in the destruction of the entire thickness of the dermis with resulting formation of a thick, non-elastic escher. • Edema beneath circumferential eschar (is a piece of dead tissue that is cast off from the surface of the skin, particularly after a burn injury) can compromise both venous and arterial blood flow and produce neurological symptoms.
Clinical MANIFESTATIONS of Shock IN Burn injuries. • Signs and symptoms of deceased tissue perfusion, or shock are viable in the burn patient. • A. Level of Consciousness • Anxiety, restlessness, and nausea are early signs of hypovolemia and/or hypoxemia.
B. Blood Pressure • Early release of substances (catecholamines) that constrict blood vessels following burn injury helps to maintain an adequate systemic blood pressure in the presence of hypovlemia. • A non-invasive blood pressure is an unreliable means of identifying shock or monitoring adequate fluid replacement in the burn patient.
C. Heart Rate • Tachycardia is not a reliable indicator of fluid volume deficit in the burn patient. • It is common for an adequately resuscitated patient to have a pulse rate of 100-120 beats per minute
D. Decreased Peripheral Perfusion • Decreased arterial blood flow can result in poor tissue perfusion in an extremity as manifested by: • 1. Cyanosis • 2. Deep tissue pain • 3. Altered sensation • 4. Progressive decrease or absence of pulses
V. SUMMARY • Initial assessment and stabilization of the burn patient requires an awareness of the pathophysiologic responses that occur with burn injuries. • The physiologic response of the patient is principally related to the extent of the burn injury, which is readily estimated by the rule of nines • the pre-hospital provider must be aware of the edema and fluid migration that occurs early following a burn injury and the subsequent need for appropriate monitoring of the burn victim.
NCPCare of the Patient During the Emergent/Resuscitative Phaseof Burn Injury Dr. Aidah Abu ElsoudAlkaissi An-Najah National University Nursing College
Nursing Diagnosis: Impaired gas exchange related to carbon monoxide poisoning, smoke inhalation, and upper airway obstruction • Goal: Maintenance of adequate tissue oxygenation
Nursing Diagnosis: Ineffective airway clearance related to edema and effects of smoke inhalation • Goal: Maintain patent airway and adequate airway clearance
Nursing Diagnosis: Fluid volume deficit related to increased capillary permeability and evaporative losses from the burn wound • Goal: Restoration of optimal fluid and electrolyte balance and perfusion of vital organs
Nursing Diagnosis: Hypothermia related to loss of skin microcirculation and open wounds • Goal: Maintenance of adequate body temperature
Nursing Diagnosis: Pain related to tissue and nerve injury and emotional impact of injury • Goal: Control of pain
Nursing Diagnosis: Anxiety related to fear and the emotional impact of burn injury • Goal: Minimization of patient’s and family’s anxiety
Collaborative Problems: Acute respiratory failure, distributive shock, acute renal failure, compartment syndrome, paralytic ileus, Curling’s ulcer • Goal: Absence of complications
Nursing Diagnosis: Fluid volume excess related to resumption of capillary integrity and fluid shift from interstitial to intravascular compartment • Goal: Maintenance of optimal fluid balance
Nursing Diagnosis: Risk for infection related to loss of skin barrier and impaired immune response • Goal: Absence of localized or systemic infection
Nursing Diagnosis: Altered nutrition, less than body requirements, related to hypermetabolism and wound healing • Goal: Attainment of anabolic nutritional status