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  • 1. BURN INJURYBURN INJURY Burns are wounds produced by variousBurns are wounds produced by various kinds of agents that cause cutaneous injurykinds of agents that cause cutaneous injury and destruction of underlying tissue.and destruction of underlying tissue.
  • 3. BURN CLASSIFICATION BY DEPTHBURN CLASSIFICATION BY DEPTH SuperficialSuperficial Partial-ThicknessPartial-Thickness – Partial-thickness superficialPartial-thickness superficial – Partial-thickness deepPartial-thickness deep Full-ThicknessFull-Thickness Deep Full-ThicknessDeep Full-Thickness
  • 4. BURN CLASSIFICATION BY EXTENTBURN CLASSIFICATION BY EXTENT Rule of NinesRule of Nines Re-evaluate 2-3 daysRe-evaluate 2-3 days post burnpost burn Burns of face, handsBurns of face, hands or feetor feet Burns complicated byBurns complicated by fractures, respiratoryfractures, respiratory tract injury or majortract injury or major soft tissue injurysoft tissue injury
  • 5. PATHOPHYSIOLOGY OF BURNS Emergent Phase - First 48 hrs. Post Burn Plasma-to-Interstitial Fluid ShiftPlasma-to-Interstitial Fluid Shift Generalized DehydrationGeneralized Dehydration OliguriaOliguria HyperkalemiaHyperkalemia HyponatremiaHyponatremia Metabolic AcidosisMetabolic Acidosis HemoconcentrationHemoconcentration Water LossWater Loss
  • 6. PATHOPHYSIOLOGY OF BURNS Fluid Remobilization Phase Starts 48 hrs. Post Burn - Lasts 2-3 days Interstitial Fluid-to-Plasma ShiftInterstitial Fluid-to-Plasma Shift HemodilutionHemodilution Increased Urinary OutputIncreased Urinary Output HyponatremiaHyponatremia Risk for Pulmonary EdemaRisk for Pulmonary Edema
  • 7. PATHOPHYSIOLOGY OF BURNSPATHOPHYSIOLOGY OF BURNS Rehabilitative PhaseRehabilitative Phase Starts 4-5 days Post BurnStarts 4-5 days Post Burn HypokalemiaHypokalemia Negative Nitrogen BalanceNegative Nitrogen Balance AnemiaAnemia HypocalcemiaHypocalcemia
  • 8. INITIAL PATIENT ASSESSMENTINITIAL PATIENT ASSESSMENT When did burn occur?When did burn occur? Nature of burningNature of burning agent?agent? Length of exposure?Length of exposure? Prior Medications?Prior Medications? Was burn sustained inWas burn sustained in an enclosed area?an enclosed area?
  • 9. INITIAL PATIENT ASSESSMENT (Continued) Any pre-existing illnesses? What is normal pre- burn height and weight? Is pain present? Any drug/food allergies? Any other injuries?
  • 10. INITIAL BURN MANAGEMENTINITIAL BURN MANAGEMENT Establish an Open AirwayEstablish an Open Airway Support CirculationSupport Circulation Maintain Urinary OutputMaintain Urinary Output Prevent GI DistressPrevent GI Distress Administer MedicationsAdminister Medications Determine Burn Depth & ExtentDetermine Burn Depth & Extent
  • 11. ESTABLISH AN OPEN AIRWAYESTABLISH AN OPEN AIRWAY Etiology ofEtiology of Respiratory BurnsRespiratory Burns S&S of Resp BurnsS&S of Resp Burns ET Tube/TrachET Tube/Trach Monitor for ARDSMonitor for ARDS Ventilator/ABG’sVentilator/ABG’s
  • 12. SUPPORT CIRCULATIONSUPPORT CIRCULATION IV AccessIV Access Fluid ReplacementFluid Replacement Invasive CardiacInvasive Cardiac MonitoringMonitoring
  • 13. MAINTAIN URINARY OUTPUTMAINTAIN URINARY OUTPUT Foley Catheter & Hourly OutputsFoley Catheter & Hourly Outputs Increased Urinary Specific GravityIncreased Urinary Specific Gravity Urinary Output - Most Reliable Index ofUrinary Output - Most Reliable Index of Adequacy of Fluid ReplacementAdequacy of Fluid Replacement
  • 14. PREVENT GI DISTRESSPREVENT GI DISTRESS NG Tube to SuctionNG Tube to Suction IleusIleus Keep NPO InitiallyKeep NPO Initially Curling’s UlcerCurling’s Ulcer
  • 15. ADMINISTER MEDICATIONSADMINISTER MEDICATIONS IV RouteIV Route Opioid AnalgesicsOpioid Analgesics Tetanus ProphylaxisTetanus Prophylaxis Antibiotics ?Antibiotics ?
  • 16. CONTINUING CARECONTINUING CARE WOUND CARE MANAGEMENTWOUND CARE MANAGEMENT InfectionInfection DebridementDebridement EscharotomyEscharotomy HydrotherapyHydrotherapy Open MethodOpen Method Closed MethodClosed Method Topical Drug TherapyTopical Drug Therapy
  • 17. CONTINUING CARECONTINUING CARE Skin GraftingSkin Grafting PurposePurpose Homograft (Allograft)Homograft (Allograft) Heterograft (xenograft)Heterograft (xenograft) Amniotic MembranesAmniotic Membranes AutograftAutograft – STSGSTSG – Mesh GraftMesh Graft
  • 18. CONTINUING CARECONTINUING CARE Impaired Physical MobilityImpaired Physical Mobility ContracturesContractures PreventionPrevention Pressure DressingsPressure Dressings
  • 19. CONTINUING CARECONTINUING CARE NUTRITIONAL THERAPYNUTRITIONAL THERAPY Factors whichFactors which necessitate optimalnecessitate optimal nutritionnutrition – Tissue destructionTissue destruction – Tissue catabolismTissue catabolism – Increased metabolicIncreased metabolic demandsdemands – Tissue regenerationTissue regeneration – Skin graftingSkin grafting
  • 20. CONTINUING CARECONTINUING CARE NUTRITIONAL THERAPY (Cont’d)NUTRITIONAL THERAPY (Cont’d) Principles of Diet TherapyPrinciples of Diet Therapy – High Protein (150 - 400 Gm)High Protein (150 - 400 Gm) – High Calories (3500 - 5000 Cal)High Calories (3500 - 5000 Cal) – High Vitamin (1 - 2 Gm Vitamin C)High Vitamin (1 - 2 Gm Vitamin C) – High CarbohydrateHigh Carbohydrate – Normal FatNormal Fat