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Discussions regarding burns and its management

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  1. 1. BURNS Jeus Jardin, RN
  2. 2. Let’s meet Mr. Burns <ul><li>The American Burn Association has estimated 4,500 fire and burn deaths per year </li></ul><ul><li>It is estimated that 45,000 burn injuries are admitted to hospitals per year. </li></ul><ul><li>The average size of a burn injury admitted to a burn center is 14% total body surface area </li></ul>
  3. 3. Save you own skin!!! <ul><li>The epidermis is divided into five stratum layers. The five layers are the following: stratum germinativum, stratum spinosum, stratum granulosum, stratum lucidum and stratum corneum. </li></ul>
  4. 4. Save you own skin!!! <ul><li>The blood vessels, sweat glands, hair follicles, macrophages, langerhan cells, mast cells and nerves are interspersed in the dermis. </li></ul>
  5. 5. What your skin does for you? <ul><li>Water and Electrolyte Balance </li></ul><ul><li>Infection Barrier </li></ul><ul><li>Excretion </li></ul><ul><li>Temperature Regulation </li></ul><ul><li>Sensation </li></ul><ul><li>Replication Secretion </li></ul><ul><li>Vitamin D Production </li></ul><ul><li>Cosmetic Appearance Social Interaction </li></ul>
  6. 6. Who touches your skin?
  7. 7. Classifications of the Burn Wound Hard, leather-like eschar, purple fluid, no sensation (insensate) Dermis and underlying tissue and possibly fascia , bone , or muscle Third- or Fourth-degree Full thickness Whiter appearance Deep (reticular) dermis Second-degree Partial thickness — deep Blisters, clear fluid, and pain Superficial (papillary) dermis Second-degree Partial thickness — superficial Erythema , minor pain, lack of blisters Epidermis involvement First-degree Superficial thickness Clinical Findings Depth Traditional Nomenclature Nomenclature
  8. 8. Classifications of the Burn Wound
  9. 10. Pathophysiology of Burns <ul><li>The physiological response to burn injury is dependent on the size and depth of burn injury, age of victim and co-morbid conditions. </li></ul><ul><li>Inflammatory Process </li></ul><ul><li>A burn >20-25% TBSA will result in a systemic response and generalized edema. </li></ul><ul><li>CO and tissue perfusion </li></ul>
  10. 11. The burned skin is divided into three zones: <ul><li>Zone of Coagulation </li></ul><ul><li>Zone of Stasis </li></ul><ul><li>Zone of Hyperemia </li></ul>
  11. 12. Assessment <ul><li>Primary Survey </li></ul><ul><li>A irway & C-Spine Stabilization Open the airway: </li></ul><ul><li>B reathing Verify: </li></ul><ul><li>C irculation Check: </li></ul><ul><li>D isability Quick Neuro Exam </li></ul><ul><li>E xposure/ Environment Examine: </li></ul><ul><li>Secondary Survey </li></ul><ul><li>R eassess A, B, C, D and E </li></ul><ul><li>M onitor Vital SignsHead-to-Toe assessment </li></ul><ul><li>I dentify Any Associated Injuries </li></ul><ul><li>O btain History </li></ul><ul><li>A sk Questions About EventTetanus </li></ul><ul><li>P rophylaxis and Pain Medication </li></ul>
  12. 13. Assessing Burn Severity <ul><li>Dependent on the Total Burn Surface Area or TBSA. </li></ul><ul><li>Rule of Palm </li></ul><ul><li>Rule of Nine </li></ul><ul><li>Lund and Browder Chart </li></ul><ul><li>(1 st degree burn are not to be counted: Traumaed.com) </li></ul>
  13. 14. Rule of Nine/Lund-Browder Chart
  14. 15. Burn Management <ul><li>Resuscitation Phase </li></ul><ul><li>Acute Phase </li></ul><ul><li>Sub-Acute Phase (2-4 Days) </li></ul><ul><li>Diuretic Phase </li></ul><ul><li>Rehabilitation Phase </li></ul>
  15. 16. Resuscitation Phase <ul><li>The initial phase of burn injury requires early interventions to ensure adequate fluid resuscitation. </li></ul><ul><li>The burns that have a large TBSA > 25% result in generalized permeability and a greater degree of intravascular fluid loss. </li></ul><ul><li>The goal of fluid resuscitation is early restoration of intravascular volume to ensure adequate organ and tissue perfusion. </li></ul>
  16. 17. Resuscitation Phase <ul><li>Acute Phase </li></ul><ul><li>Ringer's Lactate. </li></ul><ul><li>Half of the volume is administered over the first eight hours from time of injury and the second half is administered over the following 16 hours. </li></ul><ul><li>Use of the modified Parkland Formula </li></ul><ul><li>= 3cc x weight in kg x TBSA% </li></ul><ul><li>Sub Acute phase </li></ul><ul><li>This phase occurs usually the second day </li></ul><ul><li>D5W </li></ul>
  17. 18. Diuretic Phase <ul><li>This phase occurs usually within the fourth to fifth day post burn injury. </li></ul><ul><li>The urine out put may increase to 100cc or more an hour. </li></ul><ul><li>The fluid of choice is D51/2NS + 20 KCL. </li></ul><ul><li>Monitoring of serial electrolytes and patient weights are important in this phase. </li></ul>
  18. 19. Rehabilitation Phase <ul><li>Six to seven day's post burn injury. </li></ul><ul><li>There still may be areas of granulating tissue and regeneration requiring continuation of topical wound care. </li></ul><ul><li>The goals at this phase are oral pain management control, adequate oral nutritional intake, prevention of wound infection, prevention of graft loss, rehabilitation training/pressure garments, transition to home and educating the patient and family. </li></ul>
  19. 20. Goals of Wound Care <ul><li>1. Eliminate media for bacterial growth </li></ul><ul><li>2. Promote healing of partial-thickness wounds </li></ul><ul><li>3. Prevent conversion of burn wounds to a deeper thickness </li></ul><ul><li>4. Prepare full-thickness wounds for autografting </li></ul><ul><li>5. Promote patient comfort </li></ul><ul><li>6. Minimize scarring and contractures </li></ul>
  20. 21. The Role of the Nurse <ul><li>Patient caregiver and primary advocate, </li></ul><ul><li>Require extensive knowledge in aseptic wound care and treatments, </li></ul><ul><li>Main focus is pain control, wound care, infection monitoring, nutritional monitoring, </li></ul><ul><li>Patient and family educator </li></ul><ul><li>Prevention of any co-morbid conditions </li></ul>
  21. 22. Care for the Burnt, do not be Burned!!!! Thank You!!!!!!
  22. 23. References <ul><li>American Burn Association (2000). Burn incidence and treatment in the US. Retrieved February 10, 2002 from the World Wide Web: http:// www.amhrt.org , www.ameriburn.org </li></ul><ul><li>Greenfield, E., & McMannus, A. T. (1997). Infectious complications and prevention strategies for their control. Nursing Clinics of North America, 32(2), 297-309. </li></ul><ul><li>Nguyen, T.M., Gilpin, D.A., Meyer, N. A., & Herndon, D. N. (1996). Current treatment of severely burned patients. Annals of Surgery, 223(1), 14-25. </li></ul>