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Discussions regarding burns and its management

Discussions regarding burns and its management

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  • 1. BURNS Jeus Jardin, RN
  • 2. Let’s meet Mr. Burns
    • The American Burn Association has estimated 4,500 fire and burn deaths per year
    • It is estimated that 45,000 burn injuries are admitted to hospitals per year.
    • The average size of a burn injury admitted to a burn center is 14% total body surface area
  • 3. Save you own skin!!!
    • 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.
  • 4. Save you own skin!!!
    • The blood vessels, sweat glands, hair follicles, macrophages, langerhan cells, mast cells and nerves are interspersed in the dermis.
  • 5. What your skin does for you?
    • Water and Electrolyte Balance
    • Infection Barrier
    • Excretion
    • Temperature Regulation
    • Sensation
    • Replication Secretion
    • Vitamin D Production
    • Cosmetic Appearance Social Interaction
  • 6. Who touches your skin?
  • 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. Classifications of the Burn Wound
  • 9.  
  • 10. Pathophysiology of Burns
    • The physiological response to burn injury is dependent on the size and depth of burn injury, age of victim and co-morbid conditions.
    • Inflammatory Process
    • A burn >20-25% TBSA will result in a systemic response and generalized edema.
    • CO and tissue perfusion
  • 11. The burned skin is divided into three zones:
    • Zone of Coagulation
    • Zone of Stasis
    • Zone of Hyperemia
  • 12. Assessment
    • Primary Survey
    • A irway & C-Spine Stabilization Open the airway:
    • B reathing Verify:
    • C irculation Check:
    • D isability Quick Neuro Exam
    • E xposure/ Environment Examine:
    • Secondary Survey
    • R eassess A, B, C, D and E
    • M onitor Vital SignsHead-to-Toe assessment
    • I dentify Any Associated Injuries
    • O btain History
    • A sk Questions About EventTetanus
    • P rophylaxis and Pain Medication
  • 13. Assessing Burn Severity
    • Dependent on the Total Burn Surface Area or TBSA.
    • Rule of Palm
    • Rule of Nine
    • Lund and Browder Chart
    • (1 st degree burn are not to be counted: Traumaed.com)
  • 14. Rule of Nine/Lund-Browder Chart
  • 15. Burn Management
    • Resuscitation Phase
    • Acute Phase
    • Sub-Acute Phase (2-4 Days)
    • Diuretic Phase
    • Rehabilitation Phase
  • 16. Resuscitation Phase
    • The initial phase of burn injury requires early interventions to ensure adequate fluid resuscitation.
    • The burns that have a large TBSA > 25% result in generalized permeability and a greater degree of intravascular fluid loss.
    • The goal of fluid resuscitation is early restoration of intravascular volume to ensure adequate organ and tissue perfusion.
  • 17. Resuscitation Phase
    • Acute Phase
    • Ringer's Lactate.
    • 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.
    • Use of the modified Parkland Formula
    • = 3cc x weight in kg x TBSA%
    • Sub Acute phase
    • This phase occurs usually the second day
    • D5W
  • 18. Diuretic Phase
    • This phase occurs usually within the fourth to fifth day post burn injury.
    • The urine out put may increase to 100cc or more an hour.
    • The fluid of choice is D51/2NS + 20 KCL.
    • Monitoring of serial electrolytes and patient weights are important in this phase.
  • 19. Rehabilitation Phase
    • Six to seven day's post burn injury.
    • There still may be areas of granulating tissue and regeneration requiring continuation of topical wound care.
    • 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.
  • 20. Goals of Wound Care
    • 1. Eliminate media for bacterial growth
    • 2. Promote healing of partial-thickness wounds
    • 3. Prevent conversion of burn wounds to a deeper thickness
    • 4. Prepare full-thickness wounds for autografting
    • 5. Promote patient comfort
    • 6. Minimize scarring and contractures
  • 21. The Role of the Nurse
    • Patient caregiver and primary advocate,
    • Require extensive knowledge in aseptic wound care and treatments,
    • Main focus is pain control, wound care, infection monitoring, nutritional monitoring,
    • Patient and family educator
    • Prevention of any co-morbid conditions
  • 22. Care for the Burnt, do not be Burned!!!! Thank You!!!!!!
  • 23. References
    • 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
    • Greenfield, E., & McMannus, A. T. (1997). Infectious complications and prevention strategies for their control. Nursing Clinics of North America, 32(2), 297-309.
    • 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.