care of patient in burns

1. BURNS

2. DEPTH OF BURN
• According to depth of skin destruction second- and third-
degree burns are categorized in to partial-thickness burns (
epidermis and dermis) full-thickness burns ( fat , muscle and
bone)

3. EXTENTION OF A BURN
• Two commonly used guides for determining the total body
surface area affected or the extent of a burn wound are the
Lund-Browder chart and the rule of nines.

4. LOCATION OF BURN
• The severity of the burn injury is related to the location of the
burn wound. Burns to the face and neck and circumferential
burns to the chest/back may inhibit respiratory function due to
mechanical obstruction secondary to edema or leathery,
devitalized tissue (eschar) formation. These injuries also may
signal the possibility of inhalation injury and respiratory
mucosal damage.

5. PHASES OF BURN MANAGEMENT
• There are mainly three phases
• emergent (resuscitative)
• acute (wound healing)
• rehabilitative (restorative).

6. PRE-HOSPITAL CARE
• Removing the person from the source of the burn and
stopping the burning process. Rescuers must also protect
themselves from being injured.
• In the case of electrical injuries, initial management involves
removal of the patient from contact with the source of current
by a trained individual.
• Most chemical burns are best treated by brushing solid
particles off the skin, followed by thorough lavage with water.
• Small thermal burns may be covered with a clean, cool, tap
water dampened towel for the patient's comfort and protection
until definitive medical care is instituted.
• Cooling of the injured area (if small) within 1 minute helps

7. • If the thermal burn area is large, attention needs to be focused first
on airway, breathing, and circulation (the ABCs):
• Airway: check for patency, soot around nares on the tongue, singed
nasal hair, and darkened oral or nasal membranes.
• Breathing: check for adequacy of ventilation.
• Circulation: check for presence and regularity of pulses, and elevate
the burned limb above the heart to decrease pain and swelling.
• If the burn is large (i.e., >10% TBSA), it is not advisable to immerse
the burned body part in cool water since doing so might lead to
extensive heat loss. The burn should never be covered in ice as this
could cause frostbite.
• As much burned clothing as possible should be gently removed to
prevent further tissue damage. Adherent clothing should be left in
place until the patient is transferred to a hospital.
• The patient should then be wrapped in a dry, clean sheet or blanket
to prevent further contamination of the wound and to provide
warmth.

8. EMERGENT PHASE
• The emergent (resuscitative) phase is the period of time
required to resolve the immediate, life-threatening problems
resulting from the burn injury. This phase may last from the
time of the burn to 3 or more days, but it usually lasts 24 to 48
hours. The primary concern is the onset of hypovolemic shock
and edema formation. The phase ends when fluid mobilization
and diuresis begin.

9. Pathophysiology
• Fluid and Electrolyte Shifts.
• hypovolemic shock may occur by a massive shift of fluids out of the
blood vessels as a result of increased capillary permeability and can
begin as early as 20 minutes postburn.
• As the capillary walls become more permeable, water, sodium, and
later plasma proteins (especially albumin) move into interstitial
spaces and other surrounding tissue.
• The colloidal osmotic pressure decreases with progressive loss of
protein from the vascular space.
• This results in more fluid shifting out of the vascular space into the
interstitial spaces
• The net result of the fluid shift is intravascular volume depletion.
• Decreased blood pressure (BP), increased pulse rate, and other
manifestations of hypovolemic shock are clinically detectable signs.
• If not corrected, irreversible shock and death may result.

11. CLINICAL MANIFESTATIONS
• Superficial to moderate partial-thickness burns are painful.
Blisters filled with fluid and protein may occur in partial-
thickness burns. Fluid is shifted to the interstitial spaces and
third spaces.
• The patient may have signs of a dynamic ileus, such as absent
or decreased bowel sounds, as a result of the body's response
to massive trauma and potassium shifts. Shivering may occur
as a result of chilling that is caused by heat loss, anxiety, or
pain.
• The most common reason for unconsciousness is hypoxia
associated with smoke inhalation. Other possibilities include

12. COMPLICATIONS
• Cardiovascular System
• Cardiovascular system complications include
dysrhythmias and hypovolemic shock, which may
progress to irreversible shock.
• Circulation to the extremities can be severely impaired
by circumferential burns and subsequent edema
formation. These processes occlude the blood supply,
causing ischemia, paresthesias, necrosis, and
eventually gangrene.

13. • Respiratory System
• The respiratory system is especially vulnerable to two types of
injury: (1) upper airway burns that cause edema formation and
obstruction of the airway and (2) inhalation injury. Upper airway
distress may occur with or without smoke inhalation, and
airway injury at either level may occur in the absence of burn
injury to the skin.

14. • Upper Respiratory Tract Injury
• Upper respiratory tract injury results from direct heat
injury or edema formation and can lead to mechanical
airway obstruction and asphyxia.
• The edema associated with an upper respiratory tract
burn injury can be massive. Mechanical obstruction of
the airway is not limited to the patient with flame
burns to the upper airway.
• Swelling that accompanies scald burns to the face and
neck can be lethal, as can pressure from the
accumulated edema compressing the airway
externally.

15. FLUID REPLACEMENT THERAPY
• Types of fluids
• Colloids
blood
plasma and plasma expanders
electrolytes
lactated ringers
• Non – electrolytes
• D5W

16. PARKLAND/ BAXTER FORMULA
• RL: 4ML*kg BODT WT* % TBSA burned