Burns

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Burns

  1. 1. BURNS By: IRENE M. MAGBANUA, RN Professional Review Specialist
  2. 2. Scope <ul><ul><li>Prevention </li></ul></ul><ul><ul><li>Safety </li></ul></ul><ul><ul><li>Immediate Care </li></ul></ul><ul><ul><li>Assessment </li></ul></ul><ul><ul><li>Emergency Management </li></ul></ul><ul><ul><li>1 st Phase </li></ul></ul><ul><ul><li>2 nd Phase </li></ul></ul><ul><ul><li>3 rd Phase </li></ul></ul><ul><ul><li>Rehabilitation </li></ul></ul>
  3. 3. PREVENTION MAJORITY OF BURN CASES ARE DUE TO NEGLIGENCE SO HAZARD PRECAUTIONS MUST BE OBSERVED.
  4. 4. Genius effect bka makasunog ka!
  5. 5. “ di lang baga pede masunog” including your house too!
  6. 6. House on Fire
  7. 7. British Capitol in Fire, 1814
  8. 8. Washington in Flames , 1814
  9. 9. Head Injury
  10. 10. Contusion and Concussion
  11. 11. Spinal Cord Injury
  12. 12. Spinal Compression
  13. 13. Fractures
  14. 14. Bleeding
  15. 15. Inhalation Injury
  16. 16. Inhalation Injury
  17. 17. INHALATION INJURIES <ul><li>Heat Inhalation- HOT AIR OR FLAMES </li></ul><ul><li>Systemic Toxins- ENCLOSED FIRE-CO IS INHALED </li></ul><ul><li>Smoke Inhalations- FREQUENTLY HIDDEN BY MORE VISIBLE INJURIES (60-80% FATALITIES) </li></ul>
  18. 18. Indications of inhalation injury <ul><li>usually appears within 2-48 hours after the burn occurred. Indications may include: </li></ul><ul><ul><li>The patient faints </li></ul></ul><ul><ul><li>Fire or smoke present in a closed area </li></ul></ul><ul><ul><li>Evidence of respiratory distress or upper airway obstruction </li></ul></ul><ul><ul><li>Soot around the mouth or nose </li></ul></ul><ul><ul><li>Nasal hairs, eyebrows, eyelashes have been singed </li></ul></ul><ul><ul><li>Burns around the face or neck </li></ul></ul>
  19. 19. “ dami ng patay”
  20. 20. Safety <ul><li>Don’t panic </li></ul><ul><li>Drop to the floor </li></ul><ul><li>Look for the exit </li></ul><ul><li>Cover face with wet cloth </li></ul><ul><li>Immerse into cool water or running water immediately if you get burned to prevent further injury. </li></ul><ul><li>Extinguish any remaining fire by dropping and rolling onto the floor. </li></ul>
  21. 21. ASSESSMENT <ul><li>A IRWAY </li></ul><ul><li>B REATHING </li></ul><ul><li>C IRCULATION </li></ul><ul><li>D ISABILITIES </li></ul><ul><li>E XPOSE </li></ul>
  22. 22. Expose con’t <ul><li>A airway - check nose, face and neck (priority) singed and sooty hair of the nose </li></ul><ul><li>B breathing – rise and fall of chest </li></ul><ul><li>C circulation - if there is no breathing and circulation start CPR </li></ul><ul><li>D check for disability and manage accordingly </li></ul><ul><li>E expose to determine extent of injury </li></ul>
  23. 23. Expose con’t <ul><li>To check other injuries </li></ul><ul><li>Determine TBSA </li></ul><ul><li>Rule of Nines “Berker Formula” Parkland Formula (4ml x TBSA x BWkg) </li></ul><ul><li>1st 8H give ½, </li></ul><ul><li>2nd 8H give ¼ and for the </li></ul><ul><li>3rd 8H give the last part </li></ul><ul><li>Repeat ABCDE assessment </li></ul>
  24. 24. Types of Burns <ul><li>Thermal – dry flames, moist and heat </li></ul><ul><li>Mechanical – friction or abrasion </li></ul><ul><li>Chemical – acid or alkali </li></ul><ul><li>Electrical – most fatal </li></ul><ul><li>Radiation – sunlight </li></ul>
  25. 25. Classifications <ul><li>1st degree – partial thickness painful, no blisters, pink and red, epidermis </li></ul><ul><li>2nd degree – deep partial thickness painless, with blister, (+) blanch and refill epidermis and dermis </li></ul><ul><li>3rd degree – full thickness painless, leathery, fascia and muscle, F&E imbalance </li></ul><ul><li>4th degree – bones and visceral organs are affected </li></ul>
  26. 26. Layers of Skin
  27. 27. Extent of Injury
  28. 28. Epidermis only
  29. 29. All Skin Layers
  30. 30. Skin, SQ, Fascia, Muscles
  31. 31. 1 st Degree
  32. 32. 2 nd Degree
  33. 33. 3 rd Degree
  34. 34. 3 rd degree self-injury
  35. 35. 3 rd Degree
  36. 36. 4 th Degree <ul><li>Bones and visceral organs are involved </li></ul>
  37. 37. 4 th Degree
  38. 38. Sunburn, 1 st degree
  39. 39. Thermal Injury
  40. 40. Blister
  41. 41. Self-injury
  42. 42. Emergency Room <ul><li>ABCDE assessment </li></ul><ul><li>Airway and fluid resuscitation (priority) </li></ul><ul><li>Give TIG or TAT and TT </li></ul><ul><li>Prophylactic antibiotic </li></ul><ul><li>Sterile dressing for wound </li></ul>
  43. 43. Parkland Formula <ul><li>(4ml x TBSA x BWkg) </li></ul><ul><li>1st 8H give ½, </li></ul><ul><li>2nd 8H give ¼ and for the </li></ul><ul><li>3rd 8H give the last part </li></ul>
  44. 44. TBSA <ul><li>Entire trunk = A1 </li></ul><ul><li>Both upper extremities = A2 </li></ul><ul><li>Face = A3 </li></ul><ul><li>Entire back = B1 </li></ul><ul><li>Anterior left upper extremity = B2 </li></ul><ul><li>Right and left lower extremities = B3 </li></ul>
  45. 45. Parkland Formula <ul><li>A1+A2+A3 = A4 </li></ul><ul><li>Total Volume of Infusion = A5 </li></ul><ul><li>1 st 8 hours = A6 </li></ul><ul><li>2 nd 8 hours = A7 </li></ul><ul><li>3 rd 8 hours = A8 </li></ul><ul><li>B1+B2+B3 = B4 </li></ul><ul><li>Total Volume of Infusion =B5 </li></ul><ul><li>1 st 8 hours = B6 </li></ul><ul><li>2 nd 8 hours = B7 </li></ul><ul><li>3 rd 8 hours = B8 </li></ul>
  46. 46. Questions: <ul><li>Most common type of burns = A9 </li></ul><ul><li>Fatal type of burns = B9 </li></ul><ul><li>s/sx of head injury = A10 </li></ul><ul><li>s/sx of spinal cord injury = B10 </li></ul>
  47. 47. 1st Phase Fluid Accumulation IV to IT and IC <ul><li>most critical period </li></ul><ul><li>36-48H post burn, FVD or hypovolemia </li></ul><ul><li>3rd fluid shift </li></ul><ul><li>edema on the injured area (IV to IT) fatal form is circumferential edema from chest injury </li></ul>
  48. 48. 1 st Phase Con’t <ul><li>c. edema and p. edema (IV to IC) </li></ul><ul><li>hyponatremia (IV to outside from it) </li></ul><ul><li>hyperkalemia (cell injury) </li></ul>
  49. 49. 1 st Phase Con’t <ul><li> urine output to RF (dec. BV) </li></ul><ul><li>myoglobinuria destroys the kidney to RF (muscle destruction) rhabdomyolysis </li></ul><ul><li> BV -  TP -  H -  pH – Acidosis </li></ul>
  50. 50. 1 st Phase Con’t <ul><li> BV – curling’s ulcer or paralytic ileus (dec. BV), NPO, NGT lavage, TPN </li></ul><ul><li>Infection may set in (isolation) </li></ul>
  51. 51. Fluid Resuscitation
  52. 52. May progress to RF
  53. 53. Blood Monitoring
  54. 54. ETT Insertiom
  55. 55. Pulse Carbon Monoxide Oximetry
  56. 56. Arrhythmias Monitoring
  57. 57. External Defibrillator
  58. 58. “ BECAUSE OF YOU”
  59. 59. 2nd Phase Fluid Remobilization IT and IC to IV <ul><li>May last 48-60H </li></ul><ul><li>FVE (CHF) </li></ul><ul><li>Hypokalemia </li></ul><ul><li>Diuresis phase (oliguria may signifies RF) </li></ul>
  60. 60. 2 nd Phase Con’t <ul><li>Hyponatremia due to fluid loss from diuresis phase </li></ul><ul><li>Infection may set in (isolation) </li></ul><ul><li>Anemia may linger up to recovery period </li></ul><ul><li>Complications from immobility may set in (Circulo-O-electric bed) </li></ul><ul><li>Anemia may linger </li></ul>
  61. 61. “ BECAUSE OF YOU”
  62. 62. “ pakamatay ka na”
  63. 63. 3rd Phase to Recovery Period <ul><li>Infection may set in (isolation, Sulfadiazine application) </li></ul><ul><li>Healing process to scar formation and contractures </li></ul><ul><li>Surgery (Reconstructive or Plastic) STSG auto-graft </li></ul>
  64. 64. 3 rd Phase Con’t <ul><li>Debridement and Escharotomy </li></ul><ul><li>Diet: high caloric high CHON </li></ul><ul><li>Psychological Aspect: dec. self esteem, stigma, perceived body changes, isolation, depression, loss of identity these are all related to physical disfigurement. </li></ul>
  65. 65. Keloid scar (arm)
  66. 66. Scar
  67. 67. Skin Grafting
  68. 68. Old Man’s House on Fire
  69. 69. “ pinabayaan ng NANAY”
  70. 70. END
  71. 71. Short Quiz <ul><li>1. Fluid accumulation A. FVE </li></ul><ul><li>2. Fluid remobilization B. FVD </li></ul><ul><li>3. Hypokalemia C. 1 st Phase </li></ul><ul><li>4. Hyperkalemia D. 2 nd Phase </li></ul><ul><li>5. Priority during 1 st phase? A. fluid C. infection B. I&O D. all of the above </li></ul>
  72. 72. <ul><li>6. diuresis A. 1 st Phase </li></ul><ul><li>7. oliguria B. 2 nd Phase </li></ul><ul><li>8. tetany </li></ul><ul><li>9. anemia </li></ul><ul><li>10. infection </li></ul><ul><li>11. T wave elevation </li></ul><ul><li>12. T wave inversion </li></ul><ul><li>13. STSG? </li></ul><ul><li>14. type of dressing? (debridement) </li></ul><ul><li>15. diet? (recovery) </li></ul>
  73. 73. <ul><li>END OF QUIZ </li></ul>
  74. 74. SCAR <ul><li>Scar tissue forms as skin heals after an injury (such as an accident) or surgery. The amount of scarring may be determined by the size, depth, and location of the wound; the age of the person; heredity; and skin characteristics including color (pigmentation). </li></ul>
  75. 75. SURGERY <ul><li>Surgery to revise scars is done while the patient is awake, sleeping (sedated), or deep asleep and pain-free (local anesthesia or general anesthesia). </li></ul>
  76. 76. MEDICATIONS <ul><li>Medications (topical corticosteroids, anesthetic ointments, and antihistamine creams) can reduce the symptoms of itching and tenderness. </li></ul>
  77. 77. <ul><li>Scars shrink and become less noticeable as they age, therefore, immediate surgical revision is delayed until the scar lightens in color, which is usually several months or even a year after a wound has healed. </li></ul>
  78. 78. KELOID <ul><li>A keloid is an abnormal scar that is thicker, different color and texture, extends beyond the edge of the wound, and has a tendency to recur. It often creates a thick, puckered effect simulating a tumor. Keloids are removed at the point where they meet normal tissue. </li></ul>
  79. 79. <ul><li>Massive injuries (such as burns) can cause loss of a large area of skin and may form hypertrophic scars. A hypertrophic scar can cause restricted movement of muscles, joints, and tendons ( contracture ). </li></ul>
  80. 80. <ul><li>Surgical repair includes removing excessive scar tissue and a series of small incisions on both sides of the scar site, which creates V-shaped skin flaps (Z-plasty) may be used. The result is a thin, less noticeable scar because the wound closure following a Z-plasty more closely follows the natural skin folds. </li></ul>
  81. 81. GRAFTING <ul><ul><li>Skin grafting involves the taking a thin (split thickness) layer of skin from another part of the body and placing it over the injured area. Skin flap surgery involves moving an entire thickness (full thickness) of skin, fat, nerves, blood vessels, and muscle from a healthy part of the body to the injured site. </li></ul></ul>
  82. 82. <ul><ul><li>These techniques are planned when a considerable amount of skin has been lost in the original injury, when a thin scar will not heal, and when improved function (rather than aesthetic reasons) are the primary concern. Secondary procedures may later be necessary to achieve appropriate aesthetic results. </li></ul></ul>
  83. 83. First Aid for Minor Burns <ul><li>If the skin is not broken, run cool water over the burned area or soak it in a cool water (NOT ICE WATER) bath. Keep the area in the bath for five minutes. If the burn occurred in a cold environment, DO NOT apply water. A clean, cold, wet towel will also help reduce pain. </li></ul><ul><li>Burns can be extremely painful, reassure the victim and keep them calm. </li></ul>
  84. 84. <ul><li>After flushing or soaking the burn for several minutes, cover the burn with a sterile non-adhesive bandage or clean cloth. </li></ul><ul><li>Protect the burn from friction and pressure. </li></ul><ul><li>Over-the-counter pain medications may be used to help relieve pain; they may also help reduce inflammation and swelling. </li></ul><ul><li>Minor burns will usually heal without further treatment. </li></ul>
  85. 85. First Aid for Severe Burns <ul><li>DO NOT remove burnt clothing (unless it comes off easily), but do ensure that the victim is not in contact with burning or smoldering materials. </li></ul><ul><li>Make sure the victim is breathing. If breathing has stopped or the victim's airway is blocked then open the airway and if necessary begin CPR. </li></ul><ul><li>If the victim is breathing, cover the burn with a cool moist sterile bandage or clean cloth. DO NOT use a blanket or towel; a sheet is best for large burns. DO NOT apply any ointments and avoid breaking blisters. </li></ul>
  86. 86. <ul><li>If fingers or toes have been burned, separate them with dry sterile, non-adhesive dressings. </li></ul><ul><li>Elevate the burned area and protect it from pressure or friction. </li></ul><ul><li>Take steps to prevent shock. Lay the victim flat elevate the feet about 12 inches, and cover the victim with a coat or blanket. DO NOT place the victim in the shock position if a head, neck, back, or leg injury is suspected or if it makes the victim uncomfortable. </li></ul><ul><li>Continue to monitor the victim's vital signs (breathing, pulse, blood pressure). </li></ul>
  87. 87. Dont’s <ul><li>DO NOT apply ointment, butter, ice, medications, fluffy cotton dressing, adhesive bandages, cream, oil spray, or any household remedy to a burn. This can interfere with proper healing. </li></ul><ul><li>DO NOT allow the burn to become contaminated. Avoid breathing or coughing on the burned area. </li></ul><ul><li>DO NOT disturb blisters or dead skin. </li></ul>
  88. 88. <ul><li>DO NOT apply cold compresses and DO NOT immerse a severe burn in cold water. This can cause shock. </li></ul><ul><li>DO NOT place a pillow under the victim's head if there is an airway burn and they are lying down. This can close the airway. </li></ul>
  89. 89. <ul><li>THANK YOU…. </li></ul>

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