burns wounds management

1. Major Burn Management

2. Burns in Children
 Young children who have been severely
burned have a higher mortality rate
than adults.
 Shorter exposure to chemicals or
temperature can injure child sooner.
 Increased risk for for fluid and heat loss
due to larger body surface area.

3. Burns in Children
 Burns involving more that 10% of TBSA
require fluid resuscitation.
 Infants and children are at increased
risk for protein and calorie deficiency
due to decreased muscle mass and poor
eating habits.
 Scarring is more severe.

4. Burns in Children
 Immature immune system can led to
increase risk of infection.
 Delay in growth may follow extensive
burns.
Bowden text Chart 15 –28

5. Management of Burns
 Ascertain adequacy of airway, oxygen,
intubation
 Large bore needle to deliver sufficient
fluids at a rapid rate.
 Remove clothing and jewelry and
examine.

6. Alert
 The most common cause of
unconsciousness in the flame burn
patient is hypoxia due to smoke
inhalation.
 Look for ash and soot around nares.

7. Management of Burns
 Admission weight.
 Nasogastric tube to maintain gastric
decompression.
 Foley catheter for urine specimen and
monitor output.
 Evaluate burn area and determine the
extent and depth of injury.

8. Flame Burn
NG tube in place.
Catheter for fluid replacement.
Ambulation to prevent problems
associated with immobilization

9. Percentage of Areas Affected

11. Depth of Burns

12. First Degree Burn
 Involved only the epidermis and part of
the underlying skin layers.
 Area is hot, red, and painful, but
without swelling or blistering.
 Sunburn is usually a first-degree burn.

15. Second Degree Burn
 Involves the epidermis and part of the
underlying skin layers.
 Pain is severe.
 Area is pink or red and mottled.
 Area is moist and seeping, swollen, with
blisters.

17. Third Degree or Full-thickness
 Involves injury to all layers of skin.
 Destroys the nerve and blood vessels
 No pain at first
 Area may be white, yellow, black or
cherry red.
 Skin may appear dry and leathery.

19. 2nd and 3rd Degree Burns
Partial-thickness burn Full-thickness thermal burn

20. Wound Management
Dead skin and debris are
Carefully trimmed.
Gauze with ointment is applied
to burn wound.

21. Wound Management
Bowden, Dickey, Greenberg text
Children and Their Families
Hydrotherapy is used to cleanse the wound. Gauze pads are used
To debride the wound by removing exudates and previous applied
Medication.

22. Skin Grafts
Removal of split-thickness
Skin graft with dermatome.
Healed donor site

23. Compartment Syndrome
Escharotomy / fasciotomy in a severely burned arm.

24. Burn Wound Covering

25. Therapy to Prevent
Complications
Elasticized garment and
“air-plane” splints.
Physical therapy to prevent contracture
deformity.

26. Burns
Flash burn from gasoline.
Electrical burn caused by biting
of electrical cord.
Ball & Bender

27. CONCLUSION
 ABC
 HISTORY (WHEN, WHAT, WHERE)
 BURN ASSESMENT % TBSA
 DEPTH
 PAIN RELIEF
 FLUID CALCULATION & REPLACEMENT
 WOUND MANAGEMENT

28. Keep Kids Safe