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Burn
By: Nabina Paneru
Nabina Paneru
Introduction
When the skin is exposed to excessive heat,
electricity, or corrosive chemicals, the resulting
tissue damage is known as burn.
Burn due to dry heat: Burn
Burn due to moist heat: Scald
Nabina Paneru
Causes of Burn
1. Chemical Burn (Alkali Burn more
severe than Acid Burn)
Nabina Paneru
Contd.
2. Electric Burn
Nabina Paneru
Contd.
3. Radiation burn
Nabina Paneru
Contd.
4. Scaldin (Scald burn)
Nabina Paneru
Types of injury
• The Primary Injury
• The Secondary Injury
Nabina Paneru
Zones of burn as described by Jackson
in 1947
• Zone of coagulation: Irreversible tissue loss
due to coagulation of the constituent proteins.
• Zone of stasis: Area with vascular damage and
potentially reversible injury
• Zone of hyperemia: Outmost are, similar to
superficial burn. Heals rapidly.
Nabina Paneru
Nabina Paneru
Classification of burn by depth
• First Degree Burn
• Second Degree Burn
• Third Degree Burn
• Fourth Degree Burn
Nabina Paneru
Nabina Paneru
First Degree Burn
• Affects only the epidermis
• Burn site is reed, painful, dry
and with no blisters
• Usually take 3 to 7 days to heal
without scarring
• Most common type of first
degree burn is sunburn.
Nabina Paneru
Management of First Degree Burn
• Usually heals on their own within the week.
• Treatment may depend on the severity of the burn
and may include following:
 Cold compress
Lotion or ointments
Acetaminophen or ibuprofen for pain
• Usually not bandaged
Nabina Paneru
Second Degree Burn
• Involves epidermis and part
of the dermis layer of skin.
• Site appears red, blistered,
and may be swollen and
painful.
• They heal in 7 to 21 days.
Scarring is usually confined
to changes in skin pigment.
Nabina Paneru
Management of Second Degree Burn
• Burn less than 10% of the skin’s surface can usually be
treated in outpatient basis
• Depend on the severity and may include:
 Antibiotic ointments
 Dressing change one or two times per day depending on
severity
 Daily cleaning of wound to remove dead skin or ointment
 Do not burst the blisters formed
Nabina Paneru
Third Degree Burn
• All layers of the skin is
destroyed
• Extend into the subcutaneous
tissues
• Nerve endings, sweat glands,
and hair follicles are destroyed.
• No pain
• Take over 21 days to heal
Nabina Paneru
Fourth Degree Burn
• Causes skin to be waxy white to a
charred black and tend to be painless
• Very slow healing
• All surfaces of skin including muscles,
tendon, ligament are affected
• Very fatal
• If the patient survives a fourth degree
burn then skin grafting is essential.
Nabina Paneru
Management of Fourth Degree Burn
• Early cleaning and debriding (removing dead skin and
tissue from the burned area).
• Iv fluids containing electrolytes.
• Antibiotic IV or by mouth.
• Nutritional supplements and a high-protein diet.
• Analgesics
• Skin grafting (Heterograft, Isograft, Allograft etc)
Nabina Paneru
Classification of Burn by Severity
Nabina Paneru
Calculation of Burn Percentage
• Wallace Rule of Nine
• Lund-Browder Chart: Calculation of burn in
child and infants
• Palm Method
Nabina Paneru
Wallace Rule of Nine
Head: 9%
Chest (Front): 9%
Abdomen (front): 9%
Upper/mid/low back
and buttocks: 18%
Each arm: 9%
Each leg: 18%
Groin: 1%
Nabina Paneru
Nabina Paneru
Palm Method
• The size of patient palm is approximately 1%
of the TBSA
Nabina Paneru
Management of Burn
• Emergent/ resuscitative phase (ABCDEF)
• Acute/ Intermediate phase
• Rehabilitation phase
Nabina Paneru
Emergent/ Resuscitative Phase
1. On the scene care:
 Extinguish the flame
 Cool the burn
 Remove restrictive objects
 Cover the wound
 Irrigate the chemical burn
Nabina Paneru
Contd.
2. Emergency Treatment:
 A: Airway management
 B: Breathing and ventilation
 C: circulation
 D: Disability – neurological status
 E: Environment control – keep warm
 F: Fluid Resuscitation
Nabina Paneru
Fluid Resuscitation
• Resuscitate fluid till:
- Urine output is 0.5 – 1.0 ml/kg/hr
- Systolic BP is 100mm Hg
- Pulse rate below 110 bpm
Nabina Paneru
Contd.
Parkland formula for fluid resuscitation
• RL solution: 4ml * body wt (kg) * % TBSA
• Resuscitation fluid volume for the first 24 hours
• Half of this fluid is given in first 8 hrs and other half is
given over remaining 16 hrs.
• Hartmann solution is used, but other isotonic fluid may
be used.
Nabina Paneru
Contd.
<10% TBSA: Crystalloid solution E.g. NS
10-15% TBSA: ½ colloidal + ½ crystalloid
>15% TBSA: Colloidal ( Blood, Haemocele etc)
Nabina Paneru
Acute/ Intermediate Phase
1. Extensive monitoring
2. Infection prevention
3. Wound Care
4. Wound grafting
5. Pain management
6. Nutritional Support ( High protein, high calorie diet)
Nabina Paneru
Rehabilitation phase
• Prevention of hypertropic scarring
• Prevention of contracture
• Excharotomy: A surgical incision into the
eschar ( devitalized tissue resulting from burn),
to relieve the constricting effect of the burned
tissue.
Nabina Paneru
Complications of Burn
• Failure to heal
• Contracture formation
• Compartment syndrome
• Hypertropic scar
• Sepsis
• Heart Failure
• Acute Respiratory Syndrome
Nabina Paneru
Gangrene
Gangrene is a medical term used to describe the
depth of an area of the body. It develops when
the blood supply is cut off to the affected part as
a result of various processes, such as infection,
vascular disease, or trauma.
Nabina Paneru
Nabina Paneru
Nursing Diagnosis for Patients with Burn
1. Impaired gas exchange related to upper airway
obstruction/ gaseous poisoning
2. Ineffective airway clearance related to edema
3. Fluid volume deficit related to fluid loss from wound
4. Hypothermia related to loss of skin integrity
5. Pain related to nerve injury
6. Anxiety related to impact of burn injury
Nabina Paneru

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PULMONARY EMBOLISM AND ITS MANAGEMENT.pptx
PULMONARY EMBOLISM AND ITS MANAGEMENT.pptxPULMONARY EMBOLISM AND ITS MANAGEMENT.pptx
PULMONARY EMBOLISM AND ITS MANAGEMENT.pptx
 

Burns

  • 2. Introduction When the skin is exposed to excessive heat, electricity, or corrosive chemicals, the resulting tissue damage is known as burn. Burn due to dry heat: Burn Burn due to moist heat: Scald Nabina Paneru
  • 3. Causes of Burn 1. Chemical Burn (Alkali Burn more severe than Acid Burn) Nabina Paneru
  • 6. Contd. 4. Scaldin (Scald burn) Nabina Paneru
  • 7. Types of injury • The Primary Injury • The Secondary Injury Nabina Paneru
  • 8. Zones of burn as described by Jackson in 1947 • Zone of coagulation: Irreversible tissue loss due to coagulation of the constituent proteins. • Zone of stasis: Area with vascular damage and potentially reversible injury • Zone of hyperemia: Outmost are, similar to superficial burn. Heals rapidly. Nabina Paneru
  • 10. Classification of burn by depth • First Degree Burn • Second Degree Burn • Third Degree Burn • Fourth Degree Burn Nabina Paneru
  • 12. First Degree Burn • Affects only the epidermis • Burn site is reed, painful, dry and with no blisters • Usually take 3 to 7 days to heal without scarring • Most common type of first degree burn is sunburn. Nabina Paneru
  • 13. Management of First Degree Burn • Usually heals on their own within the week. • Treatment may depend on the severity of the burn and may include following:  Cold compress Lotion or ointments Acetaminophen or ibuprofen for pain • Usually not bandaged Nabina Paneru
  • 14. Second Degree Burn • Involves epidermis and part of the dermis layer of skin. • Site appears red, blistered, and may be swollen and painful. • They heal in 7 to 21 days. Scarring is usually confined to changes in skin pigment. Nabina Paneru
  • 15. Management of Second Degree Burn • Burn less than 10% of the skin’s surface can usually be treated in outpatient basis • Depend on the severity and may include:  Antibiotic ointments  Dressing change one or two times per day depending on severity  Daily cleaning of wound to remove dead skin or ointment  Do not burst the blisters formed Nabina Paneru
  • 16. Third Degree Burn • All layers of the skin is destroyed • Extend into the subcutaneous tissues • Nerve endings, sweat glands, and hair follicles are destroyed. • No pain • Take over 21 days to heal Nabina Paneru
  • 17. Fourth Degree Burn • Causes skin to be waxy white to a charred black and tend to be painless • Very slow healing • All surfaces of skin including muscles, tendon, ligament are affected • Very fatal • If the patient survives a fourth degree burn then skin grafting is essential. Nabina Paneru
  • 18. Management of Fourth Degree Burn • Early cleaning and debriding (removing dead skin and tissue from the burned area). • Iv fluids containing electrolytes. • Antibiotic IV or by mouth. • Nutritional supplements and a high-protein diet. • Analgesics • Skin grafting (Heterograft, Isograft, Allograft etc) Nabina Paneru
  • 19. Classification of Burn by Severity Nabina Paneru
  • 20. Calculation of Burn Percentage • Wallace Rule of Nine • Lund-Browder Chart: Calculation of burn in child and infants • Palm Method Nabina Paneru
  • 21. Wallace Rule of Nine Head: 9% Chest (Front): 9% Abdomen (front): 9% Upper/mid/low back and buttocks: 18% Each arm: 9% Each leg: 18% Groin: 1% Nabina Paneru
  • 23. Palm Method • The size of patient palm is approximately 1% of the TBSA Nabina Paneru
  • 24. Management of Burn • Emergent/ resuscitative phase (ABCDEF) • Acute/ Intermediate phase • Rehabilitation phase Nabina Paneru
  • 25. Emergent/ Resuscitative Phase 1. On the scene care:  Extinguish the flame  Cool the burn  Remove restrictive objects  Cover the wound  Irrigate the chemical burn Nabina Paneru
  • 26. Contd. 2. Emergency Treatment:  A: Airway management  B: Breathing and ventilation  C: circulation  D: Disability – neurological status  E: Environment control – keep warm  F: Fluid Resuscitation Nabina Paneru
  • 27. Fluid Resuscitation • Resuscitate fluid till: - Urine output is 0.5 – 1.0 ml/kg/hr - Systolic BP is 100mm Hg - Pulse rate below 110 bpm Nabina Paneru
  • 28. Contd. Parkland formula for fluid resuscitation • RL solution: 4ml * body wt (kg) * % TBSA • Resuscitation fluid volume for the first 24 hours • Half of this fluid is given in first 8 hrs and other half is given over remaining 16 hrs. • Hartmann solution is used, but other isotonic fluid may be used. Nabina Paneru
  • 29. Contd. <10% TBSA: Crystalloid solution E.g. NS 10-15% TBSA: ½ colloidal + ½ crystalloid >15% TBSA: Colloidal ( Blood, Haemocele etc) Nabina Paneru
  • 30. Acute/ Intermediate Phase 1. Extensive monitoring 2. Infection prevention 3. Wound Care 4. Wound grafting 5. Pain management 6. Nutritional Support ( High protein, high calorie diet) Nabina Paneru
  • 31. Rehabilitation phase • Prevention of hypertropic scarring • Prevention of contracture • Excharotomy: A surgical incision into the eschar ( devitalized tissue resulting from burn), to relieve the constricting effect of the burned tissue. Nabina Paneru
  • 32. Complications of Burn • Failure to heal • Contracture formation • Compartment syndrome • Hypertropic scar • Sepsis • Heart Failure • Acute Respiratory Syndrome Nabina Paneru
  • 33. Gangrene Gangrene is a medical term used to describe the depth of an area of the body. It develops when the blood supply is cut off to the affected part as a result of various processes, such as infection, vascular disease, or trauma. Nabina Paneru
  • 35. Nursing Diagnosis for Patients with Burn 1. Impaired gas exchange related to upper airway obstruction/ gaseous poisoning 2. Ineffective airway clearance related to edema 3. Fluid volume deficit related to fluid loss from wound 4. Hypothermia related to loss of skin integrity 5. Pain related to nerve injury 6. Anxiety related to impact of burn injury Nabina Paneru