This document provides information on burns, including burn classifications, pathophysiology, assessment, management, and the role of nurses in burn care. It states that an estimated 4,500 people die from fire/burn injuries annually in the US, while 45,000 suffer burn injuries severe enough to require hospitalization. The management of burns involves resuscitation to restore fluid volume, wound care to promote healing and prevent infection, pain management, nutrition support, and rehabilitation. Nurses play a key role in providing care, advocacy, education, and monitoring patients' condition and progress.

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

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.