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Burns and its management
- 3. B U R N S MANGLAM KUMARI
- 4. Burns A burn is an injury to the skin or other organic tissue primarily caused by heat or due to radiation, radioactivity, electricity, friction or contact with chemicals. (WHO)
- 5. Related Anatomy - Structure of Skin
- 6. In India……. In India, over 1 000 000 people are moderately or severely burnt every year1 – WHO 2014 The Union Health Ministry says India records: - 70 lakh burn injury cases annually of which 1.4 lakh people die of burn every year. - Around 70% of all burn injuries occur in most productive age group (15- 35 years). - Around four out of five burnt cases are women and children. - As many as 80% of cases admitted are a result of accidents at home (kitchen-related incidents).
- 7. CAUSES OF BURNS Thermal – Dry Heat, Moist Heat, Smoke and inhalation Electrical Chemical Radiation Cold Burns - Frostbite
- 11. Classification of Burns First Degree Second Degree Third Degree Fourth Degree •Depth – outer layer of the skin, epidermis •Sensation – sharp, uniform pain •Appearance – red/ pink, edematous, no blisters •Healing - +/- 7 days
- 12. Classification of Burns First Degree Second Degree Third Degree Fourth Degree •Depth – epidermis and dermis, preservation of sebaceous & sweat glands and hair follicles •Sensation – painful, sensitive to air/ temp changes •Appearance – erythematous, moist, blisters, serous exudates •Healing – 14-21 days Superficial partial thickness
- 13. Classification of Burns First Degree Second Degree Third Degree Fourth Degree •Depth – epidermis and deep dermis •Sensation – painful •Appearance – red/ white (deeper), moist, blisters, serous exudates •Healing – over 6 weeks Deep partial thickness
- 14. Classification of Burns First Degree Second Degree Third Degree Fourth Degree •Depth – extend into subcutaneous tissue •Sensation – painless to touch and pinprick, can pain to deep pressure •Appearance – black/ white, leathery, hard, dry, hair absent, no blanching •Healing – granulates, requires grafting
- 15. Classification of Burns First Degree Second Degree Third Degree Fourth Degree •Depth – extends into muscle and bone •Sensation – painless •Appearance – charred, skeletonised •Healing – requires surgery
- 17. Depending on the percentage of burns Mild (Minor): Partial thickness burns < 15% in adult or <10% in children. Full thickness burns less than 2%. Moderate: Second degree of 15-25% burns (10-20% in children). Third degree between 2-10% burns. Major (severe): Second degree burns more than 25% in adults, in children more than 20%. All third degree burns of 10% or more.
- 18. Jackson’s thermal wound theory Zone of coagulation Centre area of wound,where all tissues are damaged Zone of stasis Surrounds the coagulation areasome tissuesare damaged Zone of hyperaemia Unburned areasurrounds the stasis but it is red due to inflammation
- 19. Pathophysiology
- 20. CLINICAL MANIFESTATION OF BURNS Blisters Pain Peeling skin. Contracture Red skin. Shock (Symptoms of shock may include pale and clammy skin, weakness, bluish lips and fingernails, and a drop in alertness.) Swelling. White or charred skin. Multi organ dysfunction
- 22. ASSESSMENT OF BURNS Wallace Rule of Nines Lund and Browder Chart Palm rule
- 25. Palm Rule
- 26. CAUSES OF DEATH IN BURN Hypovolemia Shock Renal failure Pulmonary edema and ARDS Septicemia Multi organ failure
- 27. MANAGEMENT First aid management Airway clearance Fluid resuscitation Wound care Dressings can be used like Parrafine gauze Hydrocolloids Silver sulfadiazine Colloid resuscitation Reconstructive surgery
- 28. PARKLAND FORMULA Ringers Lactate 4ml/ kg body weight/ percent burn Half of the solution for first 8 hours Other half of the solution for next 16 hours
- 29. Nursing diagnosis Impaired skin integrity Risk for infection Imbalanced nutrition Impaired physical mobility Disturbed body image
- 30. References 1. http://www.who.int/violence_injury_prevention/other_injury/burns/en/ 2. http://www.who.int/mediacentre/factsheets/fs365/en/ 3. Sinha K. 10 lakh Indians suffer from burns every year. Times of India. 2012 Jun 7. Available from: http://timesofindia.indiatimes.com/india/10-lakh-Indians-suffer-from- burns-every-year/articleshow/13880849.cms 4. http://hospitals.unm.edu/burn/classification.html 5. Hettiaratchy S, Dziewulski P. ABC of Burns. British Medical Journal. Volume 328, june 2004.
Editor's Notes
- Recovery within 6 weeks as the skin has to re epithelialise from the deeply seated epithelial cells which line the hair follicles, and sweat glands