ELECTRIC BURN-NIKITA DAS

1. CLINICAL
PRESENTATION

2. DEFINITION
 An electrical injury occurs when a current passes
through the body, interfering with the function of
an internal organ or sometimes burning tissue.
 Electrical injuries (electrocution, electrical shock,
electrical burns, and electrical trauma) have
become a more common form of trauma with a
unique pathophysiology and with high mortality.

3. BASIC PHYSICS
Ohm’s Law: 𝐼 =𝑉/ 𝑅
I – current (Amps)
V – voltage (Volts)
R – resistance (Ohms)
Current = volume (or number) of electrons
flowing between 2 points per second
Voltage = the force that drives the
electrons across the potential difference
Resistance = the hindrance to flow

4. The amount and type of damage caused
to the body by electricity depend on :
Type of Current (AC or DC)
Amount of current (Amperage)
Voltage
Resistance (Ohms)
Duration of event
Route of current

5.  There are two Types of current :
Direct current (DC): is the unidirectional
flow of electric charge. Direct current is
produced by sources such as batteries .
Alternating current (AC): is the flow of
electric charge periodically reverses direction.

6.  The minimum current a human can feel
depends on the current type (AC or DC) and
frequency.
 Alternative Current (AC) is more dangerous
than Direct Current (DC) at lower amperage as
it is more likely to cause cardiac arrhythmias.

7. Alternative Current also causes
tetanic spasm of muscles of hand,
preventing the victim from
releasing his/her grasp.
Alternative current is more likely
to cause death an estimated four
to six times than Direct Current.

8. Amount of
current(mA)
Effect
1mA Barely perceptible tingle
16 Current can be grasped
and released
16-20 Muscular paralysis
20-50 Respiratory paralysis
50-100 Ventricular fibrillations
>2000 Ventricular standstill

9.  Voltage is a measure of the difference in
electrical potential between two points and is
determined by the electrical source.
 Electrical injuries are conventionally divided into
high or low voltage using 500 or 1000 V as the
most common cut point.
 The higher the voltage the more is tissue
distruction.
 No fatalities with low voltage

10. RESISTANCE (OHMS)
Tendency of a material to resist the flow of
electric current.
Specific for a given tissue, depending on its
moisture content, temperature, and other
physical properties.
 The higher the resistance of a tissue to the
flow of current, the greater the potential for
transformation of electrical energy to
thermal energy.

11.  Nerves, muscle and blood vessels, because of
their high electrolyte and water content, have a
low resistance and are good conductors.
 Bone, tendon, and fat, which all contain a large
amount of inert matrix, have a very high
resistance and tend to heat up and coagulate
rather than transmit current.
 The other tissues of the body are intermediate in
resistance (eg. dry skin)

12. DURATION OF CONTACT/EVENT
The longer the duration of contact
with high-voltage current, the greater
the electro thermal heating and
degree of tissue destruction.

13. ROUTE OF CURRENT
 The pathway that a current takes determines the
tissues at risk, the type of injury seen, and the
degree of conversion of electrical energy to heat.
 Current passing through the heart or thorax can
cause cardiac dysrhythmias and direct
myocardial damage.
 Current passing through the brain can result in
respiratory arrest, seizures, and paralysis.
 Current in proximity to the eyes can cause
cataracts.

14. The amount and type of damage caused
to the body by electricity depend on :
Type of Current (AC or DC)
Amount of current (Amperage)
Voltage
Resistance (Ohms)
Duration of event
Route of current

15. ETIOLOGY
 Children- at home with extension cords (60-
70%)
 Adult- workplace and constitute the fourth
leading cause of work-related death.
 More than 50% of the occupational
electrocutions result from power line contact,
and 25% result from electrical tools or
machines.
 Male-to-female ratio is 9:1

16. SPECIFIC CAUSES OF ELECTRICAL
INJURIES (CLASSIFICATION)
1.Low
voltage
injuries
2.High
voltage
injuries
3.Lightning
injuries
4.Other
electrical
injuries

17. LOW-VOLTAGE INJURIES( LOW-TENSION
INJURIES)
Caused by voltage less than 1000 V.
Includes most injuries caused by
household current;
The child who bites into the cord
producing lip, face and tongue injuries
as well as occupational injuries
resulting from the use of small power
tools.

18. LOW-VOLTAGE INJURY: REPRESENTATIVE ELECTRIC FIELD
LINES AND ISOPOTENTIAL LINES ESTABLISHED IN THE LOWER
FACE DURING ORAL CONTACT WITH A HOME POWER CORD.

19. HIGH-VOLTAGE INJURIES
/HIGH TENSION INJURIES
Result of exposure to 1000 V or more.
These injuries are often the result of
occupational exposure to outside power
lines .
Commonly occur when a conductive
object touches an overhead high voltage
power line.

20. HIGH-VOLTAGE INJURY: APPROXIMATE ELECTRIC
FIELD LINES WHEN CURRENT PATH EXTENDS FROM
HAND TO HAND.

22. LIGHTNING INJURIES
 Involve voltages higher than those of the other
injuries.
 Involves energy with high voltage and high
amperage but extremely short duration.
 Lightning is usually a unidirectional massive
current impulse.
 The largest flow of current tends to jump to the
ground before much of it passes through the
body.

23.  Rare pathognomonic
“flowerlike” branching
skin lesions in persons
struck by lightning.
 Caused by “flashover”
effect of non penetrating
current.

24. OTHER ELECTRICAL INJURIES
Intentional injuries include those due
to the use of high-voltage devices for
rapid incapacitation, child and or
spouse abuse, and torture.
Also, the use of skin electrodes in
medicine can cause burn.

25. TYPES OF ELECTRICAL BURNS
 Depending on the voltage, current, pathway, duration of
contact, and type of circuit, electrical burns can cause a
variety of injuries through several different mechanisms.
1. Direct contact (low and high voltage)
2. Indirect contact
a. Electric arcs
b. Flame
c. Flash

26. 1. DIRECT CONTACT
 Current passing directly through the body will heat the
tissue causing electro thermal burns, both to the surface
of the skin as well as deeper tissues, depending on their
resistance.
 It will typically cause damage at the source contact point
and the ground contact point.

27. INDIRECT CONTACT
A. ELECTRICAL ARCS
o A current spark formed between two objects of differing
potential that are not in contact with each other, usually
a highly charge source and a ground.
 Because the temperature of an electrical arc is
approximately 2500° C, it is most destructive indirect
injury.
 It causes very deep thermal burns at the point where it
contacts the skin.

29. 2. INDIRECT CONTACT
B. Flame: Ignition of clothing causes
direct burns from flames.
C. Flash: When heat from a nearby
electrical arc causes thermal burns but
current does not actually enter the body.

30. MECHANISM OF INJURY
1. Electrical energy cause direct tissue damage,
alter cell membrane resting potential, and elicit
tetany.
2. Conversion of electrical energy into thermal
energy, causing massive tissue destruction and
coagulation necrosis.
3. Mechanical injury with direct trauma resulting
from falls or violent muscle contraction.

31. CONT..
The most common entry point for electricity
is the hand; the second most common is
the head.
The most common exit point is the foot.
A current that travels from arm to arm or
from arm to leg may go through the heart
and is much more dangerous than a current
that travels between a leg and the ground.

32. CONT…
 Electrical current through the head or thorax
is more likely to produce fatal injury.
 A current that travels through the head may
affect the brain.
 Transthoracic currents can cause fatal
arrhythmic cardiac damage, or respiratory
arrest.
 Tissues differ in susceptibility to electrical
damage.

33. BODY’S RESPONSE TO BURN
Described by Jackson in 1947.
 Zone of coagulation—Occurs at the point of maximum
damage. There is irreversible tissue loss due to coagulation
of the constituent proteins.
 Zone of stasis— Characterized by decreased tissue
perfusion.
 Zone of hyperemia—Outermost zone tissue perfusion is
increased. Tissue will invariably recover unless there is
severe sepsis or prolonged hypo perfusion.

35. Pattern of injury/Tissue damage
Organ Tissue damage
Skin Flash burns, thermal burns, arc burns, linear burns,
contact electrical burns.
Muscle Swelling , pain, contractions, spasms, myonecrosis,
compartment syndrome.
Blood vessels Blood cloths, microvascular deterioration,
myoglobinemia, vasoconstriction, thrombosis, ischemia
Heart Arrhythmia , asystole, ventricular fibrillation, sinus
tachycardia, myocardial necrosis/infarction, cardiac
arrest.
Nerves Weakness , paralysis, tingling, numbness,
uncontrollable loss of urine (incontinence), and chronic
pain.

36. Pattern of injury/Tissue damage.
Organ Tissue damage
Brain Seizure, hemorrhages, poor short-term
memory, unconsciousness, ischemia,
personality changes, irritability, difficulty
sleeping.
Bones Joint dislocations, fractures, other blunt
injuries
Kidney Myoglobinuria, acute renal failure, acute
tubular necrosis.
Ears Perforation of the eardrum, hemorrhage.
Eyes Cataracts

37. CLINICAL FEATURES
Cardiovascular : asystole, Arrhythmias
Respiratory: respiratory arrest(Chest wall
muscle paralysis from tetanic contraction,
injury to the respiratory control center of
brain)
Skin:
A. High voltage electro thermal burns: as
painless, depressed areas with central
necrosis and minimal bleeding

38. HIGH VOLTAGE INJURY TO CHEST

39. HIGH-VOLTAGE INJURY ON THE CHEST

40. B.ARCING ELECTRIC BURN
Arcing electrical burns through the shoe around the rubber sole

41. C. LOW VOLTAGE BURNS

42. D. CONTACT BURN

44. CLINICAL FEATURES
Neurologic:
transient confusion,
amnesia, and impaired recall of
events if not frank loss of
consciousness,
 seizure
 direct spinal cord injury
 acute muscle tetany

45. Musculoskeletal:
fractures from blunt trauma
 compartment syndrome
ENT/head
perforated tympanic membranes
facial burns
cervical spine injury.
CLINICAL FEATURES

46. CLASSIFICATION : DEPTH
 Superficial (First degree)
 Involves only
epidermis
 Red
 Painful
 Tender
 Blanches under
pressure
 Possible swelling,
no blisters
 Heal in ~7 days
Diagnostic finding

47. CONT..
 Partial Thickness (Second
degree)
 Extends through
epidermis into dermis
 Salmon pink
 Moist, shiny
 Painful
 Blisters may be present
 Heal in ~7 to 21 days

48. CONT…
 Full Thickness (Third
degree)
 Through epidermis,
dermis into underlying
structures
 Thick, dry
 Pearly gray or charred
black
 May bleed from vessel
damage
 Painless
 Require grafting

49. CLASSIFICATION : EXTENT
Rule of nines

50. LUND AND BROWDER METHOD

51. PALM METHOD
 “Rule of Palm”
 Patient’s palm
equals 1% of his
body surface area

52. CLASSIFICATION OF BURN SEVERITY
1. Minor Burns
a. Second degree adult burns less than 15% TBSA
b. Second degree child burns less than 10% TBSA
c. Third degree child or adult burns less than 2% TBSA
2. Moderate Burns
a. Second degree adult burns involving 15 to 25% TBSA
b. Second degree child burns involving 10 to 20% TBSA
c. Third degree child or adult burns involving 2 to 10%
TBSA

53. 3. Major Burn
a.In adults, second degree burns greater than 25%
TBSA
b. In children, second degree burns greater than 20%
TBSA
c. Third degree burns greater than 10% in an adult or a
child
d. Inhalation injury
e. Electrical burns

54. INVESTIGATIONS
Routine labs + electrolytes + ABG
RFTs & LFTs
ECG (mandatory in all patients)
CK (Rhabdomyolysis + AKI)
Imaging studies
– Brain imaging
– Cervical spine x-ray
– Peripheral limbs x-ray
– Chest & Pelvic radiographs (especially in
previously unconscious patients)

55. INVESTIGATIONS
Cardiac
– ECG (mandatory)
– Monitoring (arrhythmia / autonomic
dysfunction / Haemodynamic instability)
– ECG & CK-MB = poor diagnostic in
myocardial affection
– Troponin-I & ECHO = better diagnostic

57. EMERGENT/ RESUSCITATIVE PHASE
 This phase last for 24-48 hours
 Time required to immediate life threatening problems
result from the burn injury.
 The phase ends when fluid mobilization and diuresis
begin.

58. MANAGEMENT
Securing the scene
 Power source should be turned off
Denergizing the lines
Triage should be concentrated on the
presence of cardiac or respiratory arrest
Patients require cardiac & trauma care

59. MANAGEMENT
Standard ABCDEs of any major trauma
 Pulmonary
 Low threshold for intubation, as respiratory failure
common
 Cardiac
 Serial monitoring if high V, abnormal ECG, LOC,
respiratory arrest, or CV dysfunction
 Neuro
 C-spine and log-roll precautions; CT head & spine often
warranted.
 Thorough serial neurological exams, as vessel
coagulation can result in late sequel

60. ED TREATMENT
 Resuscitation as per trauma guidelines, systematic
physical examination
1. ABCs, Spinal immobilisation
2. Prolonged cardiac resuscitation following electrical
injury.
3. CVS function – assess rhythm, check pulses , ECG.
4. Skin – inspect for burns, blisters, charred skin –
specifically skin creases, areas around joints and the
mouth

61. 4. Neurological function – mental status, pupillary
reaction, motor function, sensation
5. Eyes – visual acuity, anterior chamber,
fundoscopy
6. Ear, nose, throat – inspect tympanic
membranes, assess hearing, look for signs of
smoke inhalation
7. Musculoskeletal – inspect and palpate for
injuries (fractures / compartment syndrome)

62. TREATMENT
Fluid resuscitation
 Aggressive replacement if soft tissue injury
 Prevent Heme pigment-induced AKI
 Administer fluids till
• Normal blood pressure
• UOP ( 0.5 - 1 mL/kg/h if +ve Myoglobin // 1-2 mL/kg/h if
-ve Myoglobin)
• CK < 5000 U/L
•negative urine for hematuria
 Not estimated from skin injury degree (Parkland formula)
 Normal Saline = best solution
 Monitor K level (released from damaged muscles)
 Over correction may lead to Abdominal Compartment
Syndrome

63. FORMULA
 Parkland/Baxter Formula
Lactated Ringer’s solution: 4 mL × kg body
weight × % TBSA burned
Half to be given in first 8 hours; half to be given
over next 16 hours
 Modified Brooke
Lactated Ringer's Solution:2.0 ml x kg body wt x
% TBSA Burned
Half to be given in first 8 hours; half to be given
over next 16 hours

64. Evans Formula
Colloids: 1 mL × kg body weight × % TBSA burned
Glucose (5% in water): 2,000 mL for insensible loss
Day 1: Half to be given in first 8 hours; remaining half
over next 16 hours
Day 2: Half of previous day’s colloids and electrolytes; all
of insensible fluid replacement

65. TREATMENT
Foley's catheter
 mandatory to assess urine
output & level of hydration

66. TREATMENT
Mannitol
 – Osmotic Diuresis to maintain UOP & prevent heme pigment
deposition
 – 1gm/kg/day
 – Contraindicated if Oliguria is present
 – Stopped if target UOP not reached with rising plasma
osmolarity
Bicarbonate
 –– Prevent heme deposition
 – Give only if :
 • PH < 7.5
 • HCO3 < 30
 • No sever hypocalcemia
 – Stopped after 4-6 hours if urine PH not rising above 6.5 or if
hyperCalcemia is present

67. Prevent Tetanus:
 Tetanus toxoid booster
 Tetanus Immunoglobulin
 First series of active immunization
Prevent Tissue Ischemia:
 Elevating injuries 15* above the level of the heart.
 Performing active exercise.
 Doppler flowmeter assessment
 Escharotomy

68. SURGICAL TREATMENT
Surgical : Fasciotomy
– in Compartment syndrome
(diagnostic & therapeutic role)

69. SURGICAL MANAGEMENT
Limb amputation
– If severely affected with persistent
myoglobinuria.

70. WOUND CARE
Immediate Care:
Within 12 hours of injury, wound care consist:
 Covering the wound with sterile towel.
 Placing clean, dry sheets and blanket over the client
 Cleansing and gentle debridement of devitalized tissue in
hydrotherapy and cart shower.
 Removal of any damaging agents ( e.g.: chemical tar)
and application of any topical agents and a dressing.
 Wash with mild soap and rinse thoroughly with warm
water not exceeding 104*F.
 Hair should be shaved to within 1inch margin around the
burn wound.

71. ACUTE / INTERMEDIATE PHASE
Begins with the mobilization of
extra cellular fluid and subsequent
diuresis.
This phase ends when the burn area
is completely covered by skin graft
or when the wound is heal.
This may take from week to
months.

72. Prevent Infection:
Use of gloves, caps , masks,
shoe cover, scrub clothes and
plastic aprons.(barrier nursing)
Strict handwashing to reduce
cross-contamination.
Staff and visitors restrictions.

73. PROVIDE METABOLIC SUPPORT:
Basal metabolic rate are 40%-100% higher than normal
levels.
 CURRERI -- (25KCA X kg body weight) + (40kcal x
%TBSA burn)
 =25 X 44 + 40 X 7 =1380 KCAL
 PROTEIN REQUIREMENT
 1 GM X BODY WEIGHT + 3GM X TOTAL %
 = 1X 44+3 X 7
 = 65 GM

74. MINIMIZE PAIN AND ANXIETY
 Acute Stage Analgesic Drugs and Intravenous Doses
-Tramadol (12 years and older) 1mg/kg 4-6 hours
-Ketamine 0.2-0.5 mg/kg 15-25
minutes
-Morphine or diamorphine 0.03-0.1 mg/kg
- child 0.1 mg/kg 4-6 hours
-Fentanyl 1-1,5μgr/kg
-child 1 μgr/kg 45-60 min
-Meperidine 0.5-1 mg/kg 2-4 hours

75. DEBRIDEMENT:
Mechanical:
 Careful use of scissors and
forceps to lift and trim away
devitalized tissue.
 Wet to dry dressing change.
 Coarse gauze dressing
saturated with a prescribed
solution(Parrafin or
petroleum), applied to the
wound and leave for 6-
8hours.

76.  Enzymatic debridement:
Application of commercially prepared proteolytic and
fibrinolytic topical enzyme (eg. Papain) to the burn
wound.
 Surgical Debridement:
 Tangential excision – very thin layers of devitalized
tissue are sequentially shaved until viable tissue is
reach.
.

77. GRAFTING
Autograft: Coverage of the burn wound with a
graft of the patient’s own skin (autograft).
Biologic dressings
 Homograft - Homograft are skin obtained from
living or recently deceased humans.
 Heterografts - Heterografts consist of skin
taken from animals (usually pigs)

78. CARE OF DONOR SITE
A moist gauze dressing is applied at the
time of surgery to maintain pressure and to
stop any oozing.
The donor site may be treated in several
ways, from single-layer gauze impregnated
with petrolatum, scarlet red, or bismuth to
new biosynthetic dressings such as
Biobrane or BCG Matrix.

79.  Donor sites must remain clean, dry, and free
from pressure.
 Because a donor site is usually a partial-
thickness wound, it will heals spontaneously
within 7 to 14 days with proper care.
 Donor sites are painful, and additional pain
management must be a part of the patient’s
care.
CARE OF DONOR SITE

80. CARE OF THE PATIENT WITH AN
AUTOGRAFT
 Occlusive dressings are commonly used initially after
grafting to immobilize the graft.
 Immobilize newly grafted areas to prevent dislodging the
graft.
 Homografts, heterografts, or synthetic dressings may also
be used to protect grafts.
 The graft may be left open with skin staples to immobilize
it, which allows close observation of progress.
 The first dressing change is usually performed 3 to 5 days
after surgery, or earlier in the case of purulent drainage or
a foul odor.

81.  If the graft is dislodged, sterile saline compresses will help
prevent drying of the graft until the physician reapplies it.
 The patient is positioned and turned carefully to avoid
disturbing the graft or putting pressure on the graft site.
 If an extremity has been grafted, it is elevated to minimize
edema.
 The patient begins exercising the grafted area 5 to 7 days
after grafting.
CARE OF THE PATIENT WITH AN
AUTOGRAFT

82. BIOSYNTHETIC AND SYNTHETIC DRESSINGS
 BIOBRANE - composed of a nylon, Silastic membrane
combined with a collagen derivative.
 BCG Matrix - This dressing combines beta-glucan, a
complex carbohydrate, with collagen in a meshed
reinforced wound dressing.
 Other synthetic dressings used for burn wounds include
Tegaderm, N-Terface, and DuoDerm.

83. TOPICAL ANTIMICROBIAL
TREATMENT
 Open Method:
After application of antimicrobial cream, it is left open
without gauze dressing and reapplied as needed.
 Closed Method:
• Gauze dressing is impregnated with antimicrobial and
applied to the wound.
• Wrap from the most distal to proximal direction.
• Temporary wound coverings.

84. ANTIMICROBIAL
 Bacitracin –Interruption of cell wall
synthesis.
 Cerium Nitrate Silver Sulfadiazine-
Similar to that of silver sulfadiazine or
silver nitrate
 Gentamicin -Binds irreversibly to the
30s ribosome and inhibits protein
synthesis

85. ANTIMICROBIAL
 Mafenide Acetate -antibacterial
activity against most Gram-
positive species, including
clostridia.
 Mupirocin (Bactroban) -
inhibition of protein synthesis.
 Nitrofurazone- it inhibits several
bacterial enzymes involved in
carbohydrate metabolism. It is
bactericidal.

86. ANTIMICROBIAL
 Povidone Iodine (Betadine)
 Silver Nitrate 0.5% -
Bacteriostatic at lower
concentrations (0.5%) and
bactericidal at higher
concentrations (10%).
 Silver Sulfadiazine - Impair
bacterial DNA replication

87. MAXIMIZE FUNCTION
Therapeutic Positioning
Range of motion exercise
Splinting
Client and Family education
Ambulation
Stretching Exercise

88. REHABILITATION PHASE
Goal:
 Maximize functional capacity, minimize functional loss and
maximize emotional recovery.
The rehabilitation for patients with burn injuries starts from the
day of injury, lasting for several years and requires
multidisciplinary efforts. A comprehensive rehabilitation
programmed is essential to decrease patient’s post traumatic
effects and improve functional independence.

89. PRINCIPLES OF BURN
REHABILITATION
 The program should start early, preferably the day of injury.
 A program of care should be avoid prolonged periods of
immobility, and any body parts that is able to move freely
should be moved frequently.
 Range of motion exercise should be started the day of injury.
 There should be planned program of daily activity and
rehabilitative care. The plan should be reviewed daily as
rehabilitative needs change.

90. DISORDERS OF WOUND HEALING
Scars Keloids
Contra
ctures
Failure
to heal

91. HYPERTROPHIC SCAR
 These are Characterized
by an over abundant
formation of matrix,
especially collagen, in
wounds that heal by
granulation.

92. KELOIDS
 A large heaped-up mass of
scar tissue, a keloid may
develop and extend beyond
the wound surface

93. Failure to heal
Failure of the wound to heal result from many
factors, including infection, an underlying
disease process, shearing, pressure or
inadequate nutrition.

94. Contractures
 The burn wounds tissue
shortens because of the force
exerted by the fibroblasts and
the flexion of muscles in natural
wound healing.

95. RECONSTRUCTION SURGERIES
 The surgical plan involves recreating the initial tissue loss
and then adding appropriate tissue.
The techniques are -
 Direct closure
 Grafts
 Flaps
 Expanded skin

96. DIRECT CLOSURE
 Direct closure in burn reconstruction is the simplest form of
scar revision following excision of the scar.

97. SKIN GRAFTING
 Split or partial thickness
graft-includes epidermis and
part of dermis
Full thickness graft-
includes epidermis and full
thickness of the dermis
 Composite graft- includes the
full thickness of the skin and a
portion of the underlying tissue
such as subcutaneous tissue,
muscle, cartilage or bone.

99. FLAPS
A skin flap is a segment of skin and
subcutaneous tissue which is
transferred from its original position
on the body to another site while
maintaining its own inherent
vasculature for nourishment.

101. COMMON POST BURN CONTRACTURES AND THE RESPECTIVE
ANTI- CONTRACTURE POSITION OF NURSING.
 The flexion contracture of the neck can be avoided by
having a pillow under the shoulder and nursing with the
neck in extension

102.  The Extension contracture of the neck can
be avoided by sitting with head in flexion
and lying with pillows behind the head.

104.  Clawing of fingers can be avoided by keeping the M.P
joints in flexion. IP joints in extension, thumb mid
palmer radial abduction.

105.  The thumb and palm deformity is avoided by keeping
the wrist extended with minimal MCP flexion and
keeping the fingers extended and thumb abducted.

106.  Flexion contracture
of knee can be
avoided by keeping
the legs extended in
lying and sitting and
by using knee
extension splints.

107.  Dorsal contracture
at the ankle can be
prevented by
keeping ankles at 90
degrees

108. MASSAGE

109. EXERCISE AND STRETCHING

110. Pressure Garments

111. SILICONE
 Silicone is another modality
used to treat hypertrophic
scarring.
 It is likely to influence the
collagen remodeling phase of
wound healing.

112. PSYCHOLOGICAL IMPACT
 Reassurance
 Demonstrate genuine empathy and compassion
 Active listening
 Providing adequate information
 Answering their questions

113. SOCIAL REHABILITATION
 Individuals should be encouraged in order to re-establish
themselves in their social and vocational lives as soon as they
are able to, and their family members should be encouraged
to promote this behavior.
 Life after a burn injury, particularly a major injury can take
some significant adjusting to however with the right support
and rehabilitation, burn injured patients can lead a full life.

114.  Acute pain related to destruction of skin and tissue as
evidenced by pain score of 4.
 Hyperthermia related to infection as evidenced by temperature
of 101.1 degree F, moderate pus cells, scanty growth in wound
swab, TLC of 18.900 thousands.
 Fluid volume deficit related to loss of fluid through burn wound ,
restricted oral intake as evidenced by tachycardia, dry lips, dry
skin.
 Imbalanced nutrition less than body requirement related to
hyper metabolic state, protein catabolism as evidenced by
negative protein and calorie balance, deranged LFT.

115.  Impaired skin integrity related to disruption of skin
surface as evidenced by absence of viable tissue.
 Impaired physical mobility related to limb immobilization,
restrictive therapies as evidenced by limited ROM.
 Risk for electrolyte imbalance related to muscle and
tissue breakdown.
 Risk for infection related to destruction of skin barrier,
environmental exposure.
 Risk for ineffective tissue perfusion related to interruption
of arterial and venous blood flow.

116.  Anxiety related to threat of disfigurement,
hospitalization.
o Risk for ineffective airway clearance, pneumonia
related to prolonged bed ridden.
 Disturbed body image related to dependent client
role, traumatic event.
 Risk for complications ( compartment syndrome,
local infection, neurologic injury, DVT, arrhythmia)
related to electric injury.
 Knowledge deficit regarding the treatment regimen.

117. THANK YOU