2. INTRODUCTION TO BURN
• Burns are one of the most
devastating conditions encountered in
the medicine. The injury represents
an assault on all aspects of the
patients from the physical to the
psychological. The visible physical
and invisible psychological scars are
long lasting.
3. DEFINITION OF BURN
• Burn can be defined as any
injury that results from the
direct contact or exposure
to any thermal, chemical,
electrical or radiation
source.
4. INCIDENCE OF BURN
• India records 70 lacs burn injury
annually of which 1.4 lacs people die
and 2.4 suffers from disability.
• 70% of cases are in 15-35 years age
group.
Continue…..
5. INCIDENCE OF BURN
• 4 out of 5 cases are either women or
children.
• 80% cases with women are related to
kitchen related accidents.
• 11th leading cause of death/injury of
children age 1-9 years.
Continue…..
6. INCIDENCE OF BURN
• 250 to 300 acid attacks are reported
in India every year.
• 80% to 90% burns occur at home
7. ETIOLOGY OF BURN
1. Thermal burns
2. Chemical burns
3. Electrical burns
4. Radiation burns
5. Inhalation burns
22. 1. History Taking
1. Time of injury
2. Place of injury (open/closed)
3. unconsciousness during incidence
4. Mechanism of burn injury/agent
5. Duration of exposure to agent
6. Intentional burn injury
7. Last Tetanus shot
8. Any known Allergies
23. 2. Physical Examination
1. Complete head to toe assessment
2. Systematic assessment
3. Burn estimation / severity
assessment
24. Burn severity assessment
MINOR MODERATE MAJOR
• Adult <10%
TBSA
• Young or old
<5% TBSA
• <2% Full
thickness Burn
• Adult 10-20%
TBSA
• Young or old 5-
10% TBSA
• 2-5% Full thickness
burn
• High voltage injury
• Possible inhalation
injury
• Circumferential
burn
• Other health
problems
• Adult >20% TBSA
• Young or old >10%
TBSA
• >5% Full thickness
burn
• Known inhalation
injury
• Significant burn to
face, joints, hands or
feet
• Associated injuries
26. MANEGEMENT OF BURN
Burn care is typically categorized into
three phases of care;
1. Emergent / resuscitative phase
2. Acute / intermediate phase
3. Rehabilitative phase
27. PHASES OF BURN CARE
PHASE DURATION PRIORITIES
Emergent /
resuscitative phase
• From onset of injury to
completion of fluid
resuscitation.
• First aid
• Prevention of shock
• Prevention of respiratory
distress
• Detection and treatment of
concomitant injuries
Acute / intermediate
phase
• From beginning of
diuresis to near
completion of wound
closure.
• Wound assessment and care
• Wound closure
• Prevention and treatment of
complications, including
infection
• Nutritional support
Rehabilitation
support
• From major wound
closure to return to
individual’s optimal level
of functioning
• Prevention of scars and
contractures
• Physical, occupational and
vocational rehabilitation
• Cosmetic reconstruction
• Psychosocial counselling
28. 1. Emergent / resuscitative
phase
Medical management
1. Assess burn severity
a) Burn depth
b) Burn size
c) Burn location
d) Age
e) General health
f) Mechanism of injury
29. 1. Emergent / resuscitative
phase
Medical management
2. Treat minor burns
3. Major burns
a) Monitor airway and breathing
b) Prevent burn (hypovolemic) shock (see formula)
c) Prevent aspiration
d) Minimizing pain and anxiety
e) Wound care
f) Prevent tetanus
g) Prevent tissue ischemia
h) Transport to burn facility
30. Emergent / resuscitative phase
Calculation of fluids:
1. Consensus formula:
2. Parkland formula:
Ringer’s lactate solution= 2-4 ml X kg body weight X TBSA
½ solution in first 8 hours and rest half in next 16 hours
Volume of Ringer’s lactate= 4 ml X % BSA x weight (kg)
½ solution in first 8 hours and rest half in next 16 hours
31. Nursing management of patient
in Emergent / resuscitative phase
1. Maintaining proper oxygenation and tissues
perfusion
2. Maintaining fluid and electrolyte balance
3. Relieving pain
4. Preventing hypothermia
5. Providing initial wound care
6. Preventing infection
7. Promoting comfort
8. Relieving anxiety and proving psychological
support
33. 2. ACUTE / INTERMEDIATE
PHASE
Medical management
2. Provide metabolic support
Formula/Author name Formula for daily calorie expenditure estimate
• Curreri (25Kcal / Kg body weight) + (40Kcal X %TBSA
burn)
• Modified Harris-Benict RMR X Activity factor X injury factor
(RMR- Resting metabolic rate)
• U.S. Army Institurte Of
Surgical Research
(Age and gender specific BMR) X (0.89142 +
0.01335 X % TBSA Burn) X (M2 X 24 X Activity
factor)
34. 2. ACUTE / INTERMEDIATE
PHASE
Medical management
3. Minimizing pain
• Patient controlled analgesia devices
• Inhalation analgesic (nitrous oxide)
• Oral analgesics; opioid analgesics, NSAID’s
• Hypnosis, art and play therapy
• Guided imaginary, relaxation techniques
• Distraction therapy, biofeedback
• Music therapy
35. 2. ACUTE / INTERMEDIATE
PHASE
Medical management
4. Provide wound care
a) Wound cleansing
b) Wound debridement
i. Natural debridement
ii. Mechanical debridement
iii. Chemical debridement
iv. Surgical debridement
37. 2. ACUTE / INTERMEDIATE
PHASE
Medical management
d) Wound dressing
• Moist dressing
• Occlusive dressing for new grafts
• Non-adhesive dressings covers
38. 2. ACUTE / INTERMEDIATE
PHASE
Medical management
5. Maximize function
• Splinting
• Positioning
• Exercise
• Ambulation performance of ADI
• Pressure therapy
39. 2. ACUTE / INTERMEDIATE
PHASE
Medical management
6. Provide psychological support
• Meeting the psychological needs
• Involvement in physical therapy
• Encouragement in wound care
• Ventilation of feeling, emotions, fear
• Promoting self image
50. Nursing management of patient
in acute / intermediate phase
1. Maintaining proper oxygenation and
tissues perfusion
2. Maintaining fluid and electrolyte
balance
3. Relieving pain
4. Preventing hypothermia
5. Providing wound care
6. Preventing infection
51. Nursing management of patient in
acute / intermediate phase
8. Relieving anxiety and proving
psychological support
9. Graft care
10.Nutritional support
11.Improving mobility
12.Promoting comfort
53. 3. REHABILIATION PHASE
Medical management
2. Provide psychological support
• Self image issues
• Physical limitations
• Reintegration into society
• Fear of rejection
• Good communication
• Encourage independence
