medical surgical nursing

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OUT LINES
 DEFINITION
 CAUSES
 CLASSIFICATION
 CLINICAL MANIFESTATION
 COMPLICATION
 TREATMENT
 PREVENTION
BURN
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DEFINETION:
Burn is an injury that results from heat, chemical agents, or
radiation. Common causes - Scald------------33%
- Flame-----------30%
- Contact---------15%
- Flash-------------10%
- Electrical--------5%
- Radiation--------1% 3/2/2024
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Causes:
A. SCALD BURNS
 Scalds from hot water/liquid are most common cause of burn.
 Depth is proportional to :(To, Duration of contact &Thickness of skin).
e.g.. Water at 60 oc for 3 sec &at 69 oc for 1sec cause deep dermal or
full-thickness burn
 Immersion scalds are always deep, severe burns
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B. FLAME BURNS
 House fires(Carelessness with matches and cigarette smoking)
 Improper use of flammable liquids
 Automobile accidents
 Ignition of clothing from stoves or space heaters
 Fall into open fire
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C.FLASH BURNS
 Explosion of natural gas ,gasoline
& other flammable liquids cause intense heat for a brief time
 Depth depends on the amount and type of fuel
 Clothing, unless it ignites, is protective against flash burns
 May be associated with thermal damage to the upper airway
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D. CONTACT BURNS
Result from contact with hot metals, plastic, glass or hot
coals
Limited in extent & very deep
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E.CHEMICAL BURNS
Caused by strong acids or alkalis
Cause progressive damage until they are inactivated by rxn
c the body tissue or diluted c water
Acid burns may be more self-limiting than alkali burns
Chemical burns should be considered deep dermal or full-
thickness until proven otherwise
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8. Chemical Burn
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F. ELECTRICAL BURNS
 May be low-voltage or high-voltage
 3 mechanisms of injury :
i. Electrical current injury
ii. Electrothermal burns from arcing current
iii. Flame burn caused by ignition of clothes
Deep destruction of muscles ,nerves & vessels –myoglobinuria
ATN
●The entry &exit wound is only the tip of the iceberg
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10. Electrical Burn
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11. CLASSIFICATION:
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1. Based on area of burn
Special areas e.g. eye, face, hands, feet, perineum are
needed special attention & follow up.
At great risks are
♦ The very young
♦The very old
♦ Those whose ability to protect themselves is impaired.
*Epilepsy, Alcohol & Drug abuse
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12. 2. Based on extent of burn(% of TBSA)
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3. According to cause of burn it can be:
- chemical - scald
- electrical - ultraviolet ray
4. Based on depth/degree ( commonest classification).
a. 1st degree burn
b. 2nd degree burn
c. 3rd degree burn & or 4th degree burn
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14. Depth of Burn (Degree)
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1st 0 Burn epidermis
2nd 0 Burn superficial dermis
Deep Dermal Burn deep dermis
3rd 0 Burn subcutaneous --------→
muscle -----------------→
fat ------------- ---------→
bone ---------- ------------→
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 results from over exposure to the sunlight, contact with hot objects, or
scalding by hot water or steam.
 is burn to the outer layer/epidermis/ of the skin is damaged.
 The usual signs are:-
- Redness or discoloration
- Mild swelling and pain
 It has rapid healing process and heals without scar.
A:First degree burn
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18. B. Second Degree Burn
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Results from very deep sunburn, contact with hot liquids, and flash
burns from gasoline, kerosene and other products.
Lower part of epidermis and upper regions of dermis are damaged.
Are usually more painful than deeper burns in which the nerve endings
in the skin are destroyed.
Known as partial thickness burn.
Super imposed infection interfere with healing process.
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Its characterized by
 Red or mottled appearance
 Development of blister formation
 Considerable swelling (edema)
 Wet appearance of the surface of the skin due to the loss of plasma
through the damaged skin
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21. C. Third Degree Burns
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 Can be caused by a flame, immersion in hot water, contact with hot
objects, or electricity.
 Severe burns that penetrate all the skin layers, into the underlying fat
,muscle and bone
 Known as full thickness burn(Complete loss of all layers of the skin.)
The usual signs are:-
 Deep tissue destruction.
 Painless due total destruction of nerve ending.
 White or charred or grayish appearance
 It may require skin graft
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23. Burn Complications
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I. INFECTION
Site of infection in burn pts :
1.Wound infection
2. Pneumonia
3.Suppurative thromophelebitis
4. UTI
II. Curling ulcer
III. Contracture
IV. Hypertrophic scar
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24. MANAGEMENT
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Mgt Focuses on:
 First aid
 Adequate fluid resuscitation
 Nutritional support
 Wound management
 Rehabilitation
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 First aid for 1st degree burn
-Its aim is to relieve pain, prevent complications
-usually medical treatment is not required.
-submerge the burned area in cold water.
-Apply a dry dressing if it is necessary
Note: Severe sun burn should receive medical care as soon as possible
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First aid for 2nd degree burn
 Immerse the burned part in cold water.
 Apply dry sterile gauze or clean cloth as a protective bandage.
 Do not break blisters or remove tissue.
 If the arms or legs are affected keep them elevated.
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27. First aid for 3rd degree burn
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 Do not remove adhered particles
 Check for ABC way of life
 Cover burns with thick, sterile dressings
 If the extremity are involved, keep them above the level of the
victim’s heart.
 Have victims with face burns sit up or prop them up and keep them
under continuous observation for breathing difficulty.
 Arrange transportation to the hospital as quickly as possible.
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28. 3rd …..
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 Do not immerse an extensive burned area or apply ice water over it,
because cold may intensify the shock reaction.
 Do not apply ointment, commercial preparations, grease or other home
remedies.
 Remove any constricting items such as shoes, boots, rings and bracelets
before swelling begins.
 Cover the area lightly with a sterile or very clean
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29. Resuscitation regimens
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 The greatest amount of fluid loss in burn pts is in the 1st 24
hrs after injury.
 The most commonly used resuscitation formula is the
Parkland formula, a pure crystalloid formula.
 This calculates the amount of fluid required in the first 24
hours. Children require maintenance fluid in addition to this.
 The starting point for resuscitation is the time of injury, not
the time of admission.
 Any fluid already given should be deducted from the
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30. 1. Primary survey.
 Check ABCDE
 Airway, Breathing, Circulation
 Check for life threatening
injuries
2. Resuscitation : calculate
fluid
3. Secondary survey - more
thorough evaluation
 History
 Nature of injury (agent and
circumstances)
 Time since injury
 Medical history, medication
and allergies.
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department
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Examination: Rapid
 Check vital signs, weight
 Determine extent and depth of injury
 Rule out other injuries ,examine eyes.
 Look for circumferential burns on chest, limbs.
 Evaluate and treat inhalation injury (if indicated)
Collect blood samples :
Hct, x-match, electrolyte ,
BUN, glucose ,CBC
arterial blood gas analysis.
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Give analgesics and sedatives as indicated
▫ Give tetanus prophylaxis
▫ Calculate fluid needs and adjust infusion rate.
Note : Start 20ml/kg till assessment of extent of TBSA &
calculated fluid for 24hrs for children
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Fluid Resuscitation
 Prevent burn shock& maintains adequate perfusion of blood
 Calculate a pt’s fluid needs from the moment of burn using
Parkland formula : 4ml x wt (Kg) x % TBSA burn for 1st 24hrs.
 Start with lactated Ringer’s solution
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This volume is then given at different rates(from fast to slow rate)
½ in  1st 8 hrs
 subtract bolus that had already given 1st.
8hr counted from starting of burn
½ of 1st 24hr required fluid/remaining time(from start to now)
½ in  next 16 hrs
Next 24 hrs  give one half( ½ )of total 1st day of required fluid.
(Note: if child RL + D5W )
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35. Extent of burn
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Estimation of TBSA by: - Rules of 9
- Palm of the pt’s hand ≈ 1% BSA
 Each side of Head & Neck = 4.5%
 Each upper extremity (Arms) = 9%
 Each lower extremity (Legs) = 18% Rule of nine
 Each side of trunk= 18%
 Genitalia (perineum) = 1%
NOTE: Total = 4.5x2 + 9x2 + 18x2 + 18x2 +1x1 =100%TBSA
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36. Percent of body surface area burned (Adults)
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37. Percent of body surface area burned(adult &
child)
Heads of children tend to be
greater than 9% of TBSA(≈18%)
 The lower extremities tend to
be less than 18% of TBSA(≈14%
for each)
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Children receive maintenance fluid in addition, at
hourly rate of:
 4 ml/kg for first 10 kg of body weight plus
 2 ml/kg for second 10 kg of body weight plus
 1 ml/kg for > 20 kg of body weight
OR
1st 1okg x 100ml/24hrs +
2nd 10kg x 50ml/24hrs +
3rd + >20kg x 20ml/24hrs
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39. Nutritional support
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● Pt with major burn needs high calorie in the form of
CHO (50%)
protein (20%)
fat (30%)
● Add vitamins & minerals
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Criteria for admission
 Adults > 20% BSA burn
oChildren > 10% BSA burn
 Burns involving the face, hands, feet and
genitalia
 Suspicion of inhalation injury
 Chemical and electrical burns
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41. Prevention
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-The prevention focuses on avoiding the causes
 By Implementing good health & safety regulations
 Educating the public
E.g.-proper use of electrical appliances
-Keeping children away from corrosive chemicals ,hot water &
/fire
-Using no smoking principles in health care settings
e.g. near oxygen cylinders in ICU/PACU
- and others
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THANK YOU VERY MUCH !!!
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