B U R N S  wounds caused by excessive exposure to the following agents or causes: Causes of Burns:  Thermal [moist or dry heat]  Electrical  Chemical [strong acids and strong alkali  Radiation [UV, x-rays, radium, sunburns]

CLASSIFICATION OF BURNS  Superficial Partial thickness (1 st degree) Outer layer of dermis Erythema, pain up to 48 hrs Healing 1-2 wks [sunburn]  Deep Partial thickness (2 nd degree) Epidermis & dermis Blisters & edema, frequently quite painful Healing days  Full thickness (3 rd degree) Epidermis, dermis, subcutaneous fat Dry, pearly white or charred in appearance Not painful Eschar must be removed; may need grafting B U R N S

STAGES OF BURNS 1 st : Shock/Fluid Accumulation Phase  1 st 48 hrs  IVC  ISC  Generalized DHN [fluid shifting]  Hypovolemia [plasma loss],  BP,  C.O.  Hemoconcentration,  Hct [liquid blood component  ISC]  Oliguria [  renal perfusion], ADH release & aldosterone  HyperK, hypoNa  Metabolic acidosis B U R N S

STAGES OF BURNS 2 nd : Diuretic/Fluid Remobilization Phase  After 48 hrs  ISC  IVC  Hypervolemia,  Hemodilution,  Hct  Diuresis [  renal perfusion],  ADH & aldosterone secretion  HypoK, hypoNa [K moves back into the cells, Na+ still trapped in the edema fluids  Metabolic acidosis B U R N S

STAGES OF BURNS 3 rd : Recovery Phase  5 th day onwards  Hypocalcemia  Ca is lost on the exudates  Ca is utilized in the granulation tissue formation  Negative nitrogen balance  Due to stress response   protein catabolism  Protein intake is lesser than the demand  HypoK B U R N S

ASSESSMENT 1.Assess extent of body surface burned  Greater morbidity & mortality for burns affecting face, hands & perineum  Assess for dyspnea, stridor, hoarseness 2.Assess extent of burn injury  Rule of nine – immediate appraisal  Lund-Browder chart – more accurate  Berkow’s method – based on client’s age & changes that occur in proportion of head & legs to the rest of the body as one grows B U R N S

ASSESSMENT B U R N S 9% Front=18% Back=18% 18% 1% Burn Evaluation Chart

ASSESSMENT 3. Assess depth of burn  Major burns – 2 nd degree over 30% of body  Hospitalization - eyes, face, neck, hands, perineum, genitalia 4. Assess unique contributing factors  Age of client  Health history Diabetes, preexisting ulcers Tetanus immunization B U R N S

EMERGENCY MANAGEMENT Stop the burning process  Remove patient from source of injury  Advise client to roll on the ground if clothing is in flame [STOP-DROP-ROLL]  Throw a blanket over the client to smother the flame  Remove clothing only if hot or for scald burn  Immerse affected part in cold water [10 min]  Irrigate copiuosly w/ large amount of running water w/ chemical burns [except w/ phosphorus]  Interrupt power source w/ electrical burn B U R N S

MANAGEMENT  Maintenance of adequate airway  Promoting comfort: relieve pain  Promoting fluid-electrolyte, acid-base balance  Preventing infection  Maintaining adequate nutrition  Wound care B U R N S

METHODS OF TREATING BURNS  Open method or Exposure method Face, neck, perineum, trunk Allowing exudate to dry in 3 days  Occlusive Less pain, absorption of secretion, comfort, transportability, accelerated debridement Aesthetic considerations  Semi-open method Covering of wound w/ topical antimicrobials:  Silver sulfadiazine 1% (Flamazine)  Silver nitrate 0.5% sol’n  Mafenide acetate (sulfamylon acetate) B U R N S

BIOLOGIC DRESSING (Skin Graft)  Allograft Skin taken from other person [cadaver]  Autograft Same person  Heterograft Different species Xenograft [segment of skin from animal such as pig or dog] B U R N S

FLUID REPLACEMENT Types of fluids:  Colloids Blood Plasma & plasma expanders  Electrolytes Lactated Ringers  Non-electrolyte D5W B U R N S

FLUID REPLACEMENT EVAN’S Formula:  C – 1ml x % burns x kgBW  E - 1ml x % burns x kgBW  Glucose 5% for insensible loss – 2,000ml D5W  Administer sol’n 1 st 24 hrs – ½ [1 st 8hrs], ½ [16hrs] BROOKE Formula: [Administer as in Evan’s]  C – 0.5ml x % burn x kgBW  E - 1.5ml x % burns x kgBW  Water – 1000ml D5W B U R N S

FLUID REPLACEMENT MOORES BURN BUDGET:  75 ml of plasma, 75 ml of electrolyte-cont’g fluid for q 1%TBSA plus 2000 D5W HYPERTONIC RESUSCITATION Formula:  Hypertonic salt containing 300mEq of Na+, 100mEq of Cl-, 200mEq lactate  Administered to maintain urinary output of ml/hr B U R N S